On our last mission to PMGH, in addition to surgery for complex brain tumours and spinal pathologies, we performed surgery on babies for spina bifida cystica.
Spina bifida occurs when a baby’s spine and spinal cord do not develop properly during the first month of pregnancy. It can range from a mild form with no neurological symptoms or visible defect in the back to the more serious type called a meningomyelocoele where a fluid sac containing parts of the spinal cord or spinal nerves bulge out through an opening in the spine. This kind of spina bifida can cause moderate to severe disabilities.
In developed countries with antenatal screening and advanced surgical facilities, the baby can have surgery while still inside the womb which can help reduce damage to the spinal cord. Often the surgery is scheduled within the first 48 to 72 hours after birth.
Unfortunately, there is a lack of antenatal screening in the remote areas of PNG and the issue is often not known about until the baby’s birth. Furthermore, there is a lack of referral pathways for the baby to receive timely surgical management, and children often present at quite a late stage with an extreme and critical defect. Neurological damage affecting mobility and bowel and bladder function may have occurred at this stage and the child may be unable to lie on its back.
Late-stage surgery cannot reverse any spinal cord damage that has already occurred but can make the child more comfortable, allow them to lie on their back and reduce the risk of infection and breakdown of the skin covering the defect.
On our previous missions to Port Moresby General Hospital, we could not perform elective surgery for the cases that presented due to a lack of appropriate surgical and anaesthetic equipment and an undefined post-operative care pathway. However, after undertaking a needs assessments for personnel and equipment, we were able to perform three of these surgeries during our June 2024 mission for infants from various villages around Papua New Guinea.
The surgeries were successfully performed on children aged 3 months, 9 months and 18 months and the techniques were taught to the local neurosurgery team and theatre staff.
We look forward to following up with these children and their families on our next mission.
https://www.healthdirect.gov.au/spina-bifida#what-is
