Timeliness of surgical repair among infants with spina bifida

Background:  The Spina Bifida (SB) Association guidelines recommend SB repair within 48 hours of birth.  Timely repair of SB is associated with improved health outcomes.  We identified the proportion of infants with SB who had timely SB repair and examined factors associated with timely repair. 

Methods: This was a retrospective, statewide, population-based study of infants with SB born in Florida 1998-2007, ascertained by the Florida Birth Defects Registry and linked to hospital discharge records.  Using procedural codes to identify the first recorded SB repair among infants with a birth hospitalization, we examined mean and median time to SB repair and stratified results by presence of hydrocephalus and isolated (no other major birth defect) vs. non-isolated SB.  Using Poisson multivariable regression, we examined selected factors (payer, hydrocephalus, presence of other birth defects) associated with timely repair. 

Results: Of 299 infants with a recorded SB repair, 54% were born to non-Hispanic white mothers, 25% were preterm, 80% had hydrocephalus, and 20% had non-isolated SB.  Approximately 69% of infants had SB repair by day two, 15% between days three through seven, and 16% after day seven.  Mean and median time to SB repair was 11.3 and 1.0 days, respectively (range: 0-305 days).  After adjusting for selected factors, hydrocephalus was the only characteristic associated with repair by day two (adjusted prevalence ratio = 1.80, 95% confidence interval: 1.31-2.48). 

Conclusions:  Majority of infants with SB had surgical repair within the first two days of life.  Infants with hydrocephalus were more likely to have timely repair.