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Am J Perinatol 2021; 38(12): 1263-1270
DOI: 10.1055/s-0040-1712165
Original Article

Factors Associated with Early Neonatal and First-Year Mortality in Infants with Myelomeningocele in California from 2006 to 2011

Vijaya Kancherla
1   Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
,
Chen Ma
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Gerald Grant
3   Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
,
Henry C. Lee
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
4   California Perinatal Quality Care Collaborative, Stanford, California
,
Susan R. Hintz
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
4   California Perinatal Quality Care Collaborative, Stanford, California
,
Suzan L. Carmichael
2   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
5   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
› Author Affiliations
Funding This study received its financial support from the National Institute on Minority Health and Health Disparities (grant number R01 MD007796).
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Abstract

Objective The aim of this study is to examine factors associated with early neonatal (death within first 7 days of birth) and infant (death during the first year of life) mortality among infants born with myelomeningocele.

Study Design We examined linked data from the California Perinatal Quality Care Collaborative, vital records, and hospital discharge records for infants born with myelomeningocele from 2006 to 2011. Survival probability was calculated using Kaplan–Meier Product Limit method and 95% confidence intervals (CI) using Greenwood's method; Cox proportional hazard models were used to estimate unadjusted and adjusted hazard ratios (HR) and 95% CI.

Results Early neonatal and first-year survival probabilities among infants born with myelomeningocele were 96.0% (95% CI: 94.1–97.3%) and 94.5% (95% CI: 92.4–96.1%), respectively. Low birthweight and having multiple co-occurring birth defects were associated with increased HRs ranging between 5 and 20, while having congenital hydrocephalus and receiving hospital transfer from the birth hospital to another hospital for myelomeningocele surgery were associated with HRs indicating a protective association with early neonatal and infant mortality.

Conclusion Maternal race/ethnicity and social disadvantage did not predict early neonatal and infant mortality among infants with myelomeningocele; presence of congenital hydrocephalus and the role of hospital transfer for myelomeningocele repair should be further examined.

Key Points

  • Mortality in myelomeningocele is a concern

  • Social disadvantage was not associated with death

  • Hospital-based factors should be further examined

Keywords

infant mortality - health status disparity - neonatal mortality - myelomeningocele - open spina bifida


Publication History

Received: 17 December 2019

Accepted: 14 April 2020

Article published online:
30 May 2020

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