{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T04:23:47Z","timestamp":1775795027162,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100015158","name":"Fondren Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015158","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019961","name":"Tramuto Porter Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019961","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the ambulatory status of a cohort of children who had undergone prenatal repair of an open neural tube defect (ONTD) using one of two different methods (fetoscopic or open hysterotomy) with that of a cohort who had undergone postnatal repair, and to identify the best predictors of ambulation at 30\u2009months of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a retrospective review of a cohort of children who underwent ONTD repair either prenatally (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009110), by fetoscopic surgery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200973) or open hysterotomy surgery (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200937), or postnatally (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200951), in a single tertiary hospital between November 2011 and May 2023. The cohort comprised a consecutive sample of cases who had undergone ONTD repair\n                      <jats:italic>in\u2010utero<\/jats:italic>\n                      following Management of Myelomeningocele Study (MOMS) trial criteria and cases who had undergone postnatal repair, meeting the same criteria, which were also followed up after birth at the same institution. Motor function assessment by ultrasound was recorded at referral, 6\u2009weeks after prenatal repair, or after referral in postnatally repaired cases, and at the last ultrasound scan before delivery. Clinical examinations to assess motor function at birth and at 12\u2009months were retrieved from records. Intact motor function was defined as first sacral myotome (S1) motor function. Ambulatory status data at each follow\u2010up visit were collected. The proportion of children who were able to walk independently after 30\u2009months of age was compared between those who had undergone fetoscopic\n                      <jats:italic>vs<\/jats:italic>\n                      open prenatal surgery and between prenatal (by either fetoscopic or open surgery) and postnatal ONTD repair. Logistic regression analyses were performed to identify predictors for independent ambulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After 30\u2009months, the proportion of infants who were able to walk independently was higher in prenatally\n                      <jats:italic>vs<\/jats:italic>\n                      postnatally repaired cases (51.8%\n                      <jats:italic>vs<\/jats:italic>\n                      15.7%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01), and there was no difference between those with fetoscopic (52.1%)\n                      <jats:italic>vs<\/jats:italic>\n                      open (51.4%) prenatal repair (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.66). In the prenatally repaired group, having intact motor function at 12\u2009months (adjusted odds ratio (aOR), 9.14 (95%\u2009CI, 2.64\u201331.63),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) and at birth (aOR, 4.50 (95%\u2009CI, 1.21\u201316.80),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02) were significant predictors of independent walking at 30\u2009months; an anatomical level of lesion below L2 at referral (aOR, 1.83 (95%\u2009CI, 1.30\u20132.58),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.01) and female gender (aOR, 3.51 (95%\u2009CI, 1.43\u20138.61),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01) were also predictive for this outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prenatally repaired cases of ONTD have a better chance of being able to walk independently at 30\u2009months than do those who undergo postnatal repair. In patients with prenatally repaired ONTD, ambulatory status at 30\u2009months can be predicted by observing a low lesion level at referral (below L2) and intact motor function postnatally. These results have implications for parental counseling and planning for supportive therapy in pregnancies affected by ONTD. \u00a9 2024 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.27589","type":"journal-article","created":{"date-parts":[[2024,1,20]],"date-time":"2024-01-20T09:53:10Z","timestamp":1705744390000},"page":"203-213","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Ambulation after\n                    <i>in\u2010utero<\/i>\n                    fetoscopic or open neural tube defect repair: predictors for ambulation at\u200930\u2009months"],"prefix":"10.1002","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-9859","authenticated-orcid":false,"given":"M.","family":"Sanz Cortes","sequence":"first","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-2054","authenticated-orcid":false,"given":"R.","family":"Corroenne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Pyarali","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. M.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics &amp; Gynecology, Division of Maternal\u2013Fetal Medicine Baylor College of Medicine &amp; Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. 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