News / Health

    Delicate Surgery Reduces Complications of Devastating Birth Defect

    Jessica Berman

    Delicate fetal surgery performed in the womb can prevent or minimize the disabling complications of a birth defect called spina bifida, in which the newborn's spinal cord does not fully form or, in the worst cases, grows exposed outside the baby’s back.  The deformity has meant life in a wheelchair for many children.  But the pioneering surgical procedure promises to help spina-bifida children avert that fate and lead more normal lives.

    The fetal surgery has been undergoing  human clinical trials with a team of doctors, led by Scott Adzick, chief surgeon at Children’s Hospital of Philadelphia, in the eastern U.S. state of Pennsylvania.  The delicate procedure they have been perfecting involves lifting the womb containing the fetus out of the mother at between 20 and 26 weeks of pregnancy, and operating on the fetus to repair the deformed spinal cord.  

    Katherine Mulligan of Cincinnati, Ohio underwent the procedure at Children's Hospital when she was pregnant with her son Sean, who is now 10.   She says before the procedure, her son’s prognosis was bleak. "A doctor [had] told us he would be in a wheelchair, we would have bowel and bladder problems, he would need a shunt due to hydrocephalus (water on the brain).  And today,  he plays basketball, baseball, soccer, tennis, swimming, does it all.  We still cannot get over how lucky we were.  Our life would be very, very different if it weren't for [Children’s Hospital of Philadelphia] and fetal surgery," she said.

    Spurred on by the success of cases like the Mulligan's, surgeon Scott Adzick led teams of investigators at CHOP, at Vanderbilt University in Tennessee and at the University of California-San Francisco, through 183 surgeries during the past eight years, on pregnant women whose fetuses had the severest form of spina bifida, called myelomeningocele.  

    Women who underwent the prenatal surgery were delivered by Caesarean section at 37 weeks.  The outcomes for their babies were compared to the health of infants who were delivered by C-section at 37 weeks, and had their spines surgically repaired within 24 hours of delivery.  

    Among children who were examined at one year after birth and again at 30 months, Adzick says those who had the surgery in utero fared significantly better than newborns who had the repair procedure done after delivery. "Although the ability to walk depends upon the spina bifida lesion somewhat, at 30 months of age children in the prenatal repair group were much more likely to walk independently; 42 percent compared to children in the post-natal repair group, [only]  21 percent," he said.

    Also, at one year, twice as many children in the post-natal surgery group required a shunt, or valve, to relieve pressure from fluid accumulations on the brain, compared to children who had their spines repaired in the womb.

    Because of its success, the eight-year trial was stopped early at the end of 2010 and Adzick and other surgeons were given permission to perform the fetal operation routinely.

    Adzick believes infants who underwent prenatal surgery fared better because he says the womb can be as toxic as it is nurturing to a fetus with spina bifida. "You have this exposed, unprotected spinal cord, even in utero, [brushing] up against the walls of the womb or the walls of the uterus which causes trauma as well.  So, by doing the operation before birth, you are protecting it.  You are putting  tissue layers between the developing spinal cord and the inter-uterine environment," he said.

    Adzick adds that the amniotic fluid inside the womb - in which the developing fetus is floating - contains fetal urine, which can be corrosive to the exposed spinal cord.

    Researchers now want to see if they can identify which babies would benefit the most from prenatal surgery by looking at the leg movements of the fetus.  Adzick says researchers also want  to develop a plastic material they can inject into the womb to patch the exposed spinal cord lesion of a fetus with spinal bifida.

    The surgeons hope their success with in-utero spina bifida repairs will help to broaden the application of fetal surgery to other serious, and more life-threatening fetal birth defects.

    A study describing the delicate fetal surgery is published this week in the New England Journal of Medicine.

    You May Like

    Can EU Survive a Brexit?

    Across Europe politicians are asking if the British vote to leave the European Union will set in motion dynamics that will see other member states leave too

    Video Entrepreneurs Tackle Sexual Harassment, Rural Health Care at Global Summit

    VOA talks to enterprising business people from India, Nigeria, Myanmar about their programs to help their respective countries overcome obstacles

    Key African Anti-Venom About to Permanently Run Out

    The tale of Fav-Afrique’s demise is a complicated one that reflects a deeper crisis brewing in global public health

    This forum has been closed.
    Comments
         
    There are no comments in this forum. Be first and add one

    Featured Videos

    Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
    Britain’s Vote to Leave EU Sends Shockwaves Through Global Marketsi
    X
    June 24, 2016 10:43 AM
    Britain’s historic decision to leave the European Union is sending shockwaves through global markets. Markets from Tokyo to Europe tumbled Friday under the uncertainty the ballot brings, while regional leaders in Asia took steps to limit the possible fallout. VOA’s Bill Ide has more from Beijing.
    Video

