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
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Mortality in myelomeningocele is a concern
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Social disadvantage was not associated with death
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Hospital-based factors should be further examined
Keywords
infant mortality - health status disparity - neonatal mortality - myelomeningocele
- open spina bifida
