Renée Shellhaas, MD, MS, highlights breathing issues in spina bifida

In this interview, Renée Shellhaas, MD, MS, professor at Washington University in St. Louis, discussed findings from a multicenter study examining breathing abnormalities in newborns with severe spina bifida, specifically myelomeningocele.

The study enrolled 173 infants across 9 centers in the United States, including babies who underwent either fetal surgery or postnatal surgery for myelomeningocele. To account for differences in which infants were more likely to receive fetal versus postnatal surgery, the investigators used propensity score–adjusted analyses.

Sleep-disordered breathing (SDB) was assessed using a polysomnogram performed before hospital discharge during the newborn admission. The study found that SDB was highly prevalent: just over half of the infants (53%) had evidence of sleep-disordered breathing. While this condition was not universal, it was common enough to represent a significant clinical concern in this population.

Initial, unadjusted analyses suggested that infants who underwent fetal surgery had more severe SDB, with an apnea–hypopnea index approximately 50% greater than that of infants who had postnatal surgery. However, after adjusting for prematurity, the apparent difference by surgical approach disappeared. Instead, gestational age at delivery emerged as the primary driver of SDB risk.

Infants who undergo fetal surgery are more likely to be born preterm, and prematurity itself substantially increases the risk of sleep-disordered breathing. Notably, other clinical factors—such as hydrocephalus, the need for a ventriculoperitoneal shunt, the level of the spinal lesion, or the degree of Chiari 2 malformation—were not predictive of SDB risk.

Shellhaas emphasized the clinical significance of these findings. Although fetal surgery for myelomeningocele is known to improve motor outcomes and reduce the need for treatment of hydrocephalus, cognitive outcomes are less clearly improved. In contrast, sleep-disordered breathing is both identifiable and treatable, even in newborns.

Early interventions, such as supplemental oxygen, may mitigate potential adverse effects on neurodevelopment. Because SDB is known to affect behavior and cognition in otherwise healthy children, its significant prevalence in this medically complex population represents an actionable opportunity for early screening and intervention.

The research team is continuing to follow the cohort to evaluate 2-year neurodevelopmental outcomes and repeat sleep studies. While additional data are needed, existing evidence from other high-risk populations suggests that early identification and treatment of SDB may improve developmental outcomes.

Shellhaas also highlighted existing guidelines from the Spina Bifida Association of America recommending sleep consultation and polysomnography in infancy—guidelines that are not consistently implemented. Together, these findings underscore the importance of prioritizing sleep evaluation as part of comprehensive care for infants with myelomeningocele, particularly those born preterm.

No relevant disclosures.

Reference

Breathing disruptions during sleep widespread in newborns with severe spina bifida. WashU Medicine. January 23, 2026. Accessed January 28, 2026. https://www.eurekalert.org/news-releases/1113357?