Seventeen-Day Survival in Anencephaly from a Resource-Limited Neonatal Unit in Togo: a case report

Seventeen-Day Survival in Anencephaly from a Resource-Limited Neonatal Unit in Togo: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Seventeen-Day Survival in Anencephaly from a Resource-Limited Neonatal Unit in Togo: a case report Houessou Agbo Mensan, Guedenon Koffi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9237120/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anencephaly is a severe and usually fatal neural tube defect marked by the absence of the cerebral hemispheres. Most affected infants are either stillborn or live only a few hours to several days after birth. Reports from resource-limited settings remain relatively rare. Case Presentation We report the case of a female newborn of West African origin delivered via cesarean section at Sylvanus Olympio University Hospital in Lomé, Togo. The pregnancy was notable for first-trimester bleeding and limited access to prenatal care. At birth, the newborn presented an absence of frontal and parietal cranial bones, exposing neural tissue. The rest of the physical examination was unremarkable. Despite the severity of her condition, the newborn survived for 17 days with supportive care in the neonatal unit. Conclusion This case highlights the occurrence of anencephaly in a resource-limited setting and the challenges of prenatal diagnosis and prevention where access to screening is limited. Improving prenatal care and increasing access to folic acid supplementation and prenatal ultrasound could help reduce the incidence of neural tube defects. Pediatrics Anencephaly prenatal diagnosis Togo case report Figures Figure 1 Figure 2 Figure 3 Introduction Anencephaly is a severe congenital deformity caused by failure of the cranial neural tube to close during early embryonic development. This defect results in the absence of the cerebral hemispheres and major cranial abnormalities. The exposed neural tissue deteriorates from prolonged contact with amniotic fluid. Anencephaly is considered a lethal condition. Most affected fetuses are stillborn, and live-born infants usually survive only a few hours or days ( 1 , 2 ). Despite this bleak outlook, neural tube defects remain among the most common congenital malformations globally, with higher rates reported in many low- and middle-income countries. A systematic review and meta-analysis by Oumer et al. reported that, in Africa in 2021, the prevalence of anencephaly was 0.14%, with higher rates in Ethiopia (0.37%), Algeria (0.24%), and Eritrea (0.19%) ( 3 ). Although anencephaly generally results in very limited survival, rare cases of brief survival beyond several days have been documented. Baird et al. reported that 40% of liveborn anencephalic infants survive longer than 24 hours, and of these, 5% are still alive on the seventh day in high-income countries such as Canada ( 4 ). Dickman et al. reported a 28-month-old anencephalic infant in the United States who did not require life-sustaining interventions ( 5 ). The documentation of such cases is especially rare in resource-limited healthcare settings. We report a case of an infant with anencephaly who survived for 17 days in the neonatal unit at Sylvanus Olympio University Hospital in Lomé, Togo. Patient Information The patient was a female newborn delivered by cesarean section at 38 weeks of gestation due to arrest of the labor's active phase. The mother was a 32-year-old woman, gravida 6, para 5, aborta 1, with no known chronic medical conditions. She works as a homemaker. The father was a 36-year-old carpenter. The family belonged to a low socioeconomic background. This child was the sixth pregnancy, with two previous unexplained child deaths reported in the family history—one in utero and another during early childhood from sudden infant death syndrome. These deaths were not formally investigated to determine their cause. During pregnancy, the mother experienced first-trimester bleeding at approximately 12 weeks of gestation. She attended only two antenatal visits during pregnancy, which is below the recommended number of prenatal consultations. Second-trimester ultrasound examination was not performed due to financial constraints. Clinical findings At birth, the newborn cried immediately and did not require resuscitation. The Apgar score was 9 at one minute and 10 at five minutes. Upon admission to the neonatal unit, she weighed 3.5 kg, her length was 50 cm, her temperature was 37.2°C, her respiratory rate was 60 breaths per minute, and her heart rate was 135 beats per minute. Physical examination revealed the absence of frontal and parietal bones, with exposed rudimentary neural tissue, consistent with severe cranioschisis (Fig. 1 showing an anencephalic newborn at admission showing absence of frontal and parietal cranial bones with exposed neural tissue, and Fig. 2 showing clinical examination of the newborn in the supine position demonstrating