Anencephaly and Other Congenital Abnormalities
Authors: M. J. Pleydell
Journal: BMJ (1960)

have been normal and no cerebral signs had been seen; but we cannot, of course, be sure that he did not suffer perinatal cerebral damage.The prognosis, therefore, appears to be very good for babies who survive the initial episode of chilling.Only 3 out of 36 had disabilities which might possibly be attributable to it-namely, cerebral palsy, mild mental retardation, and epilepsy with mild mental retardation.With one exception there was no interference with growth and physical or mental development in the remainder.Discussion Cold injury is, for the most part, a preventable disease.If ever central heating becomes a widespread method of heating houses in this country, then its incidence will presumably decrease.Apparently it is almost unknown in North America, probably because there the houses are properly warmed and many more confinements take place in hospital.However, it seems unlikely that many bedrooms in Britain will be efficiently warmed for some time to come, and therefore active measures will be neededto prevent the condition.The most important measure is the education of all who handle newborn babies at home in the danger of its occurrence during the cold months of the year, in the factors which predispose to it, and in its recognition.The appendix to the paper of Mann and Elliott (1957) sets out simple rules for midwives which, if followed, would substantially reduce the incidence of this disease.The recognition that a baby is chilled is also important, and in the early stages this can be difficult unless the condition is kept in mind.The complaint by the parent or midwife that a baby in the first week of life is refusing to feed, that it is cold, or that the limbs are swollen is highly significant in the cold months of the year.Unfortunately a low-reading thermometer will seldom be carried by the practitioner or midwife.Probably all chilled babies should be admitted to hospital.Certainly the severely chilled ones need all the resources of modern paediatric care.even though the details of treatment are still controversial. SummaryAll hypothermic newborn babies (183) admitted to the Children's Hospital, Birmingham, over an 11-year period were classified into aetiological groups.Seventy of these were examples of " primary cold injury," the most important or only factor being external chilling.In three-quarters of the 70 babies the minimum air temperature at the start of their illness was below 350 F. (1.70 C.); in four-fifths the chilling occurred in January to March.Other factors thought to be important are delay in wrapping the baby after birth, tight wrapping, failure to heat the room at night, as well as factors inherent in the neonate.Nearly all wcre born at home.The commonest symptoms were feeding difficulty, oedema, coldness to touch, and lethargy.Symptoms dated from birth in a third and from the first week in four-fifths.The commonest signs on admission were oedema (77%), immobility, a florid complexion, and sclerema.Oedema is thus an important pointer to the diagnosis.Oliguria was common in severe cases, and in a small investigation the blood urea, phosphorus, and potassium were found to be elevated.Treatment varied, but it is agreed that warming should be slow.One-quarter of the babies died.Pulmonary haemor- rhage was a universal finding at necropsy.A follow-up survey of 36 (69%) survivors showed that 92% were normal.One child has cerebral palsy and two are mentally retarded to a mild degree.