Document Detail

In utero meconium passage in fetuses and newborns with myelomeningocele.
MedLine Citation:
PMID:  19278315     Owner:  NLM     Status:  MEDLINE    
OBJECT: The authors retrospectively investigated whether midgestational fetal myelomeningocele (fMMC) repair alters intrauterine meconium exposure. METHODS: Prior to the National Institutes of Health Management of Myelomeningocele Study, 54 fetuses underwent fMMC repair at the authors' institution. Forty-six fMMC sacs were available for pathological examination and 53 MMC sacs from postnatally repaired MMCs (pMMCs) were available for comparison. The presence and distribution of meconium were blindly evaluated using a grading system defined as follows: absent (no meconium present), mild (<10 meconium-positive histiocytes [MPHs]/hpf), moderate (10-25 MPHs/hpf), and severe (>25 MPHs/hpf). Hall's bile stain was used to confirm meconium and Prussian blue and Fontana Masson stains to exclude hemosiderin and melanin, respectively. RESULTS: Compared to pMMCs (79%), meconium histiocytosis was less prevalent in fMMC sacs (57%; p=0.017). Meconium staining was completely absent in 43% of the fMMC sacs. Mild meconium histiocytosis was found in 35% fMMC and 61% pMMC sacs (p=0.035). There was no statistical difference between groups with moderate and severe meconium histiocytosis. CONCLUSIONS: Meconium passage in MMCs can occur early in fetal life. Fetal MMC repair may reduce the duration of meconium exposure, thereby potentially limiting the toxic injury to the vulnerable neural elements.
Enrico Danzer; Linda M Ernst; Natalie E Rintoul; Mark P Johnson; N Scott Adzick; Alan W Flake
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  3     ISSN:  1933-0707     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-03-12     Completed Date:  2009-04-23     Revised Date:  2010-04-06    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  141-6     Citation Subset:  IM    
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, and The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4318, USA.
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MeSH Terms
Age Factors
Cohort Studies
Fetal Diseases / etiology,  metabolism*,  surgery*
Fetal Therapies
Gestational Age
Histiocytes / metabolism
Infant, Newborn
Meconium / physiology*
Meningomyelocele / etiology,  metabolism*,  surgery*
Neurosurgical Procedures
Retrospective Studies
Comment In:
J Neurosurg Pediatr. 2010 Apr;5(4):422; author reply 422   [PMID:  20367352 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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