Desenvolvimento neuropsicomotor de crianças com mielomeningocele operadas intraútero

Abstract

Introduction: Myelomeningocele (MMC) is a congenital defect of the central and peripheral nervous system, caused by an injury resulting from a fusion defect in the midline of the caudal neural tube. This injury can occur at different levels of the spine and may present variable degrees of impairment and neuromotor and cognitive dysfunctions. Intrauterine correction surgery can preserve neuropsychomotor function. It’s essential to evaluate children submitted to the method, so that risks of developmental delays can be classified, investigated and detected, and their evolution can be monitored. Objective: To evaluate the neuropsychomotor development of children with myelomeningocele after intrauterine surgical correction. Methods: It consists of an observational cross-sectional cohort study of a quantitative nature. The study was done at the Laboratory of Neurofunctional Physiotherapy of the Department of Physiotherapy of the UFC and Nucleus of Treatment and Early Stimulation (NUTEP), located in the city of Fortaleza - CE. Children with myelomeningocele who underwent surgery for correction by the intrauterine method from May 2021 to December 2021 in the city of Fortaleza participated in this study. These children were assessed using the Alberta Infant Motor Scale (AIMS) and the Bayley III Scale of Child Development. Results: The sample consisted of 15 children, the majority (53.4%, n=8) female who, on average, underwent intrauterine correction surgery at the 25th week of gestational age and were born at the 32nd week of gestational age, 86.6% (n=13) were premature (born before completing 37 weeks of gestational age). When comparing the anatomical level of neurological injury during the fetal ultrasound and the functional level assessed, a significant improvement can be observed in 60% of children (n=9). According to the AIMS assessment, most of the sample was characterized with abnormal development (<5%). Regarding the findings of the Bayley scale, most children obtained scores with a median classification in cognition, obtaining an average score of 83.4±18.19, and language, with an average of 85.8± 14.31, and borderline motor, mean of 77.2±18.01. Conclusion: Most of the sample was premature, but with good vitality and adequate weight for gestational age. The AIMS identified abnormal development in the sample and the motor domain score on the Bayley III Scale was borderline, but there was a significant improvement in the functional level compared to the level of injury.