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Aim The aim of this study is to outline the role of primary external ventricular drains (EVD) in the management of open myelomeningoceles in the neonatal setting in Ireland. Methods Retrospective cohort study involving all infants who underwent open myelomeningocele repair in a teritary centre in Ireland between January 2009 and April 2016. Medical charts and laboratory data was reviewed on all infants meeting the inclusion criteria. Results One hundred and forty-three neonates underwent open myelomeningocele repair in the 6.5 year period. EVD were inserted at the time of primary wound closure in 19 cases (13%). EVD were used to aid in wound closure and as a primary method of cerebrospinal fluid (CSF) diversion. They remained in place for a median of 8 days, ranging from 1-22 days. All EVD, apart from one, in our series were replaced by a ventricular-peritoneal (VP) shunt at some stage. Conclusion EVD were used in 13% of cases of open myelomeningocele repairs from Jan 2009-Apr 2016 as a primary measure to aid in management. Compared to the cohort in whom an EVD was not inserted at the time of surgery, there was a decrease in the rate of infections. However, there was an increased rate of wound dehiscence/leak and a later need for VP shunt insertion., Competing Interests: There are no conflicts of interest to declare.

The management policy at Our Lady's Hospital for Sick Children, Crumlin, for newborn spina bifida infants consists of immediate operation for those considered likely to benefit and full nursery care for those who do not have early surgery. In the eleven years since this policy was first implemented, there have been 493 infants admitted with open myelomeningocele, of whom 260 (52.7%) were managed non-operatively. The mortality for all infants so managed was 78% at one year. 171 (66%) of this group died without further intervention. 89 (34%) survived long enough for some form of treatment to be instituted. 41 of these children are still alive and it is felt that their handicaps have not been increased by their early management. It is argued that an approach to management which considers the needs and interests of the individual infant is more acceptable than one that seeks to enforce total care, regardless of circumstances, or the impersonal assignment, by criteria, into "treatment" and "non-treatment" groups.