Nephrotic syndrome after treatment with 5-aminosalicylic acid.

reduced during the first six months by non-closure of the defect. Presumably non-closure allows cerebrospinal fluid to escape from the open neural tube, postponing the development of hydrocephalus until epithelium has formed. As deferred shunt operations are associated with a better prognosis,4 nonclosure may in fact be advantageous, delaying the onset of ventriculitis until the child is immunologically more competent. Thus early closure has no advantage over non-closure with respect to mortality and the incidence of hydrocephalus and ventriculitis. Non-closure not only means that neonates are spared major operations but also reduces the number of shunt operations required in children who have a limited life expectancy. Knowing that non-closure is safe and potentially beneficial means that the family does not have to make an urgent and immediate choice between life and death on the birth of a baby with an open neural tube defect,5 allowing time for all concerned fully to assess the baby's condition.