Spina bifida baby with open back still operated in the womb

Unborn child in the womb operated on the open back
In Heidelberg, doctors have operated on an unborn child in the womb on an open back. The defect, referred to as spina bifida aperta, can, among other things, cause the affected children to be severely impaired in their motor skills and to develop a so-called hydrocephalus.

Child operated in the womb
At Heidelberg University Hospital, doctors have operated a child on the open back (spina bifida aperta) with a procedure that is unique in Europe. The baby was able to develop in the abdomen of his mother for another eleven weeks after the procedure before being born on Tuesday, August 9, by caesarean section.

In Heidelberg, doctors have operated on an unborn baby in the womb on the open back. Mother and child are obviously fine. (Image: Kzenon / fotolia.com)

The unborn remained connected to the umbilical cord
The Medical Director of the University Gynecological Clinic Heidelberg, Professor Christof Sohn, stated in a statement: "For the procedure during pregnancy, we have opened the uterus similar to a cesarean section. The child was carefully lifted out a bit and remained connected to the umbilical cord. "

Affected people often develop a water head
As explained in the communication, the defect referred to as spina bifida aperta occurs between the twentieth and twenty-eighth day of pregnancy when the vertebral bodies and often also the skins surrounding the spinal cord do not close. Depending on the extent and location of the defect, the affected children are later severely impaired in their motor skills and often develop a so-called water head, in which cerebral water accumulates within the skull. Due to the disturbances, it can also lead to paralysis.

One in every 1,000 children is born open-back
The Professional Association of Paediatricians (BVKJ) writes on its website "kinderaerzte-im-netz.de" that in Central Europe about one in every 1,000 children with an open back in the world. Girls are therefore more affected than boys. Because an open back occurs frequently in some families, genetic causes are suspected.

Various risk factors
Apparently also a lack of folic acid, vitamin B9, or a disturbance of folic acid metabolism plays a role in the first weeks of pregnancy. Women who want to have children should therefore take prophylactic folic acid. The use of certain active substances, such as valproic acid for epilepsy or fever in early pregnancy, gestational diabetes or maternal obesity are considered risk factors.

Most of the affected children are treated after birth
Although most children with open back are treated only after birth, but there have also been prenatal interventions. Experience has already been gained in the United States. "The study results from the USA impressively demonstrate the great advantage of open fetal surgery of spina bifida," said the pediatric neurosurgeon. Heidi Bächli, who operated on the back of the child in Heidelberg. "The children are less likely to suffer from a hydrocephalus, the cerebellum shifts less strongly into the spinal canal and the extent of paralysis can be significantly reduced."

Best possible start into life
The boy's spine was not completely formed around the spinal cord and nerves. "The early surgery allowed the boy to develop successfully in the womb without any further damage to the spinal cord," Dr. Bächli. "During the operation, spinal cord, hard meninges and skin were closed layer by layer. This is how we gave the baby the best possible start in life: the risk for a hydrocephalus was reduced and severe damage to the spinal cord could be largely prevented, "explained Professor Andreas Unterberg from the Neurosurgical University Clinic Heidelberg.

Mother and baby are soon to be released from the clinic
Significant changes in the brain of the child, which were detectable before surgery, had receded during pregnancy. "This is a huge success, which was only possible through intensive interdisciplinary cooperation," says Professor Sohn. According to media reports, the baby is developing magnificently. Next Sunday, mother and child will be released from the hospital. (Ad)