Prevalentie, klinisch beeld en prognose van neuralebuisdefecten in Nederland

Objective. To determine the live birth prevalence of neural tube defects (NTD) in the Netherlands and describe the clinical picture. Design. Descriptive. Setting. TNO Prevention and Health, Leiden, the Netherlands. Method. Data collected through active surveillance of NTD on a monthly basis by paediatricians throughout the country. Results. From October 1993 to September 1995, 203 infants with NTD were registered. Six were diagnosed with an encephaly, 10 with encephalocele and 157 with spina bifida. On 30 children no further information was available. Seventy-nine per cent of children with spina bifida had a myelomeningocele and 11% had a meningocele. Hydrocephalus was found in 75% of all registered infants and in 81% of infants with myelomeningocele. In 18% of the latter group a kyphosis was diagnosed. In 45% of 131 children prognosis of ambulation was fair: they were expected to learn to walk. In 32% prognosis for motor disorder was very poor, and unsupported sitting was considered to be unlikely. At the time of registration, when most children were less than a month old, 55 (27%) had died; in infants with a myelomeningocele this was 35%. In many children treatment had not been started, probably because the prognosis was poor. Some had not been referred to a multidisciplinary team and only one of them received a hydrocephalus valve. Conclusion. The prevalence of spina bifida in the Netherlands is at least 100 live-born children per year among 195,000 total births. Mortality in the first month is high and for many surviving infants a severe handicap can be expected. Preventive strategies (such as folic acid suppletion) are urgently needed.