A post-natal myelomeningocele repair completed on a 26-week premature neonate

Myelomeningocele (MMC) is a common neural tube defect that leads to lifelong physical and neurological disabilities. Fetal surgery for MMC repair, first studied in the Management of Myelomeningocele Study (MOMS) trial, showed improved neurologic outcomes when performed between prenatal estimated gestational age (eGA) of 19 0/7 to 25 6/7 weeks1. Limited data exists on postnatal MMC repairs at less than 30 weeks eGA and extremely low birth weight due to high mortality rates. No literature exists regarding MMC repair at the bedside. Our case describes an MMC repair performed postnatally on a 26 6/7 weeks eGA neonate weighing 650 grams on day of life 3. Due to significant hemodynamic instability requiring vasoactive medications and high-frequency oscillator ventilator (HFOV) support, the repair was performed at the bedside. The neonate did well with no postoperative infectious concerns or need for cerebrospinal fluid (CSF) diversion to date. Serial brain MRIs were performed and showed stable ventriculomegaly with minimal hindbrain herniation. This case report describes a successful bedside postnatal MMC repair on an extremely premature, low birth weight neonate on HFOV and inotropic medications. Per the MOMS trial, fetal MMC repair is associated with a 50% reduction in CSF diversion procedures, thus lowering the risk of life-long risk of malfunction and negative neurologic outcomes1. This case illustrates that postnatal repair in extremely preterm neonates may also be associated with decreased risk of CSF diversion. Long-term follow-up and larger case series are needed to determine the impact of postnatal repair in premature neonates.