Abstract：
OBJECTIVE: Low- and middle-income countries (LMICs) face higher incidences and burdens of care for neural tube defects (NTDs) and hydrocephalus compared with high-income countries (HICs), in part due to limited access to neurosurgical intervention. In this scoping review, we aim to integrate studies on prenatal care, counseling, and surgical management for families of children with spinal dysraphism and hydrocephalus in LMICs and HICs.
METHODS: PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched for English language articles pertaining to prenatal care, counseling, and surgical management for families of children with spinal dysraphism and hydrocephalus in HICs and LMICs. Identified abstracts were screened for full-text review. Studies meeting inclusion criteria were reviewed in full and analyzed.
RESULTS: Seventy studies met the inclusion criteria. Twelve studies (16.9%) were conducted in HICs only, 50 studies (70.4%) were conducted in LMICs only, and 9 studies (12.7%) encompassed both. On thematic analysis, seven underlying topics were identified: epidemiology, folate deficiency and supplementation/fortification, risk factors other than folate deficiency, prenatal screening, attitudes and perceptions about NTDs and their care, surgical management, and recommendations for guideline implementation.
CONCLUSIONS: NTDs have become a widely acknowledged public health problem in many LMICs. Prenatal counseling and care and folate fortification are critical in the prevention of spinal dysraphism. However, high-quality, standardized studies reporting their epidemiology, prevention, and management remain scarce. Compared with NTDs, research on the prevention and screening of hydrocephalus is even further limited. Future studies are necessary to quantify the burden of disease and identify strategies for improving global outcomes in treating and reducing the prevalence of NTDs and hydrocephalus. Surgical management of NTDs in LMICs is currently limited, but pediatric neurosurgeons may be uniquely equipped to address disparities in the care and counseling of families of children with spinal dysraphism and hydrocephalus.
METHODS: PubMed, Embase, Global Index Medicus, and Web of Science electronic databases were searched for English language articles pertaining to prenatal care, counseling, and surgical management for families of children with spinal dysraphism and hydrocephalus in HICs and LMICs. Identified abstracts were screened for full-text review. Studies meeting inclusion criteria were reviewed in full and analyzed.
RESULTS: Seventy studies met the inclusion criteria. Twelve studies (16.9%) were conducted in HICs only, 50 studies (70.4%) were conducted in LMICs only, and 9 studies (12.7%) encompassed both. On thematic analysis, seven underlying topics were identified: epidemiology, folate deficiency and supplementation/fortification, risk factors other than folate deficiency, prenatal screening, attitudes and perceptions about NTDs and their care, surgical management, and recommendations for guideline implementation.
CONCLUSIONS: NTDs have become a widely acknowledged public health problem in many LMICs. Prenatal counseling and care and folate fortification are critical in the prevention of spinal dysraphism. However, high-quality, standardized studies reporting their epidemiology, prevention, and management remain scarce. Compared with NTDs, research on the prevention and screening of hydrocephalus is even further limited. Future studies are necessary to quantify the burden of disease and identify strategies for improving global outcomes in treating and reducing the prevalence of NTDs and hydrocephalus. Surgical management of NTDs in LMICs is currently limited, but pediatric neurosurgeons may be uniquely equipped to address disparities in the care and counseling of families of children with spinal dysraphism and hydrocephalus.
摘要：
目标：与高收入国家（HIC）相比，中低收入国家（LMICs）在神经管缺陷（NTDs）和脑积水方面面临更高的发病率和负担，部分原因是神经外科介入治疗的机会有限。在这次范围审查中，我们的目标是整合产前护理研究，咨询,以及对LMICs和HICs中患有脊柱发育不良和脑积水的儿童家庭的手术管理。
方法：PubMed，Embase,全球指数Medicus，和WebofScience电子数据库被搜索有关产前护理的英文文章，咨询,以及对患有脊髓发育不良和脑积水的儿童家庭的手术管理。筛选确定的摘要进行全文审查。对符合纳入标准的研究进行了全面审查和分析。
结果：70项研究符合纳入标准。12项研究（16.9%）仅在HIC中进行，50项研究（70.4%）仅在LMIC中进行，9项研究(12.7%)涵盖了这两项。关于专题分析，确定了七个基本主题：流行病学，叶酸缺乏和补充/强化，叶酸缺乏以外的危险因素，产前筛查,对NTD及其护理的态度和看法，手术管理,和指导方针实施建议。
结论：NTDs已成为许多低收入国家公认的公共卫生问题。产前咨询和护理以及叶酸强化对于预防脊柱发育不良至关重要。然而,高品质，标准化研究报告他们的流行病学，预防,管理仍然稀缺。与NTDs相比，对脑积水的预防和筛查的研究更加有限。未来的研究有必要量化疾病负担，并确定改善治疗和减少NTDs和脑积水患病率的全球结果的策略。LMIC中NTDs的外科治疗目前有限，但是儿科神经外科医生可能具备独特的能力，可以解决脊柱发育不良和脑积水患儿家庭在护理和咨询方面的差异。
方法：PubMed，Embase,全球指数Medicus，和WebofScience电子数据库被搜索有关产前护理的英文文章，咨询,以及对患有脊髓发育不良和脑积水的儿童家庭的手术管理。筛选确定的摘要进行全文审查。对符合纳入标准的研究进行了全面审查和分析。
结果：70项研究符合纳入标准。12项研究（16.9%）仅在HIC中进行，50项研究（70.4%）仅在LMIC中进行，9项研究(12.7%)涵盖了这两项。关于专题分析，确定了七个基本主题：流行病学，叶酸缺乏和补充/强化，叶酸缺乏以外的危险因素，产前筛查,对NTD及其护理的态度和看法，手术管理,和指导方针实施建议。
结论：NTDs已成为许多低收入国家公认的公共卫生问题。产前咨询和护理以及叶酸强化对于预防脊柱发育不良至关重要。然而,高品质，标准化研究报告他们的流行病学，预防,管理仍然稀缺。与NTDs相比，对脑积水的预防和筛查的研究更加有限。未来的研究有必要量化疾病负担，并确定改善治疗和减少NTDs和脑积水患病率的全球结果的策略。LMIC中NTDs的外科治疗目前有限，但是儿科神经外科医生可能具备独特的能力，可以解决脊柱发育不良和脑积水患儿家庭在护理和咨询方面的差异。