cranial defect characteristic of anencephaly.). Protruding from this defect was pink tissue, neither hemorrhagic nor necrotic. The ears, eyes, nose, and mouth appeared normally positioned. No other abnormalities were observed during the physical examination. She passed meconium and accepted formula from a bottle because she was unable to breastfeed successfully. Diagnostic assessment The diagnosis of anencephaly was made on the basis of characteristic cranial abnormalities observed during postnatal physical examination. Prenatal diagnostic evaluation was limited because maternal serum alpha-fetoprotein screening was not performed, and second-trimester ultrasound examination was unavailable due to financial constraints. Therapeutic Intervention After delivery, the newborn was admitted to the neonatal unit for supportive care. Management included administering intravenous fluids and continuous clinical monitoring. No surgical intervention was performed, in accordance with current management guidelines for anencephaly. Owing to the unavailability of hospice services in Togo, she remained in the neonatal unit until her death (Fig. 3 showing an anencephalic newborn receiving supportive care in the neonatal intensive care unit). Routine immunizations were not given at the hospital because short-term survival was anticipated. Follow-up and Outcomes Despite the severity of the congenital anomaly, the newborn remained clinically stable for several days while receiving supportive care. The infant ultimately survived for 17 days before death. Discussion Anencephaly is one of the most severe neural tube defects and is generally considered incompatible with long-term survival. This condition results from failure of the cranial neural tube to close during early embryogenesis, leading to the absence of the cerebral hemispheres and the exposure of undeveloped neural tissue. Most affected fetuses are stillborn, and those born alive usually survive only a few hours to several days because of the missing higher brain structures needed for maintaining physiological functions. The absence of other fetal abnormalities or birth defects in this case has also been reported in the literature; this suggests that anencephaly is typically a single fetal abnormality and is not usually part of a well-known syndrome ( 4 ). Despite the generally poor prognosis, rare cases of short-term survival have been documented. Survival in these situations is thought to depend primarily on preserving brainstem structures responsible for vital autonomic functions, such as breathing and heart rate regulation ( 1 , 6 ). The current case is notable for a survival of 17 days, which is uncommon in infants with anencephaly, especially in healthcare settings with limited resources. Documenting such cases is important because it emphasizes the variability in clinical outcomes even in conditions usually considered incompatible with life ( 4 , 5 ). From an epidemiological perspective, neural tube defects remain a significant global health concern. The incidence of these diseases varies widely across geographic regions and is often higher in low- and middle-income countries, where nutritional deficiencies and limited access to prenatal care are more common. Several studies conducted in African settings have reported relatively high prevalence rates of neural tube defects, which are often associated with socioeconomic disparities and barriers to antenatal screening. In Abidjan, the prevalence of neural tube defects diagnosed by ultrasound during the antenatal period was 1.55%. In Morocco, low socioeconomic status, lack of prenatal care, and maternal consumption of fenugreek during pregnancy were also identified as predictive factors for the development of neural tube defects in the Moroccan context ( 7 , 8 ). Prenatal diagnosis of anencephaly is generally straightforward when proper screening methods are accessible. Maternal serum alpha-fetoprotein testing and second-trimester ultrasonography can identify most cases early in pregnancy. Early diagnosis enables proper counseling of families and informed decisions about pregnancy management. However, in many resource-limited settings, financial constraints and inadequate healthcare infrastructure hinder routine access to these diagnostic tools. In the present case, the lack of a second-trimester ultrasound led to the diagnosis being made only after birth ( 9 , 10 ). Prevention remains the most effective way to reduce the burden of neural tube defects. Many studies have shown the protective effect of periconceptional folic acid supplementation. Countries that have mandated folic acid fortification of staple foods have seen significant decreases in neural tube defect rates. In addition to nutritional strategies, increasing access to prenatal screening services is essential. Policies that subsidize or offer free prenatal ultrasound exams at public health facilities could greatly improve early detection in low-resource