Current practice in the management of newborns with spina bifida in Germany

Introduction: Clear recommendations on how to manage newborns with spina bifida are found in the literature. Nevertheless, neurosurgery and paediatric surgery departments in German hospitals use different methods to treat these patients. The objective of this study was to assess the current situation regarding the management of spina bifida, which is a first and indispensable step towards the development of standards of practice.

Material and methods: In the second half of 2009, we sent standardised questionnaires to 139 neurosurgery departments (number of returned questionnaires: 98) and 73 paediatric surgery departments (returned questionnaires: 63) in order to identify the principles of management of spina bifida. Paediatric patients with spina bifida are treated in 57 of the neurosurgery departments and in 19 of the paediatric surgery departments.

Results: In 41 of the 57 neurosurgery departments and 16 of the 19 paediatric surgery departments providing care for newborns with spina bifida, standard treatment consists of surgical closure of the lesion within 24 hours of birth. In 53 neurosurgery departments and 17 paediatric surgery departments, babies with spina bifida are born by elective caesarean section. The diagnostic procedures that are performed range from no diagnostic procedure to magnetic resonance imaging of the spine.

The criteria underlying the placement of shunts and time to plastic surgery are highly variable.

Conclusions: In Germany, there are no uniform criteria for the management of newborns with spina bifida. Clear and consistent guidelines must be established in an interdisciplinary approach in order to improve and better coordinate the management of spina bifida.