Myelomeningocele in One Neonate from a Fraternal Triplet Birth: Two Case Reports on Neurosurgical and Multidisciplinary Treatment During the Perinatal Period

Background: Few reports have described open spinal dysraphism in triplets or higher-order pregnancies, making details on the clinical course and the outcome of these cases scarce. Case reports: Among 61 neonates who underwent repair surgery for myelomeningocele (MMC) in our institutions, there were two cases of MMC occurring in one neonate from a fraternal triplet birth. Case 1 was a girl weighing 2086 g, born at 35 weeks of gestation by cesarean section prompted by the disabling abdominal protuberance of her mother. She had severe motor weakness in her lower extremities and other congenital malformations. Case 2 was a boy weighing 1573 g, born at 32 weeks of gestation by emergency cesarean section because of preterm rupture of membrane. He had respiratory disorders requiring continuous positive airway pressure (CPAP) management in the neonatal intensive care unit (NICU) for 51 days. Both patients underwent successful surgical repair of MMC, followed by placement of a ventriculoperitoneal shunt. In both cases, the other members of the triplet were low-birth-weight infants, with two of them requiring CPAP management in the NICU for 17-18 days due to pulmonary immaturity. Conclusion: The incidence of triplet pregnancies has been increasing. Because triplets are at an increased risk of premature birth and low-birth-weight, perioperative management of triplets with MMC requires careful procedures to manage blood loss, hypothermia, and cerebrospinal fluid leakage. The other members of the triplet may also be affected by prematurity and congenital anomalies that require management in NICU. The birth of triplets with MMC may overwhelm perinatal medical departments. The cases presented in this paper demonstrate that although management of a triplet with MMC is challenging, cooperation within the multidisciplinary medical team can result in favorable outcome.