areas ( 11 – 13 ). In addition to its clinical aspects, this case highlights broader public health challenges related to maternal healthcare access in low-income settings. Limited antenatal visits, financial barriers to diagnostic imaging, and lack of awareness of preventive strategies contribute to the delayed detection of congenital anomalies. Enhancing antenatal care programs, increasing access to prenatal screening, and implementing national folic acid supplementation or fortification initiatives could significantly reduce the occurrence of neural tube defects in similar environments. Overall, this case adds to the literature by documenting a rare survival period in an infant with anencephaly in a resource-limited neonatal care setting. Reporting such cases is valuable for enhancing the understanding of the natural history of this condition and emphasizing the need for preventive public health measures. Key Learning Points Anencephaly is a lethal neural tube defect, with most affected infants surviving only hours or days after birth. Survival beyond several days is uncommon and may depend on residual brainstem function and supportive care. Limited access to prenatal screening in resource-limited settings can delay diagnosis until birth. Public health interventions such as folic acid supplementation and subsidized prenatal ultrasound screening are critical for preventing neural tube defects. Conclusion Although rare, anencephaly still occurs in healthcare settings with limited resources. This case demonstrates the variability in survival rates among affected infants and the difficulties of prenatal diagnosis when access to screening is restricted. Enhancing prenatal care, increasing access to ultrasound screenings, and promoting folic acid supplementation are crucial strategies for reducing neural tube defects in similar environments. Declarations Ethics approval and consent to participate: Not applicable Consent for publication: Written informed consent was obtained from the patient's legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Availability of data and materials: Not applicable Competing interests: The authors declare that they have no competing interests Funding: The authors received no financial support for the preparation of this manuscript. Authors' contributions: MH managed the case, collected the clinical data, and drafted the manuscript. JG contributed to patient management and critically revised the manuscript. All authors read and approved the final manuscript. Acknowledgments: Not applicable Authors' information (optional): Not applicable References Berg B. Anencephaly. In: Aminoff MJ, Daroff RB, editors. Encyclopedia of the Neurological Sciences (Second Edition). Oxford: Academic Press; 2014. p. 172–3. Nakano KK. Anencephaly: a review. Dev Med Child Neurol. 1973;15(3):383–400. Oumer M, Kibret AA, Girma A, Tazebew A, Silamsaw M. Prevalence of anencephaly in Africa: a systematic review and meta-analysis. Sci Rep. 2021;11(1):23707. Baird PA, Sadovnick AD. Survival in infants with anencephaly. Clin Pediatr (Phila). 1984;23(5):268–71. Dickman H, Fletke K, Redfern RE. Prolonged unassisted survival in an infant with anencephaly. BMJ Case Rep. 2016;2016. Greene ND, Copp AJ. Neural tube defects. Annu Rev Neurosci. 2014;37:221–42. Konan A, Garba I, Sétchéou A, Tra-Bi O, Manéwa S, Broh Y, et al. Pathologies malformatives du tube neural dépistées à l’échographie prénatale à Abidjan. Journal of Neuroradiology. 2017;44(2):83. Mohammed Amine Radouani NC, Loubna Benmiloud, Laila Elammari, Khalid Lahlou, Amina Barkat. Epidemiologie et facteurs de risque des anomalies de fermeture du tube neural: donnees marocaines. Pan African Medical Journal. 2015;22. Lelong N, Thieulin AC, Vodovar V, Goffinet F, Khoshnood B. [Epidemiological surveillance and prenatal diagnosis of congenital anomalies in the Parisian population, 19812007]. Arch Pediatr. 2012;19(10):1030–8. Brock DH, Bolton AE, Monaghan JM. Prenatal diagnosis of anencephaly through maternal serum-alphafetoprotein measurement. Lancet. 1973;2 7835:923–4. Crider KS, Bailey LB, Berry RJ. Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients. 2011;3(3):370–84. De Wals P, Tairou F, Van Allen MI, Uh SH, Lowry RB, Sibbald B, et al. Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med. 2007;357(2):135–42. Dehe S, Vodovar V, Verite V, Goujard J. Prévention primaire des anomalies de fermeture du tube neural par supplémentation périconceptionnelle en acide folique. Bulletin épidémiologique hebdomadaire. 2000;21:87–9. