Neural Tube Defect in a Resource Limited Setting: Clinical Profile and Short Term Outcome

Figures & data

Table 1 The Maternal Obstetric History and Risk Factors for NTD

Variables	Number	Percent
Maternal age
≤19	17	6.8
20–29	162	64.8
30–39	70	28
≥40	1	0.4
Mather’s residence
Urban	97	38.8
Rural	153	61.2
Parity
Primiparous	93	37.2
Multiparous	157	62.8
History of abortion
No	244	97.6
Yes	6	2.4
History of stillbirth
No	248	99.2
Yes	2	0.8
History of early neonatal loss
No	249	99.6
Yes	1	0.4
ANC visit for the index pregnancy
Yes	237	94.8
No	13	5.2
Maternal febrile illness during first trimester pregnancy
Yes	9	3.6
No	226	90.4
Undocumented	15	6
Obstetrics ultrasound for the index pregnancy
Yes	219	87.6
No	31	12.4
Folic acid supplementation
Never	76	30.4
Periconceptional	3	1.2
After first trimester	135	54.0
Undocumented	36	14.4
History of NTD affected pregnancy previously
No	245	98
Yes	5	2
Diagnosis
Prenatal	22	8.8
Postnatal	228	91.2
Mode of delivery
SVD	227	90.8
Instrumental	3	1.2
C/S	20	8

Table 2 Clinical Profile of Children with NTD (n = 250)

Variables	Number	Percent
Age at admission
≤3 days	106	42.4
4 days–28 days	91	36.4
29 days–1 year	49	19.6
>1 year	4	1.6
Sex
Male	126	50.4
Female	124	49.6
Gestational age
Term	224	89.6
Preterm	26	10.4
Type of NTD
Myelomeningocele	193	77.2
Encephalocele	24	9.6
Meningocele	26	10.4
Lipomyelocele	7	2.8
Location of myelomeningocele (n=193)
Cervical	6	3.1
Thoracic	4	2.1
Thoracolumbar	28	14.5
Lumbar	69	35.8
Lumbosacral	79	40.9
Sacral	7	3.6
Location of Meningocele (n=26)
Cervical	3	11.5
Thoracic	3	11.5
Lumbar	11	42.3
Lumbosacral	7	26.9
Sacral	2	7.7
Location of Encephalocele (n=24)
Occipital	21	87.5
Occipitocervical	3	12.5
Location of lipomyelocele (n=7)
Lumbar	2	28.6
Lumbosacral	2	28.6
Sacral	3	42.9
Associated malformation
Chiari II malformation	79	31.6
Hydrocephalus	135	54
Club foot	49	19.6
Admission duration until surgery
≤3 days	18	7.2
4 days-28 days	217	86.8
>28 days	15	6
Duration of hospitalization
<14 days	58	23.2
14–21 days	74	29.6
>21 days	118	47.2

Figure 1 Status of NTDs at presentation (n = 250).

Abbreviation: MMC, myelomeningocele.

Table 3 Types of Surgery Performed

Surgical Intervention	Frequency
Myelomeningocele (n=193)
Repair alone	184
Repair + VP shunt	5
Repair + EVD	1
Repair + untethering	1
Abscess drainage + repair	2
Encephalocele (n=24)
Repair	23
Abscess drainage + repair	1
Meningocele (n=26)
Repair	26
Lipomyelocele (n=7)
Repair	7

Abbreviations: VP, ventriculoperitoneal; EVD, External ventricular drainage.

Table 4 Logistic Regression Analysis on Factors Associated with Mortality in Children with NTD (N = 250)

Variable	Category	COR (95% CI), p	AOR (95% CI), p
Meningitis/ventriculitis	Present	7.85(3.01,20.47),<0.001	3.8(1.12,12.9),0.03
	Absent	1	1
Sepsis at admission	Present	6.18(1.76,21.67),0.004	2.89(0.68,12.21),0.15
	Absent	1	1
Gestational age	Preterm	42.39(13.84, 129.79),<0.001	26(8.01,86.04),<0.001
	Term	1	1
Arnold Chiari malformation II	Present	2.91(1.15,7.35),0.024	2.01(0.61,6.68),0.25
	Absent	1	1

Abbreviations: COR, Crude Odds Ratio; AOR, Adjusted Odds Ratio; CI, Confidence Interval; p, p-value; 1, reference variable.

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.