Qualidade de vida em crianças com mielomeningocele submetidas a reparo intrauterino e cirurgia pós-natal

Abstract

Myelomeningocele (MMC) is the most common congenital neural tube defect, affec-ting multiple organs and significantly impacting survival and quality of life. Intrauterine MMC repair reduces the need for ventricular shunting and increases independent ambulation rates. Objective: To evaluate the quality of life in children with MMC who underwent intrauterine versus postpartum repair. Design: A cross-sectional study utilized the PedsQL questionnaire, administered to guardians of children aged 2 to 7 years. Setting: Sarah Hospital- Rio de Janei-ro. Participants: This study included 28 children who underwent intrauterine myelomeningo-cele repair and 65 who underwent postpartum repair. Outcome measures: The statistical tests were logistic regression and Pearson correlation coefficient Results: The intrauterine group showed greater ambulation likelihood (p=0.007) and a functional level mainly in lumbar and sacral regions, compared to thoracic and lumbar functional levels in the the postpartum group (p=0.004). Hydrocephalus was present in 89.3% (25) of the intrauterine group and 100% (65) of those in the postnatal group (p=0.025). Ventriculoperitoneal (VP) shunting was required in 49.2% (12) of the intrauterine group and 60.0% (52) in the postpartum group (p=0.001). Clean intermittent catheterization was performed in 82.2% (25) of children with intrauterine repair and 81.5% (53) of those with postpartum repair (p=0.945). Prematurity was higher in the in-trauterine group (OR 10.25; 95%CI 3.17–33.10). Guardians reported better quality of life in physical (p=0.035), social (p=0.035), psychosocial domains (p=0.019), and total score (p=0.016) for the intrauterine group. Conclusion: Intrauterine repair was associated with better health-related quality of life outcomes.