    Video Britain’s Vote to Leave EU Sends Shockwaves Through Global Markets

    Britain’s historic decision to leave the European Union is sending shockwaves through global markets. Markets from Tokyo to Europe tumbled Friday under the uncertainty the ballot brings, while regional leaders in Asia took steps to limit the possible fallout. VOA’s Bill Ide has more from Beijing.
    Video

    Video Tunisian Fishing Town Searches for Jobs, Local Development Solutions

    As the European Union tries to come to grips with its migrant crisis, some newcomers are leaving voluntarily. But those returning to their home countries face an uncertain future.  Five years after Tunisia's revolution, the tiny North African country is struggling with unrest, soaring unemployment and plummeting growth. From the southern Tunisian fishing town of Zarzis, Lisa Bryant takes a look for VOA at a search for local solutions.
    Video

    Video 'American Troops' in Russia Despite Tensions

    Historic battle re-enactment is a niche hobby with a fair number of adherents in Russia where past military victories are played-up by the Kremlin as a show of national strength. But, one group of World War II re-enactors in Moscow has the rare distinction of choosing to play western ally troops. VOA's Daniel Schearf explains.
    Video

    Video Experts: Very Few Killed in US Gun Violence Are Victims of Mass Shootings

    The deadly shooting at a Florida nightclub has reignited the debate in the U.S. over gun control. Although Congress doesn't provide government health agencies funds to study gun violence, public health experts say private research has helped them learn some things about the issue. VOA's Carol Pearson reports.
    Video

    Video Trump Unleashes Broadside Against Clinton to Try to Ease GOP Doubts

    Recent public opinion polls show Republican Donald Trump slipping behind Democrat Hillary Clinton in the presidential election matchup for November. Trump trails her both in fundraising and campaign organization, but he's intensifying his attacks on the former secretary of state. VOA National Correspondent Jim Malone reports.
    Video

    Video Muslim American Mayor Calls for Tolerance

    Syrian-born Mohamed Khairullah describes himself as "an American mayor who happens to be Muslim." As the three-term mayor of Prospect Park, New Jersey, he believes his town of 6,000 is an example of how ethnicity and religious beliefs should not determine a community's leadership. Ramon Taylor has this report from Prospect Park.
    Video

    Video Internal Rifts Over Syria Policy Could Be Headache for Next US President

    With the Obama administration showing little outward enthusiasm for adopting a more robust Syria policy, there is a strong likelihood that the internal discontent expressed by State Department employees will roll over to the next administration. VOA State Department correspondent Pam Dockins reports.
    Video

    Video Senegal to Park Colorful ‘Cars Rapide’ Permanently

    Brightly painted cars rapide are a hallmark of Dakar, offering residents a cheap way to get around the capital city since 1976. But the privately owned minibuses are scheduled to be parked for good in late 2018, as Ricci Shryock reports for VOA.
    Video

    Video Florida Gets $1 Million in Emergency Government Funding for Orlando

    The U.S. government has granted $1 million in emergency funding to the state of Florida to cover the costs linked to the June 12 massacre in Orlando. U.S. Attorney General Loretta Lynch announced the grant Tuesday in Orlando, where she met with survivors of the shooting attack that killed 49 people. Zlatica Hoke reports.
    Video

    Video How to Print Impossible Shapes with Metal

    3-D printing with metals is rapidly becoming more advanced. As printers become more affordable, the industry is partnering with universities to refine processes for manufacturing previously impossible things. A new 3-D printing lab aims to bring the new technology closer to everyday use. VOA's George Putic reports.
    Video

    Video Big Somali Community in Minnesota Observes Muslim Religious Feast

    Ramadan is widely observed in the north central US state of Minnesota, which a large Muslim community calls home. VOA Somali service reporter Mohmud Masadde files this report from Minneapolis, the state's biggest city.
    Video

    Video During Ramadan, Faith and Football Converge in Lebanon’s Megadome

    In Beirut, a group of young entrepreneurs has combined its Muslim faith and love of football to create the city's newest landmark: a large, Ramadan-ready dome primed for one of the biggest football (soccer) tournaments in the world. But as the faithful embrace the communal spirit of Islam’s holy month, it is not just those breaking their fasts that are welcome.

    Special Report

    Adrift The Invisible African Diaspora