For decades, medical care for kids born with spina bifida has concentrated on mending the spine and preserving the brain from physical harm. Now, a groundbreaking multi-centre study has shown a silent and usually undetectable hazard that occurs far earlier—while these newborns sleep. Researchers discovered that more than half of kids with the most severe form of spina bifida fail to breathe properly while sleeping, an issue that may quietly damage brain development but might be avoided with early intervention.

The study, conducted by scientists from Washington University School of Medicine in St Louis in partnership with Michigan Medicine and eight other institutions across the United States, was just published in the journal Paediatrics. It implies a significant shift in how doctors can safeguard learning, memory, and IQ in infants born with this illness. 

Spina bifida is a congenital condition in which the spinal cord does not develop properly. Myelomeningocele, the most severe kind, exposes the spinal cord and frequently causes movement issues and hydrocephalus, a condition in which fluid accumulates in the brain. Even following successful surgery before or shortly after birth, many children experience lifelong difficulties with attention, memory, and learning. 

According to new research, sleep-disordered breathing, a condition in which respiration slows or pauses regularly during sleep, may be a contributing factor. This can limit oxygen delivery to the brain at a vital period of development. 

The study included 173 babies who had undergone myelomeningocele surgery. Prior to hospital discharge, they conducted thorough sleep studies to assess breathing patterns, brain activity, muscle movement, and heart rhythm. The findings were startling: more than half of the babies had indications of sleep-disordered breathing, with premature babies being at the highest risk. 

"The vast majority of these newborns with breathing problems would have gone undetected without the comprehensive sleep studies performed by our multidisciplinary research teams prior to hospital discharge," said Renée Shellhaas, MD, the study's lead author and a professor of neurology at Washington University. "This research demonstrates how bringing together expertise from multiple specialities can identify critical but previously overlooked opportunities to improve outcomes for vulnerable infants." 

Sleep-disordered breathing can take several forms. Obstructive sleep apnoea occurs when the airway becomes obstructed. Central sleep apnoea occurs when the brain fails to provide the correct signals to breathe. In both circumstances, recurrent decreases in oxygen and interrupted sleep can have an impact on brain development and function. 

"Sleep-disordered breathing is a significant contributor to behavioural problems and is likely to contribute to cognitive deficits as well, but it has not been well studied or routinely screened for in newborns," said Ronald Chervin, MD, a professor of sleep medicine at the University of Michigan. "This study addresses a critical gap in our understanding." 

Crucially, the findings offer optimism. Treatments for sleep-related respiratory difficulties are already available and frequently used with older children. Detecting the condition early may assist in safeguarding the growing brain. 

"What if early diagnosis and treatment of something as seemingly straightforward as sleep-disordered breathing could improve cognitive development for at-risk babies?" Shellhaas said. "It transforms everything for these babies. It significantly changes the lives of their families. "This has the potential to revolutionise the field." 

Some hospitals, notably St Louis Children's Hospital, are already exploring routine sleep screenings for high-risk neonates. Researchers are now tracking the study's youngsters until they reach the age of two to learn more about how early treatment affects long-term brain and physical development. 

If the findings are validated, sleep screening could become the new standard of care for newborns born with myelomeningocele, changing treatment away from simply healing the body and towards actively protecting the mind.