Newborns with spina bifida face a high risk of undetected breathing problems during sleep that may contribute to long-term cognitive difficulties, according to a new multi-center study led by researchers at Washington University School of Medicine in St. Louis and Michigan Medicine.

The study, published on January 23 in the journal Pediatrics, focused on infants who had undergone surgery for myelomeningocele, the most severe form of spina bifida.

While sleep-related breathing disorders have long been recognized in older children and adults with the condition, the research found that such problems begin much earlier than previously understood and affect more than half of newborns.

Spina bifida is a malformation of the spinal cord that can result in mobility impairments and hydrocephalus, a buildup of fluid in the brain.

Children with the condition are known to face increased risks of learning, attention and memory problems as they grow older.

The new findings suggest that sleep-disordered breathing may be an important and previously overlooked factor contributing to these challenges.

The researchers analysed breathing patterns, brain activity, muscle activity and heart rhythms in 173 newborns who had undergone myelomeningocele repair.

The study involved multidisciplinary teams from nine medical centers across the United States, bringing together specialists in neonatology, sleep medicine, neurosurgery, pediatric surgery, obstetrics, neurology and psychology.

According to the study, more than half of the infants showed evidence of sleep-disordered breathing, including obstructive sleep apnea, in which the airway becomes blocked, and central sleep apnea, in which the brain’s control of breathing is impaired. Babies born prematurely were found to be at the highest risk.

“The vast majority of these newborns with breathing problems would have been completely undetected without comprehensive sleep studies performed before hospital discharge,” said Dr. Renée Shellhaas, lead author of the study and a professor of neurology at Washington University School of Medicine, who also treats patients at St. Louis Children’s Hospital.

Untreated sleep-disordered breathing can lead to repeated sleep disruption and intermittent low oxygen levels, which over time may impair attention, executive function and overall cognitive development.

Researchers say identifying and treating these problems early could offer a meaningful way to improve outcomes for children with spina bifida.

“Sleep-disordered breathing is a significant contributor to behavioral problems and likely to cognitive deficits as well, but it has not been routinely screened for in newborns,” said Dr. Ronald Chervin, a coauthor of the study and professor of sleep medicine at the University of Michigan Medical School.

The findings have already begun to influence clinical practice. St. Louis Children’s Hospital, which provides specialized care through its Spina Bifida Clinic, is now considering routine screening of high-risk newborns to identify sleep-related breathing problems and initiate early treatment.

Myelomeningocele affects approximately three out of every 10,000 babies born in the United States. Surgical repair, either before birth or shortly after delivery, improves motor outcomes and reduces certain complications, but many patients continue to face long-term social and learning challenges.

The research team is continuing to follow the study participants until age two to assess their sleep patterns as well as cognitive and physical development. The researchers say the ongoing follow-up will help determine whether early identification and treatment of sleep-disordered breathing leads to measurable improvements in long-term outcomes.

The authors suggest that newborns with myelomeningocele may serve as an important model for broader efforts to identify and manage sleep-related breathing disorders in other high-risk infant populations.