National Institute for Health and Clinical Excellence (NICE)
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Procedure carried out on unborn babies with spina bifida could improve their neurodevelopment

Operations are set to start taking place in the NHS.

Babies at risk of spina bifida can be operated on while still in the womb using a new innovative operation, a NICE committee has said.

NICE looked at two operations for babies with open neural tube defect – one, involving surgically opening the womb to operate on the fetus inside (open repair) and the other carried out through keyhole surgery to reach the unborn baby. 

The committee said the evidence on the open repair shows serious but well recognised safety concerns for the mother and baby but found it  works well enough for it to be used in the NHS as long as it is done in specialised centres, by clinicians and teams with specific training and experience and there are special arrangements for clinical governance, consent, and audit in place.

NHS England has announced plans to fund open fetal surgery for spina bifida for those who are eligible for the procedure, with the service expected to be operational in the coming weeks.

Professor Kevin Harris, clinical advisor for the Interventional Procedures Programme at NICE, yesterday said:

“These innovative procedures have the potential to reduce the symptoms that would otherwise result from spina bifida, improving the quality of life for those with the condition.

“However, these are technically challenging procedures and should only be done in specialised centres, by clinicians and teams with specific training and experience in fetal surgery and who analyse the outcomes to both the fetus and mother.”

Maternity minister Nadine Dorries yesterday said:

"Every baby deserves the best start to life, so I'm delighted more families will benefit from pioneering Spina bifida surgery which could transform babies' lives even before they have been born.

"We are committed to transforming maternity services in England - as set out in our NHS Long Term Plan - and this latest development is a hugely positive step towards making this the safest country in the world to give birth."

Professor Stephen Powis, NHS medical director, said: “The NHS will be offering open spinal surgery for spina bifida for unborn babies to eligible women in just a few weeks.”

In a second piece of guidance, the committee found the internal keyhole repair requires further evidence to be collected and should only be used in the context of research, the committee said.

An open neural tube defect happens while the baby is developing in the womb. Part of the spinal column does not close properly, leaving a gap that exposes the spinal cord and nerves to the outside of the body. This results in the baby being born with spina bifida, which may cause lifelong disability.

Both procedures aim to prevent further damage to a baby’s brain, spinal cord and nerves. The earlier action can be taken to cover the spinal column the better the chances that the symptoms of spina bifida are reduced.

There is no cure for spina bifida. Every week four women give birth to an affected child.

Usual current practice involves operating on babies within 48 hours of their birth. These new options could be carried out before 26 weeks of pregnancy have passed.

The operations have been assessed by NICE’s interventional procedures advisory committee, which makes recommendations on which procedures are considered best clinical practice for the NHS.


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