Cause of death in children with meningomyelocele or hydrocephalus.

Meningomyelocele is one of the most important congenital abnormalities, and is often associated with hydrocephalus. A recent survey (Eckstein and Macnab, 1966) showed that the mortality rate with modem treatment had faUen from about 50% in 1958 to about 20% at present. The purpose of this report is to review the causes of death in a combined series of 1091 patients with meningomyelocele or hydrocephalus seen at three children's hospitals in London in recent years. Of these, 206 patients had hydrocephalus only, and 885 had a meningomyelocele with or without hydrocephalus. Table I sets out the distribution of the patients in the various hospitals and indicates the period of review, which varied from one centre to another. The patients were, by and large, an unselected group, except that they had of course all been referred to a paediatric surgical centre for treatment. The basic policy of treatment in the three centres was essentially the same and the Holter valve was used for a ventriculoatrial shunt in cases of hydrocephalus since 1958 in all three hospitals. While closure of the spinal defect was usually delayed in children seen early in this review, the policy since 1962 has been to close the meningomyelocele as an emergency procedure as soon after birth as possible. The cause of death was ascertained whenever possible by studying the records of the post-mortem examination or the clinical notes of children in whom necropsy was not performed. In the case of children dying at home or in other hospitals, an effort was made to contact local practitioners to ascertain the cause of death. The necropsy rate on the patients reviewed in the three hospitals was 39%, 77%, and 83 %°, respectively. The age at death is shown in Fig. 1. This clearly