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9237120","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":612846318,"identity":"8e53849b-ff32-4854-8355-c1b2216fb0c0","order_by":0,"name":"Houessou Agbo Mensan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIiWNgGAWjYBADHn4QmVBAghYZyQaQFgMStNgYHABRxGjhn5F+Tbpwjw2P8fnViR8eGDDI84sdwK9F4kZOmfSMZ2k8ZjfebpYAOsxw5uwEAtbcyEmT5jlwGKjl7AaQlgSD2wS0yMO0GM84u/kHUVoMbqQfA2sx4O/dRpwthmfeMFvPOJDGI3GDd5tFgoEEYb/IHU9/eLvggI09f//ZzTd/VNjI80sT0AKMdwNmMC0BVilBSDkIsD+AaOE/QIzqUTAKRsEoGIkAALaMQzZT+GAuAAAAAElFTkSuQmCC","orcid":"","institution":"CHU Sylavnus Olympio","correspondingAuthor":true,"prefix":"","firstName":"Houessou","middleName":"Agbo","lastName":"Mensan","suffix":""},{"id":612846319,"identity":"c7926b39-423e-4b0a-a128-706eefd8a54c","order_by":1,"name":"Guedenon Koffi","email":"","orcid":"","institution":"CHU Sylvanus Olympio","correspondingAuthor":false,"prefix":"","firstName":"Guedenon","middleName":"","lastName":"Koffi","suffix":""}],"badges":[],"createdAt":"2026-03-26 18:02:52","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9237120/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9237120/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105786751,"identity":"1519f666-68f0-4b06-9a79-e6c48869bd4c","added_by":"auto","created_at":"2026-03-31 06:49:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1156910,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;showing an anencephalic newborn at admission showing absence of frontal and parietal cranial bones with exposed neural tissue\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9237120/v1/b14a92fd665d59df6724bbd4.png"},{"id":105904234,"identity":"e8b408e0-933e-47bd-b006-918290f72f36","added_by":"auto","created_at":"2026-04-01 10:06:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":17963,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;showing clinical examination of the newborn in the supine position demonstrating cranial defect characteristic of anencephaly\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9237120/v1/58d7fccab3a5b8075107eb46.jpg"},{"id":105786752,"identity":"67631ded-d2b6-457c-95a4-384b74e9f493","added_by":"auto","created_at":"2026-03-31 06:49:20","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1085322,"visible":true,"origin":"","legend":"\u003cp\u003eshowing an anencephalic newborn receiving supportive care in the neonatal intensive care unit\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9237120/v1/5b02893c452e25763d7b3d2f.png"},{"id":105907142,"identity":"9ec61fdb-5446-44c4-a765-788987dc7d8d","added_by":"auto","created_at":"2026-04-01 10:28:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2681562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9237120/v1/b050418a-d46d-42b3-9897-6acd6629c019.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eSeventeen-Day Survival in Anencephaly from a Resource-Limited Neonatal Unit in Togo: a case report\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnencephaly is a severe congenital deformity caused by failure of the cranial neural tube to close during early embryonic development. This defect results in the absence of the cerebral hemispheres and major cranial abnormalities. The exposed neural tissue deteriorates from prolonged contact with amniotic fluid. Anencephaly is considered a lethal condition. Most affected fetuses are stillborn, and live-born infants usually survive only a few hours or days (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite this bleak outlook, neural tube defects remain among the most common congenital malformations globally, with higher rates reported in many low- and middle-income countries. A systematic review and meta-analysis by Oumer et al. reported that, in Africa in 2021, the prevalence of anencephaly was 0.14%, with higher rates in Ethiopia (0.37%), Algeria (0.24%), and Eritrea (0.19%) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Although anencephaly generally results in very limited survival, rare cases of brief survival beyond several days have been documented. Baird et al. reported that 40% of liveborn anencephalic infants survive longer than 24 hours, and of these, 5% are still alive on the seventh day in high-income countries such as Canada (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Dickman et al. reported a 28-month-old anencephalic infant in the United States who did not require life-sustaining interventions (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The documentation of such cases is especially rare in resource-limited healthcare settings.\u003c/p\u003e \u003cp\u003eWe report a case of an infant with anencephaly who survived for 17 days in the neonatal unit at Sylvanus Olympio University Hospital in Lom\u0026eacute;, Togo.\u003c/p\u003e"},{"header":"Patient Information","content":"\u003cp\u003eThe patient was a female newborn delivered by cesarean section at 38 weeks of gestation due to arrest of the labor's active phase. The mother was a 32-year-old woman, gravida 6, para 5, aborta 1, with no known chronic medical conditions. She works as a homemaker. The father was a 36-year-old carpenter. The family belonged to a low socioeconomic background. This child was the sixth pregnancy, with two previous unexplained child deaths reported in the family history—one in utero and another during early childhood from sudden infant death syndrome. These deaths were not formally investigated to determine their cause. During pregnancy, the mother experienced first-trimester bleeding at approximately 12 weeks of gestation. She attended only two antenatal visits during pregnancy, which is below the recommended number of prenatal consultations. Second-trimester ultrasound examination was not performed due to financial constraints.