A baby has undergone surgery in the womb for spina bifida, and since he was born six weeks ago, the baby is healthy and developing well, according to a statement from the Great Ormond Street Hospital (GOSH) for children in London.
Spina bifida occurs when the so-called neural tube, a hollow structure that begins to form around the third week of pregnancy, does not develop properly and essentially ends with a hole in it, according to the Centers for Disease Control and Prevention (CDC). Later, the neural tube generates the baby’s brain and spinal cord, so a hole in the structure can cause mild to severe nerve damage and lead to physical and intellectual damage.
Helena, a mother in the United Kingdom, learned that her developing baby had spina bifida during the 20th week of pregnancy, the statement said.
“It was a very large lesion on her back and half of her spine was exposed,”
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Fortunately, in 2011 a landmark clinical trial showed that operating on babies in the womb could save them from some of the harmful effects of spina bifida, Live Science previously reported. Compared to babies with spina bifida who underwent surgery after birth, those operated on in the womb were twice as likely to walk unaided until 2 years of age and developed fewer neurological problems.
Open fetal surgery carries some risks, as it somewhat increases the risk of premature birth and requires mothers to deliver by cesarean section, or there is a risk of uterine rupture, according to Live Science.
“The procedure is complex, time-sensitive and not without risks, but the significant and life-changing impact on babies … and their families cannot be overestimated,” said Dr Dominic Thompson, GOSH’s lead neurosurgeon. “It matters a lot to the quality of their lives.”
Helen’s operation involved 25 clinicians from GOSH hospitals and University College London, as well as from the university hospitals in Leuven in Belgium, where the operation was performed, BBC News reports.
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The procedure generally involves giving the mother anesthesia, which also passes to the fetus, and then cutting through the abdomen and uterus to reach the fetal spine, according to a statement from GOSH. Neurosurgeons then remove any skin attached to the exposed spinal cord and place the cord inside the spinal canal before suturing the closed tissues.
Helena underwent surgery in her 23rd week of pregnancy, and three months later she gave birth to her daughter Mila at University College London. There is still some excess fluid in the newborn’s brain, but so far Mila is showing signs of healthy development, according to a statement from GOSH.
“She can move her legs and she has a feeling for her toes, so it’s absolutely amazing,” Helena told BBC News. “I am so grateful to the surgeons who performed this operation, because her life would have looked very different without her.” Including Mila, the team has performed the same operation on 32 babies since January 2020.
“We are very excited about the next phase of prenatal surgery for babies with spina bifida, including less invasive approaches,” said Dr. Paolo De Copi, part of the fetal spina bifida surgery team, in a statement.
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Since 2011, several groups have developed less invasive versions of fetal surgery, which require only small incisions in the uterus and thus pose less risk to both mother and child, Stat News reported. And some doctors have developed techniques to avoid large incisions either in the uterus or in the abdomen, but by 2019 this approach is still quite new and not widespread.
“As with any new approach, we must first fully understand the benefits and risks of mother and baby,” said De Coppy. “Although we strive to make these future procedures as safe as possible, it is clear that prenatal surgery for patients with spina bifida leads to better results.”
Originally published in Live Science.