Question

Postnatal prognosis of antenatally treated MMC.

Hint:

Antenatal treatment of MMC offers significant advantages in terms of neurological function and reduces the risk of complications, but long-term care is still required for the child’s development and quality of life.

Answer 1

The postnatal prognosis of a child with lumbosacral meningomyelocele (MMC) treated antenatally depends on various factors, including the severity of the defect, the extent of spinal cord involvement, and the timing of the surgery.
Step 1: Early Postnatal Outcomes:
1. Neurological Function: Children who have undergone fetal surgery for MMC tend to have better neurological function, including improved motor skills and reduced risk of paralysis, compared to those who undergo surgery after birth.
2. Hydrocephalus: Hydrocephalus, which is common in MMC, may still occur after fetal surgery, but the risk of requiring a shunt is lower in those treated antenatally.
3. Spinal Cord Development: Antenatal surgery helps in preventing further spinal cord injury, which improves functional outcomes. However, many children still experience some degree of motor and sensory impairment in the lower limbs.
Step 2: Long-Term Prognosis:
1. Mobility: Children treated antenatally for MMC often have better chances of walking independently or with minimal assistance. However, many still require mobility aids.
2. Urinary and Bowel Control: Bladder and bowel dysfunction is common, with children requiring interventions such as intermittent catheterization and medications to manage incontinence.
3. Cognitive and Developmental Issues: Most children with MMC have normal cognitive function, though developmental delays or learning difficulties can occur in some cases.
Step 3: Lifelong Follow-Up:
1. Orthopedic Care: Long-term orthopedic care may be required to manage musculoskeletal deformities that occur due to spinal cord injury.
2. Neurogenic Bladder Management: Regular follow-ups with urologists to manage bladder and bowel dysfunction are essential to improve the quality of life.