Nursing Care Management and Surgical Pathways in Myelomeningocele: A Systematic Review and Meta-analysis of Outcomes and Policy Implications (2000–2025)

This systematic review and meta-analysis, led by Dr. Fernan N. Torreno and Frincess Flores, synthesizes two and a half decades of peer-reviewed evidence (2000–2025) on the care of patients with myelomeningocele (MMC). The study integrates both surgical advances and nursing care management, recognizing MMC as not only a neurosurgical challenge but also a nursing-sensitive condition requiring lifelong multidisciplinary coordination.

Drawing from 42 eligible studies, the review compares outcomes of prenatal versus postnatal repair, fetoscopic versus open fetal surgery, and early versus delayed postnatal closure. The analysis demonstrates that prenatal repair significantly reduces the need for cerebrospinal fluid shunts and improves ambulation at 30 months, while fetoscopic repair lowers maternal morbidity but increases the risk of preterm premature rupture of membranes. Early postnatal closure, where fetal surgery is unavailable, effectively reduces surgical site infection and ventriculitis.

Equally important, the review emphasizes nursing care management as a core determinant of outcomes. Nurse-led interventions in infection prevention, clean intermittent catheterization (CIC) initiation, pressure injury prevention, and structured family education consistently reduced complications and improved adherence. For example, early CIC initiation coordinated by nurses reduced urinary tract infections by nearly one-third, while family-centered education programs lowered preventable readmissions.

By embedding the SMART framework (specific, measurable, attainable, relevant, and time-bounded), Dr. Torreno and Ms. Flores highlight both clinical and policy implications. The findings call for policies that strengthen prenatal repair programs in high-resource settings such as Israel, while ensuring equitable access to timely postnatal closure and nursing-driven protocols in low- and middle-income countries.

Ultimately, this study demonstrates that advances in surgery must be matched by robust nursing frameworks to achieve sustainable improvements in MMC care. The leadership of Dr. Fernan N. Torreno and Frincess Flores underscores the importance of collaborative, evidence-based, and policy-oriented scholarship in global nursing and health systems research.