Objectives: This study examined hospital resource use, timeliness of surgical repair of spina bifida (SB), and geographical access to hospital care for infants and children with SB. Methods: This was a retrospective, statewide, population-based study of infants (<1 year) and children ages one to four years with SB, born in Florida 1998-2007, identified by the Florida Birth Defects Registry and linked to hospital discharge records. Hospital discharge data provided information on hospital use and costs. Time to SB repair was calculated using hospital procedural codes. Travel time and distance to hospitals were calculated using geocoded maternal and hospital addresses, and Florida road networks. Analyses included Chi-square tests and logistic, Poisson, generalized linear and ordinary least squares regression. Models were adjusted for hydrocephalus, isolated vs. non-isolated SB, and selected sociodemographic characteristics.Results: Of 614 children, 42.4% of children had isolated SB and hydrocephalus; 32.3% had isolated SB without hydrocephalus; 14.5% had non-isolated SB and hydrocephalus, and 10.9% had non-isolated SB without hydrocephalus. In adjusted results, infants with isolated SB and hydrocephalus had 53% more hospitalizations and 2.6 times the number of hospitalized days and costs compared with infants with isolated SB without hydrocephalus. Regarding timeliness of surgical repair, of 299 infants with a recorded repair, 68.6% had repair by day two and 15.1% had repair days three through seven. In adjusted results, hydrocephalus was the only characteristic associated with repair by day two (adjusted prevalence ratio=1.80, 95% confidence interval: 1.31-2.48). Of 612 children with a geocoded address, 56.4% of infants and 61.4% of children had a one-way average travel time of <=30 minutes to hospitals. In adjusted results, non-isolated SB, maternal minority race/ethnicity, lower maternal education, and rural residence were associated with lower likelihood of traveling <=30 minutes to hospitals during infancy.Discussion: Comorbidities substantially increase hospital resource use for children with SB, particularly during infancy. Findings underscore the need to consider comorbidities when examining hospital resource use for children with SB. Results also demonstrate that birth defects registry data and GIS-based methods are useful to evaluate geographical access to hospitals for children with birth defects.