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A baby underwent surgery in the womb for spina bifida, and since being born six weeks ago, the child 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 forming around the third week of pregnancy, does not develop properly and essentially ends up with a hole in it, according to the Centers for Disease Control and Prevention (CDC). The neural tube later gives rise to the baby’s brain and spinal cord, so a hole in the structure can cause mild to severe nerve damage and result in physical and intellectual disabilities.
Helena, a mother in the U.K., learned her developing baby had spina bifida during her 20th week of pregnancy, according to the statement.
“It was a very large lesion on her back and half of her spine was exposed,” Helena told BBC News. “They said that it was likely she will be paralyzed, incontinent and will need a shunt to drain the fluid from her brain later on.”
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Thankfully, in 2011, a landmark clinical trial showed that operating on babies in the womb could spare them from some of the harmful effects of spina bifida, Live Science previously reported. Compared with babies with spina bifida who received surgery after birth, those operated on in the womb were twice as likely to walk without assistance by the age of 2 and developed fewer neurological problems.
The open fetal surgery does carry some risks, as it somewhat raises the risk of premature birth and requires mothers to deliver via C-section, or else risk rupturing the uterus, according to Live Science.
“The procedure is complex, time-sensitive and not without its risks, but the significant and life-changing impact on babies … and their families, cannot be overstated,” Dr. Dominic Thompson, lead neurosurgeon at GOSH, said in the statement. “This makes all the difference to the quality of their lives.”
Helen’s operation involved 25 clinicians from GOSH and University College London Hospitals, as well as University Hospitals Leuven in Belgium, where the surgery was conducted, according to BBC News.
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In general, the procedure involves giving an anesthetic to the mother, which also passes to the fetus, and then cutting through the abdomen and uterus to reach the fetus’s spine, according to the GOSH statement. Neurosurgeons then separate any skin attached to the exposed spinal cord and place the cord inside the spinal canal before stitching the tissues closed.
Helena received surgery in her 23rd week of pregnancy, and three months later, she gave birth to her daughter Mila at University College London Hospital. There is still some excess fluid on the newborn’s brain, but so far, Mila is showing signs of healthy development, according to the GOSH statement.
“She can move her legs, and she’s got feeling to her toes so it’s absolutely amazing,” Helena told BBC News. “I’m just so grateful to the surgeons who’ve done this operation because her life would look very different without it.” Including Mila, the team has performed the same operation on 32 babies since January 2020.
“We’re very excited about the next phase of the prenatal surgery for babies with spina bifida, including less invasive approaches,” Dr. Paolo De Coppi, part of the fetal surgical team for spina bifida, said in the statement.
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Since 2011, several groups have developed less invasive versions of the fetal surgery that only require minor incisions in the uterus and thus pose fewer risks to both mother and child, Stat News reported. And some doctors have developed techniques to avoid making large incisions in either the uterus or the abdomen, but as of 2019, this approach was still quite new and not widespread.
“As with any new approach, we first need to fully understand the benefits and risks involved to mother and baby,” De Coppi noted. “While we look to make these future procedures as safe as possible, what is clear is that prenatal surgery for patients with spina bifida leads to better outcomes.”
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