\u003c/p\u003e \n\n\n\n\n\n"},{"header":"Clinical findings","content":"\u003cp\u003eAt birth, the newborn cried immediately and did not require resuscitation. The Apgar score was 9 at one minute and 10 at five minutes. Upon admission to the neonatal unit, she weighed 3.5 kg, her length was 50 cm, her temperature was 37.2°C, her respiratory rate was 60 breaths per minute, and her heart rate was 135 beats per minute.\u003c/p\u003e\u003cp\u003ePhysical examination revealed the absence of frontal and parietal bones, with exposed rudimentary neural tissue, consistent with severe cranioschisis (Fig.\u0026nbsp;1 showing an anencephalic newborn at admission showing absence of frontal and parietal cranial bones with exposed neural tissue, and Fig.\u0026nbsp;2 showing clinical examination of the newborn in the supine position demonstrating cranial defect characteristic of anencephaly.). Protruding from this defect was pink tissue, neither hemorrhagic nor necrotic. The ears, eyes, nose, and mouth appeared normally positioned. No other abnormalities were observed during the physical examination. She passed meconium and accepted formula from a bottle because she was unable to breastfeed successfully.\u003c/p\u003e\u003ch3\u003eDiagnostic assessment\u003c/h3\u003e\u003cp\u003eThe diagnosis of anencephaly was made on the basis of characteristic cranial abnormalities observed during postnatal physical examination. Prenatal diagnostic evaluation was limited because maternal serum alpha-fetoprotein screening was not performed, and second-trimester ultrasound examination was unavailable due to financial constraints.\u003c/p\u003e\u003ch3\u003eTherapeutic Intervention\u003c/h3\u003e\u003cp\u003eAfter delivery, the newborn was admitted to the neonatal unit for supportive care. Management included administering intravenous fluids and continuous clinical monitoring. No surgical intervention was performed, in accordance with current management guidelines for anencephaly. Owing to the unavailability of hospice services in Togo, she remained in the neonatal unit until her death (Fig.\u0026nbsp;3 showing an anencephalic newborn receiving supportive care in the neonatal intensive care unit). Routine immunizations were not given at the hospital because short-term survival was anticipated.\u003c/p\u003e\u003ch3\u003eFollow-up and Outcomes\u003c/h3\u003e\u003cp\u003eDespite the severity of the congenital anomaly, the newborn remained clinically stable for several days while receiving supportive care. The infant ultimately survived for \u003cb\u003e17 days\u003c/b\u003e before death.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnencephaly is one of the most severe neural tube defects and is generally considered incompatible with long-term survival. This condition results from failure of the cranial neural tube to close during early embryogenesis, leading to the absence of the cerebral hemispheres and the exposure of undeveloped neural tissue. Most affected fetuses are stillborn, and those born alive usually survive only a few hours to several days because of the missing higher brain structures needed for maintaining physiological functions. The absence of other fetal abnormalities or birth defects in this case has also been reported in the literature; this suggests that anencephaly is typically a single fetal abnormality and is not usually part of a well-known syndrome (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the generally poor prognosis, rare cases of short-term survival have been documented.\u003c/p\u003e \u003cp\u003eSurvival in these situations is thought to depend primarily on preserving brainstem structures responsible for vital autonomic functions, such as breathing and heart rate regulation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The current case is notable for a survival of 17 days, which is uncommon in infants with anencephaly, especially in healthcare settings with limited resources. Documenting such cases is important because it emphasizes the variability in clinical outcomes even in conditions usually considered incompatible with life (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom an epidemiological perspective, neural tube defects remain a significant global health concern. The incidence of these diseases varies widely across geographic regions and is often higher in low- and middle-income countries, where nutritional deficiencies and limited access to prenatal care are more common. Several studies conducted in African settings have reported relatively high prevalence rates of neural tube defects, which