SUMMARY Recent advances in the surgery and management of hydrocephalus and spina bifida are surveyed, and the implications of preserving the lives of severely disabled children are discussed in practical and ethical terms. RÉSUMÉ Résultat des traitements globaux avec références spéciales aux displasies médullaires L'auteur étudient les progrès recents dans la chirurgie et le traitement général des hydrocéphalies et spina bifida; ils discutent les consequences du maintien en vie d'enfants grave‐ment handicapés, sur le plan pratique et moral. ZUSAMMENFASSUNG Die Schwierigkeit einer totalen Pflege mil besonderer Berücksichtigung der Myelodysplasie Neuere Fortschritte in der Chirurgie und im Umgang mit dem Hydrocephalus und der Spina bifida werden berichtet, und die Folgerungen aus der Erhaltung des Lebens von schwer geschadigten Kindern werden in praktischen und ethischen Begriffen diskutiert. RESUMEN El impacto del tratamiento total con especial referenda a la mielodisplasia Se discuten en el campo práctico y ético, los avances recientes en la cirugía y el tratamiento general de la hidrocefalia y de la espina bífida, asi como las implicaciones para preservar la vida de niños con una incapacidad grave.
JOURNAL Premature InfantsThis group contains all infants under 52 lb. (2.5 kg.) birth weight, irrespective of the expected date of delivery. The systolic pressures that were recorded ranged from 35 to 70 mm. Hg, with a mean of 54. The lower end of the range was recorded in two infants who survived only three days, and it should also be noted that one infant with a pressure of 50 mm. Hg died on the first day. As shown in Figs. 2 and 3 the systolic pressure at birth was related to birth weight but not to maturity.The premature infants attained values not significantly different from those of full-time infants by the third month, and the highest pressure recorded in any infant, 105 mm. Hg, at 6 months was in a prematurely born infant with a pressure of 50 mm. Hg at birth. TwinsThere were four sets of twins in this series. Where one was anoxic it had the lower blood pressure; for instance, in one set of twins the first baby born did not breathe for five minutes and had a blood pressure 25 mm. Hg below its sibling, who breathed spontaneously at once. DiscussionThe method of palpation which has been used to measure the mean systolic pressure of the newborn is simple and reliable and gives readily reproducible values suitable for comparison. Woodbury, Hamilton, and Robinow (1938) found that there was a close correlation in infants between the mean systolic pressure measured by an intra-arterial needle in the umbilical artery and by palpation of the brachial artery only when a 2.5-cm. cuff was used. The method also compares well with the flush method, recently assessed by Reinhold and Pym (1955) The effect of the different conditions prevailing at birth upon the neonatal blood pressure was studied by Reis and Chaloupka and by Bowman (1933). The former included in their series three toxaemic pregnancies, and found that this condition had no effect on the systolic pressure of the newborn; this is in agreement with our own findings and those of Brasch (1949). Reis and Chaloupka also concluded that the more trauma to which the head was exposedthat is, the higher the forceps applied-and the larger the head, the higher would the blood pressure be. In two caesarean sections no effect on the blood pressure was noted, but there is no record at what interval after delivery these recordings were made. Bowman found in " cerebral " babies that the pressure was higher than normal, and was lowered by lumbar puncture. We were uncertain what was meant by this term, but if those cases emitting a " cerebral" cry are indicated, then in our series a lower systolic pressure than normal was found. Summary Palpation of the brachial artery below a 2.5-cm. inflatable cuff was used to measure the neonatal systolic blood pressure. The normal mean systolic pressure at birth was found to be 69 mm. Hg, rising to 93 mm. Hg at 6 months. Foetal anoxia and abnormal forms of delivery such as caesarean section caused a significant lowering of systolic pressure at birth ; the blood pressure of these babies recovered to normal levels within a few days. Dru...
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