Folic acid deficiency in conceptual period is still major cause of Meningomyelocele in rural area of western UP

• Author Details:   
• Namita Sharma
• Pradeep Bharti
• Sanjay Sharma ^*

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Introduction: Meningomyelocele is congenital defect in backbone of children and most common neural tube closure defect and malformations affecting brain and spine of children. It have high rate of morbidity and disability in survived children. This is the second most common caused for morbidity and mortality in children. global prevalence of Meningomyelocele has been reported to be 0.8–1 per 1,000 live births. The Hydrocephalus may affect as many as 80% of children with Meningomyelocele. use of periconceptional folic acid supplements, prevents ~50–75% of cases of neural tube defects the. This study aims to evaluate and clinical profile and use of folic acid in pericoceptual period by mother in rural area of western U.P., and outcome of children with Meningomyelocele.
Methods and Materials: 226 patients with Meningomyelocele admitted to SVBP hospital, Meerut and private in private hospitals of near by area between august2015 to dec’18, were analyzed prospectively. The data regarding clinical profile with associated congenital anomalies and supplementation of folic acid by mother in conceptuals period and post surgical disabilities were obtained by questionnaire- interview with the parents,drug history pertaining to drugs causing folic acid deficiency was unavailable as most of the patients belonged to low socio economic strata and were less literate. MRI was the essential investigation in all patients. The data was analyzed by SPSS 21.0 version.
Results: Mean age of presentation is 9.1 months. M:F ratio is 1.1:1. Lumbosacral region is involved in 73.5% patients. Hydrocephalus was the most common (63.71%, n=144) associated anomaly. In 92% cases there is no history of folic acid supplementation & all patients were from low socioeconomic status. Excision & repair of Meningomyelocele is the most commonly (80% n=180) performed surgery, dural patch was used to close the larger defect in 8.35%(n=15).and 20% patients were not operate due to various regions. In our study out of180 operated patients 80%(n=144) patients improved & discharged, and 6.6%(n=12) patients expired, 13.35%(n=24) patients left against medical advice (LAMA).
Conclusion: Low socioeconomic status & no maternal supplementation of folic acid in conceptual period are the important risk factors for the development of Meningomyelocele. Timely intervention with excision and repair gives good result. The use of Dural patch to closed the neural tube dural defect was good alternative, modified z-plasty can be use to cover large defects.

Keywords: Meningomyelocele, Hydrocephalus, Folic acid supplementation, Dural patch.