are often associated with socioeconomic disparities and barriers to antenatal screening. In Abidjan, the prevalence of neural tube defects diagnosed by ultrasound during the antenatal period was 1.55%. In Morocco, low socioeconomic status, lack of prenatal care, and maternal consumption of fenugreek during pregnancy were also identified as predictive factors for the development of neural tube defects in the Moroccan context (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrenatal diagnosis of anencephaly is generally straightforward when proper screening methods are accessible. Maternal serum alpha-fetoprotein testing and second-trimester ultrasonography can identify most cases early in pregnancy. Early diagnosis enables proper counseling of families and informed decisions about pregnancy management. However, in many resource-limited settings, financial constraints and inadequate healthcare infrastructure hinder routine access to these diagnostic tools. In the present case, the lack of a second-trimester ultrasound led to the diagnosis being made only after birth (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevention remains the most effective way to reduce the burden of neural tube defects. Many studies have shown the protective effect of periconceptional folic acid supplementation. Countries that have mandated folic acid fortification of staple foods have seen significant decreases in neural tube defect rates. In addition to nutritional strategies, increasing access to prenatal screening services is essential. Policies that subsidize or offer free prenatal ultrasound exams at public health facilities could greatly improve early detection in low-resource areas (\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition to its clinical aspects, this case highlights broader public health challenges related to maternal healthcare access in low-income settings. Limited antenatal visits, financial barriers to diagnostic imaging, and lack of awareness of preventive strategies contribute to the delayed detection of congenital anomalies. Enhancing antenatal care programs, increasing access to prenatal screening, and implementing national folic acid supplementation or fortification initiatives could significantly reduce the occurrence of neural tube defects in similar environments.\u003c/p\u003e \u003cp\u003eOverall, this case adds to the literature by documenting a rare survival period in an infant with anencephaly in a resource-limited neonatal care setting. Reporting such cases is valuable for enhancing the understanding of the natural history of this condition and emphasizing the need for preventive public health measures.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eKey Learning Points\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAnencephaly is a lethal neural tube defect, with most affected infants surviving only hours or days after birth.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSurvival beyond several days is uncommon and may depend on residual brainstem function and supportive care.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLimited access to prenatal screening in resource-limited settings can delay diagnosis until birth.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePublic health interventions such as folic acid supplementation and subsidized prenatal ultrasound screening are critical for preventing neural tube defects.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAlthough rare, anencephaly still occurs in healthcare settings with limited resources. This case demonstrates the variability in survival rates among affected infants and the difficulties of prenatal diagnosis when access to screening is restricted. Enhancing prenatal care, increasing access to ultrasound screenings, and promoting folic acid supplementation are crucial strategies for reducing neural tube defects in similar environments.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Not applicable\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u0026nbsp;Written informed consent was obtained from the patient\u0026apos;s legal guardian for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Not applicable\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding: The authors received no financial support for the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: MH managed the case, collected the clinical data, and drafted the manuscript. JG contributed to patient management and critically revised the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgments: Not applicable\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; information (optional): Not applicable\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBerg B. Anencephaly. In: Aminoff MJ, Daroff RB, editors. Encyclopedia of the Neurological Sciences (Second Edition). Oxford: Academic Press; 2014. p. 172\u0026ndash;3.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNakano KK. Anencephaly: a review. Dev Med Child Neurol. 