You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
it is a devastating congenital defect of the central nervous system with no known cure , characterized by protrusion of the meninges and spinal cord through open vertebral arches leading to paralysis .
varying degrees of mental retardation , bowel and bladder dysfunction as well as orthopedic disabilities also occur in association with this debilitating disorder10,18 ) .
the etiological mechanisms behind neural tube defects ( ntds ) have yet to be completely elucidated , although their frequency has been reported to show variation depending on race , ethnic origin , geographical location and socioeconomic status6 ) .
folic acid deficiency is one of best - documented risk factors for the development of ntds17 ) .
the incidence of ntds is high in turkey , affecting 3 - 9 newborns in every 1000 live births11,16 ) .
although many studies have focused on prenatal measures to decrease the frequency of mmc , research aimed at preventing the severe morbidity associated with this disorder is limited .
the aim of this study was to evaluate the demographic and clinical characteristics as well as the frequency of associated anomalies in our mmc patient population , while also attempting to establish the relationship between timing of surgery and duration of hospital stay .
this retrospective study was conducted at zekai tahir burak maternity teaching hospital , situated in ankara , with the approval of the local ethics committee .
the medical records of newborns diagnosed with mmc between january 2009 and may 2011 were systematically reviewed , and relevant data such as demographics , findings on physical examination , presence of mmc - associated anomalies , size of the mmc defect and its localization were recorded . for those who underwent surgery , the timing of surgery as well as the post - operative duration of hospital
stay ( patients without complication and did not need any treatment for addition anomalies are discharged ) , length of antibiotic course ( vancomycin or cefotaxime for meningitis / ventriculitis and/or local infection ) and morbidity were also recorded .
those who underwent surgery within the first 5 days after birth were placed in group 1 while group 2 was comprised of those who were operated later than 5 days .
data analysis was performed using the statistical package for the social sciences ( spss ) for microsoft windows , version 15.0 ( spss inc . , chicago , il , usa ) .
comparisons between groups were made using the chi - square test for categorical variables and the student 's t - test for numerical variables .
data analysis was performed using the statistical package for the social sciences ( spss ) for microsoft windows , version 15.0 ( spss inc . ,
comparisons between groups were made using the chi - square test for categorical variables and the student 's t - test for numerical variables .
values were provided as either percentage or meanstandard deviation , were applicable . a p - value of < 0.05 was considered indicative of statistical significance .
the complete medical records of 30 patients who were retrieved were deemed suitable for analysis , the demographic and clinical characteristics of whom are summarized in table 1 .
none of the mothers of the subjects included in this study had used any form of folic acid supplementation either before or during their pregnancies .
a diagnosis of mmc was made antenatally by ultrasonography in 18 patients ( 40% ) .
only 3 of the births ( 10% ) were a result of a consanguineous marriage .
localization of the mmc , neurological status , associated anomalies and complications are summarized in table 2 .
the most frequently encountered localization was the lumbosacral area ( 46.6% ) , with 76.6% of patients having lower extremity neurological abnormality .
overall , mmc - related complications were observed in 16 patients ( 53.3% ) , the most common complication being bladder dysfunction .
hydrocephaly was the most commonly observed anomaly , occurring in 25 ( 83.3% ) of our patients , followed by other anomalies ( table 2 ) .
overall , the mean lateral ventricle diameter was 20.24.8 mm , with no discernable difference between groups ( p>0.05 ) .
all patients with hydrocephaly were subjected to scanning by cranial computerized tomography to confirm the diagnosis as well as to screen for the presence of other anomalies .
comparisons between groups revealed that patients in group 1 who underwent surgery within 5 days of life had significantly lower durations of hospital stay and received shorter courses of antibiotics ( p<0.001 for both ) compared to patients in group 2 ( table 1 ) .
all the newborns , except one , remained problem free related to surgery after discharge .
only one of the newborns who had transposition of the great arteries died while under follow - up in another center .
