HUC-FICS: Cryopreserved Human Umbilical Cord as a Meningeal Patch in Fetoscopic Spina Bifida Repair
Study Details
Study Description
Brief Summary
The objective is to test the efficacy of a laparotomy-assisted fetoscopic surgical approach to cover spina bifida spinal cord developmental defects using cryopreserved human umbilical cords (NEOX Cord 1K®) as a meningeal and skin patch.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: NEOX Cord 1K applied fetoscopically Patients intending to undergo open in-utero spina bifida repair will be offered to be screened for an alternative minimally invasive approach. All eligible pregnant mothers' fetuses within the trial will receive NEOX Cord 1K® as a spinal cord cover to close the developmental defect. In some cases, at the discretion of the Pediatric Neurosurgeon, NEOX Cord 1K® may be required to cover the skin. All eligible subjects meeting all inclusion criteria but none of the exclusion criteria may be enrolled. |
Device: NEOX Cord 1K applied fetoscopically
Under general anesthesia and tocolysis, in-utero repair begins with a laparotomy that is followed by exteriorization of the uterus. The fetus is then positioned by external cephalic version. Uterine entry will be accessed using 3 cannulas, followed by heated-humidified carbon dioxide insufflation for visualization. Then, fetoscopically the placode will be examined and dissected. The lesion will be repaired using NEOX Cord 1K® (HUC) for closure of the first layer over the neural placode. Primary closure of the skin will then occur, or NEOX Cord 1K® (human umbilical cord) will be used for skin closure at the discretion of the Pediatric Neurosurgeon. Finally, the laparotomy site will be sutured in multiple layers.
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Outcome Measures
Primary Outcome Measures
- Number of participants that can ambulate independently by walking at least 10 steps [30-36 months after delivery]
Secondary Outcome Measures
- Number of participants with lower extremity motor and sensory levels exceeding the anatomical level of the lesion by ≥ 2 segments [30-36 months after delivery]
Eligibility Criteria
Criteria
Inclusion Criteria:
Maternal Inclusion Criteria:
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Singleton pregnancy
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Gestational age at screening is 19 to 25 5/7 weeks and gestational age at surgery is 22 to 25 6/7 weeks
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Maternal age: 18 years and older
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Body mass index ≤45 kg/m2 (pre-pregnancy)
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No preterm birth risk factors (short cervix <20 mm or a history of previous preterm delivery)
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No previous uterine incision in the active uterine segment
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Willing to undergo an open fetal repair if the fetoscopic approach is unsuccessful
Fetal Inclusion Criteria:
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Spina bifida defect between T1 to S1 vertebral levels
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Chiari II malformation
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No evidence of kyphosis (curved spine)
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No major life-threatening fetal anomaly unrelated to spina bifida
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Normal karyotype, or a normal chromosomal microarray analysis (CMA), or a CMA with variants of unknown significance [fluorescence in situ hybridization (FISH) acceptable if ≥ 24 weeks].
Exclusion Criteria:
Maternal Exclusion Criteria:
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Non-resident of the United States
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Multifetal pregnancy
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Poorly controlled insulin-dependent pregestational diabetes
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Poorly controlled A2 diabetes mellitus (A2DM) insulin-dependent diabetes
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Current or planned cerclage or documented history of an incompetent cervix
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Placenta previa or placental abruption
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Short cervix of < 20 mm
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Obesity as defined by a body mass index of > 45 kg/m2
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Previous spontaneous singleton delivery prior to 37 weeks
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Maternal-fetal Rh isoimmunization, Kell sensitization, or a history of neonatal alloimmune thrombocytopenia
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HIV or Hepatitis-B positive status
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Known Hepatitis-C positivity
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Uterine anomaly such as large or multiple fibroids or a mullerian duct abnormality that is diagnosed via imaging prior to surgery, which that are unavoidable during surgery
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Other medical conditions which are contraindication to surgery or general anesthesia
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Patient does not have a support person
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Inability to comply with the travel and follow-up requirements of the trial
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Patient does not meet psychosocial standardized assessment criteria
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Participation in this or another intervention study that influences maternal and fetal morbidity and mortality
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Maternal hypertension
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Zika virus positivity
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Allergy/history of drug reaction to Amphotericin B
Fetal exclusion criteria:
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Major fetal anomaly not related to spina bifida
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Kyphosis in the fetus of 30 degrees or more
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Ventriculomegaly greater than 15 mm and no movements noted at hip and knee joints
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | The University of Texas Health Science Center at Houston | Houston | Texas | United States | 77030 |
Sponsors and Collaborators
- The University of Texas Health Science Center, Houston
Investigators
- Principal Investigator: Ramesha Papanna, MD, MPH, The University of Texas Health Science Center, Houston
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HSC-MS-23-0584