1973;15(3):383\u0026ndash;400.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOumer M, Kibret AA, Girma A, Tazebew A, Silamsaw M. Prevalence of anencephaly in Africa: a systematic review and meta-analysis. Sci Rep. 2021;11(1):23707.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBaird PA, Sadovnick AD. Survival in infants with anencephaly. Clin Pediatr (Phila). 1984;23(5):268\u0026ndash;71.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDickman H, Fletke K, Redfern RE. Prolonged unassisted survival in an infant with anencephaly. BMJ Case Rep. 2016;2016.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGreene ND, Copp AJ. Neural tube defects. Annu Rev Neurosci. 2014;37:221\u0026ndash;42.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKonan A, Garba I, S\u0026eacute;tch\u0026eacute;ou A, Tra-Bi O, Man\u0026eacute;wa S, Broh Y, et al. Pathologies malformatives du tube neural d\u0026eacute;pist\u0026eacute;es \u0026agrave; l\u0026rsquo;\u0026eacute;chographie pr\u0026eacute;natale \u0026agrave; Abidjan. Journal of Neuroradiology. 2017;44(2):83.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMohammed Amine Radouani NC, Loubna Benmiloud, Laila Elammari, Khalid Lahlou, Amina Barkat. Epidemiologie et facteurs de risque des anomalies de fermeture du tube neural: donnees marocaines. Pan African Medical Journal. 2015;22.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLelong N, Thieulin AC, Vodovar V, Goffinet F, Khoshnood B. [Epidemiological surveillance and prenatal diagnosis of congenital anomalies in the Parisian population, 19812007]. Arch Pediatr. 2012;19(10):1030\u0026ndash;8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBrock DH, Bolton AE, Monaghan JM. Prenatal diagnosis of anencephaly through maternal serum-alphafetoprotein measurement. Lancet. 1973;2 7835:923\u0026ndash;4.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCrider KS, Bailey LB, Berry RJ. Folic acid food fortification-its history, effect, concerns, and future directions. Nutrients. 2011;3(3):370\u0026ndash;84.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDe Wals P, Tairou F, Van Allen MI, Uh SH, Lowry RB, Sibbald B, et al. Reduction in neural-tube defects after folic acid fortification in Canada. N Engl J Med. 2007;357(2):135\u0026ndash;42.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDehe S, Vodovar V, Verite V, Goujard J. Pr\u0026eacute;vention primaire des anomalies de fermeture du tube neural par suppl\u0026eacute;mentation p\u0026eacute;riconceptionnelle en acide folique. Bulletin \u0026eacute;pid\u0026eacute;miologique hebdomadaire. 2000;21:87\u0026ndash;9. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Sylvanus Olympio University Hospital ","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anencephaly, prenatal diagnosis, Togo, case report","lastPublishedDoi":"10.21203/rs.3.rs-9237120/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9237120/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAnencephaly is a severe and usually fatal neural tube defect marked by the absence of the cerebral hemispheres. Most affected infants are either stillborn or live only a few hours to several days after birth. Reports from resource-limited settings remain relatively rare.\u003c/p\u003e\u003ch2\u003eCase Presentation\u003c/h2\u003e \u003cp\u003eWe report the case of a female newborn of West African origin delivered via cesarean section at Sylvanus Olympio University Hospital in Lom\u0026eacute;, Togo. The pregnancy was notable for first-trimester bleeding and limited access to prenatal care. At birth, the newborn presented an absence of frontal and parietal cranial bones, exposing neural tissue. The rest of the physical examination was unremarkable. Despite the severity of her condition, the newborn survived for 17 days with supportive care in the neonatal unit.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis case highlights the occurrence of anencephaly in a resource-limited setting and the challenges of prenatal diagnosis and prevention where access to screening is limited. Improving prenatal care and increasing access to folic acid supplementation and prenatal ultrasound could help reduce the incidence of neural tube defects.\u003c/p\u003e","manuscriptTitle":"Seventeen-Day Survival in Anencephaly from a Resource-Limited Neonatal Unit in Togo: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-31 06:49:16","doi":"10.21203/rs.3.rs-9237120/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"491022de-af39-4e31-94f2-64d02b062b83","owner":[],"postedDate":"March 31st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":65213211,"name":"Pediatrics"}],"tags":[],"updatedAt":"2026-03-31T06:49:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-31 06:49:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9237120","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9237120","identity":"rs-9237120","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}