ntds are the second most frequently encountered congenital malformations after cardiac anomalies . due to recent advances in ultrasonography and its widespread use during antenatal follow - up , early in utero recognition of the disorder is now possible11,16 ) .
unfortunately , due to socio - cultural taboos regarding abortion , none of the families had consented to medical termination of pregnancy7 ) .
folic acid deficiency is the most widely recognized risk factor for the development of ntds9 ) .
preconceptional supplementation of folic acid at a daily dose of 0.4 mg has been reported to decrease ntds rates by 60 - 70%17 ) .
none of the mothers of the subjects included in this study had used any form of folic acid supplementation either before or during their pregnancies .
mmc most commonly occurs in the lumbar area , with a reported frequency of 60 - 70%8,12 ) . in our study ,
lumbosacral mmc was observed in 46.6% , with a lumbar localization present in 40% of patients ( table 2 ) .
hydrocephaly and the chiari ii malformation are the most frequently observed anomalies in association with mmc13 ) . in our study population ,
hydrocephalus was present in 83.3% of patients , followed in decreasing order of other anomalies ( table 2 ) . taking this in to consideration ,
it is prudent that all patients with mmc should be screened for the presence of other anomalies that may be associated with the disorder , with the help of a careful physical examination , cranial imaging studies and urinary system ultrasonography5,8 ) .
an early and aggressive surgical approach in babies diagnosed with mmc has been shown to be associated with lower early morbidity and mortality rates2,3 ) . in a retrospective study ,
early surgical intervention ( < 72 hours after birth ) was found to be associated with a more favorable outcome in terms of urinary symptoms in patients with mmc , and investigators postulated that surgery within the first 24 hours increases the likelihood of maintaining urinary tract function15 ) . in another study where the outcomes of prenatal ( in utero ) and postnatal surgery were compared ,
it was observed that prenatal intervention was associated with better motor development while also alleviating the need for shunt placement in most patients .
however , authors stressed on the difficulty of the intrauterine procedure as well as the potential maternal and fetal risk posed by such surgery1,4 ) . in a different study ,
corrective surgery was performed immediately after birth citing the added risk associated with in utero intervention for patients with mmc .
investigators reported on a low postoperative complication rate and less severe neurodevelopmental retardation with this approach14 ) . with this study
, we managed to demonstrate that patients operated upon within the first 5 days of life had significantly lower durations of hospital stay while also requiring shorter courses of antibiotics ( p<0.001 ) . in light of these findings
, it is recommended to perform surgery as soon as possible , particularly in patients diagnosed prenatally .
our study findings suggest that early surgical intervention was associated with a shorter duration of hospital stay and antibiotic therapy as well as a lower complication rates .
national policies for prevention , in utero diagnosis , and early surgical intervention are required for better prognosis .
objectiveto investigate the effect of surgery time on prognosis of newborns with meningomyelocele.methodsthe records of neonates with meningomyelocele were retrospectively analyzed . 
 demographic and clinical characteristics as well as information , timing of surgery , and durations of hospital stay and antibiotic therapy were recorded.resultsthe records of 30 babies were included in the final analysis . 
 overall , the mean gestational age was 37.72.7 weeks , with a mean birth weight of 2967755 g and head circumference of 35.83.8 cm . in terms of localization , 
 46.6% of the meningomyeloceles were lumbosacral , 40% were lumbar , 10% were thoracolumbar and 3.3% were thoracal . 
 the mean size of the meningomyelocele sacs was 4.331.2 cm . 
 newborns underwent surgery on average of 8.25.9 days after birth , with an overall mean duration of hospital stay of 3025.1 days . 
 patients were divided into two groups based on timing of surgery ( group 1 , 5 days ; group 2 , > 5 days ) , and comparisons between groups revealed that earlier surgery was associated with significantly shorter durations of hospital stay ( p<0.001 ) and antibiotic therapy ( p<0.05).conclusionearly surgical intervention ( 5 days ) was associated with a shorter duration of hospital stay and antibiotic therapy as well as a lower complication rate . 
 we recommend that corrective surgery be undertaken as soon as reasonably possible .