Search

SUMMARY An analysis of deformities of the renal tract in a survey of 4, 500 necropsies in children showed an overall prevalence of renal tract deformities in 7.8 per cent. When the renal tract deformities were analysed in relation to the presence of meningomyeloceles, it was found that the incidence in the latter was 29 per cent. overall, ranging from 25 per cent. at birth to 58 per cent. at between the ages of 3 and 5 years. The types of deformity seen in children with meningomyeloceles are similar to those in children without meningomyelocele but there is an added factor of dilatation deformity developing later.

The liver in children contains a greater amount of connective tissue in relation to parenchymal tissue than in adults and there is often more in the left than in the right lobe. Livers from 150 children who died between birth and 12 years of age, under different circumstances, were studied.The findings suggested that hypoxia was an important factor leading to increase in fibrous tissue in children's livers. Children who had cyanosis at birth and prolonged hypoxia associated with pathological conditions showed the highest ratio of connective tissue to liver parenchyma. The predominant non-hepatic lesions found were cyanotic congenital heart disease, coarctation of the aorta, acute respiratory distress, congenital malformation of the central nervous system, and shock after abdominal surgery.

The death certificates and necropsy reports of the 1115 Sheffield infants who died under 2 years of age in 1969-78 were examined. This study showed the apparent disappearance of deaths with hypernatraemia and in particular deaths presenting as cot deaths. The fall in incidence may be as much the result of an intensive local campaign on child care and infant feeding as of the change in the composition of dried milk for baby feeding.

This study indicates: A need for education in the labour ward and in the initial handling of the family. A need to defend the family from initial inadequate advice. The child's deformity and death should be handled in the context of the parents' own family culture.

IN 1974 we described how we had used routine obstetric and perinatal records to construct a scoring system for identifying within 24 h of birth infants at risk of dying unexpectedly, and we reported the results of the first year of a prospective evaluation of the system1. We now have the final results of the study which confirm that the scoring system is effective. The study data and subsequent work suggest that deaths can be reduced by increased surveillance of high risk infants.