Imagine a newborn battling not only a severe spinal condition but also unseen struggles with breathing during sleep. This is the harsh reality for many babies with spina bifida, a condition far more complex than meets the eye. A groundbreaking study led by Washington University School of Medicine in St. Louis and Michigan Medicine has uncovered a hidden link between severe spina bifida in newborns and sleep-related breathing issues, potentially revolutionizing how we approach their care.
Spina bifida, a birth defect affecting the spinal cord, often leads to mobility challenges and hydrocephalus, a dangerous buildup of fluid in the brain. But here's where it gets even more concerning: these children face a heightened risk of lifelong cognitive difficulties. Now, researchers have discovered that sleep-disordered breathing is a widespread yet frequently overlooked problem in newborns with the most severe form of spina bifida, myelomeningocele. And this is the part most people miss: addressing these sleep issues early could be a game-changer for their cognitive development.
Published in Pediatrics on January 23, the study focused on newborns who underwent surgery for myelomeningocele. While sleep disorders in older children and adults with this condition are known, this research reveals that these problems begin much earlier than previously thought, affecting over half of these newborns. But here's where it gets controversial: could something as seemingly simple as treating sleep-disordered breathing in infancy significantly alter the developmental trajectory for these children?
Lead author Renée Shellhaas, MD, emphasizes the critical role of comprehensive sleep studies in identifying these issues before hospital discharge. Without such studies, most of these breathing problems would go undetected. This collaborative effort across multiple specialties highlights a previously overlooked opportunity to improve outcomes for these vulnerable infants.
Myelomeningocele occurs when the spinal column fails to form properly during early fetal development, leaving the spinal cord exposed. It affects approximately three in every 10,000 babies born in the U.S. While surgery, either in utero or shortly after birth, improves motor outcomes and reduces complications, these children remain at high risk for social, learning, and cognitive challenges. Sleep-disordered breathing, including conditions like obstructive sleep apnea, exacerbates these risks by disrupting sleep and reducing oxygen levels, potentially leading to attention and executive function deficits.
Coauthor Ronald Chervin, MD, points out that while sleep-disordered breathing is a known contributor to behavioral and cognitive issues, it has been understudied in newborns. This study bridges a critical gap, suggesting that early intervention could have a profound impact on long-term outcomes.
The research involved an unprecedented collaboration among nine centers across the U.S., bringing together experts from neonatology, sleep medicine, neurosurgery, and more. They monitored breathing patterns, brain activity, muscle activity, and heart rhythms in 173 newborns who had undergone myelomeningocele repair. Strikingly, over half exhibited sleep-disordered breathing, with preterm babies at the highest risk. This finding underscores the potential for early intervention to improve not only breathing but also brain function.
What if something as straightforward as treating sleep issues could transform cognitive development for these at-risk babies? Shellhaas poses this thought-provoking question, suggesting it could be a paradigm shift for both the children and their families. The research team is now following participants until age two to assess the long-term impact of early treatment on sleep, cognition, and physical development.
This study isn’t just about spina bifida; it’s a call to action for broader efforts to diagnose and treat sleep-related breathing problems in high-risk infants. As Shellhaas notes, addressing these issues could be a powerful intervention to enhance neurodevelopment, not just for children with spina bifida but potentially for others at risk.
But here’s the question we leave you with: Should sleep-disordered breathing in high-risk infants be treated as a priority in developmental care? Share your thoughts in the comments—we want to hear from you!
This research was supported by the National Institutes of Health (NIH) grant number R01 HL147261, with additional support from the University of Michigan. The views expressed are those of the authors and do not necessarily reflect the official stance of the NIH.
Disclosures: Dr. Shellhaas receives royalties from UpToDate and serves as a consultant for the Epilepsy Study Consortium. Dr. Chervin receives royalties from UpToDate, consults for Eli Lilly & Company, and serves as president of the International Pediatric Sleep Association.
About WashU Medicine: A global leader in academic medicine, WashU Medicine excels in research, patient care, and education, with over 3,000 faculty members. Its NIH research funding ranks second among U.S. medical schools, and it commits over $1 billion annually to innovation and training. WashU Medicine physicians staff top hospitals like Barnes-Jewish and St. Louis Children’s, and its training programs are among the best in the nation.
