Open Neural Tube Defects at the National Hospital, Abuja: an Analysis of Clinical Patterns and Neonatal Outcome

Abstract

Summary 

Background: Neural tube defect is the most common congenital abnormality of the central nervous system.

Objectives: 'To document the clinical patterns and neonatal outcome of babies with open neural tube defects at the National Hospital, Abuja.. 

Design: Retrospective review. Patients: All babies admitted into the Newborn Unit of the hospital with a diagnosis of open neural tube defect between July 2000 and June 2003. Methods: Case notes were retrieved and relevant information was extracted for analysis. 

Results: Eighteen babies (13 males, five females) presented with open neural tube defects of which 16 (88.9 percent) were outborn. Although 14 of the mothers received routine antenatal care, only eight of them took folic acid regularly. Prenatal diagnosis was made in one of five mothers who had antenatal abdominal ultrasound. The predominant clinical type was lumbosac ral myelomeningocele (61.1 percent). Six (33.3 percent) babies had hydrocephalus at presenta tion, while three of the babies with encephalocele were microcephalic. Vaginal deliverywas asso ciated with an increased risk of ruptured myelocele sac. Limb paralysis and sphincteric dysfunc tion occurred in eight (44.4 percent) of the babies. The defects were repaired at a mean age of 7.8+ 3.1 days in five patients, while three babies died (anencephaly-1, ruptured sac with menin gitis = 2), resulting in a mortality rate of 16.7 percent.

Conclusion: We suggest that efforts be intensified to diagnose these lesions antenatally, in order to allow for prenatal counseling, planned cautious delivery and prompt multidisciplinary postna tal management, as these would most likely result in improved neonatal outcome.