- 1.We agree that 30 months of age is too young to make definitive assessments in children who grow and mature at varying rates. Thirty months was selected as the earliest time for which there existed validated tools to make an initial attempt at understanding the impact of fetal surgery on motor function. On both the Bayley and Peabody motor scales, the prenatal surgery group had better motor function than the postnatal group, even though those in the prenatal surgery group had more severe anatomic levels of lesions. We very much look forward to the upcoming publication of MOMS 2 results, which evaluates the children at ages 6–10 years.
- 2.Male sex was acknowledged to be an identified finding, and we await longer-term follow-up data from MOMS 2.
- 3.The issue of the role of spinal cord tethering and other postnatal surgeries and their role in long-term motor function impairment is important. The relationship of these interventions to long-term outcomes as well as their impact on cost and quality of life need to be further evaluated.
- 4.We agree that the issue of walking independently, while statistically true as narrowly defined in this rigorous trial, minimizes the complexity of this disorder and does not reflect the full impact of the initial location of the lesion and the role played on the future motor outcome of the child.
The authors report no conflict of interest.