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1. A review of 193 African and Indian children suffering from spina bifida has been made. Forty-three were seen on the first day of life and the remainder during subsequent weeks of life. 2. For the baby with mild or moderate paralysis and an open spinal lesion early closure was of value in preventing progressive neural damage. 3. For the baby with severe paralysis and an open myelomeningocele early operation was not of value in preventing further neural damage, and all remained severely paralysed. immediate operation to close the spinal lesion is not justified in babies with severe paralysis: survivors may be treated by later operation to prevent recurrent meningitis.

Background Lumbar puncture (LP) is usually performed when there is a clinical suspicion of meningitis in babies with suspected sepsis. NICE recently published their guidelines on ‘antibiotics for early-onset neonatal infections’ with guidance on when LPs should be considered. Aim To audit the number of LPs carried out in term babies (>37+0 weeks) in a tertiary neonatal unit, their indications and outcomes. Methods A list of term babies who had an LP was obtained from the Microbiology Department between 01/01/2012 and 31/12/2013. The Badger electronic patient record and hospital blood results systems were reviewed to collect the data. Results In the last 2 years we had 1,514 distinct term babies admitted to the neonatal unit. 76 babies had an LP during this period. The reasons for LPs were; (a) raised CRP in 61 cases (median CRP was 66), (b) positive blood culture in 6 cases, (c) abnormal neurology in 7 cases, and (d) 2 were for no other clinical focus. There were no positive cultures, although one was positive for herpes simplex virus type 1 on PCR. At discharge, 4 had a diagnosis of meningitis, 1 with encephalitis, 1 with congenital neuropathy. The remainder had a diagnosis of sepsis or suspected sepsis. Conclusion The majority of LPs in term babies were performed because of raised CRP. We only had one positive finding on PCR. As per NICE guidance, we rely on a combination of clinical findings and CRPs when deciding which babies to LP. References Antibiotics for early-onset neonatal infection - Nice

The first case that I show you to-day is one of suustroke. The following is the history : " J.W., age twenty-five, born in Ireland, has been in this country about two years. He has always been healthy, with the exception of bronchitis, which he has every fall. He denies having had venereal disease. He has always been a heavy driuker, and often gets drunk. For two weeks previous to admission he had been drinking very hard. On the 6th of September he was working on the University grounds. With the exception of the effects of his spree he felt as well as usual.About ten a. m. he began to feel weak and dizzy, but continued at work. These symptoms increased, and at half-past eleven he fell unconscious, and was brought to the hospital." This case presented the symptoms usually seen in sunstroke. This condition is to be differentiated from heat exhaustion. Iu the latter the symptoms as a rule develop more gradually. The loss of consciousness is usually not so complete, and if the skin is examined it will be found cold and clammy, whereas if, in a case of true sunstroke, the hand be placed on the surface, or the thermometer be introduced into the rectum, it will be found that the patient is burning hot. The sudden onset, the complete loss of consciousness, and the high temperature distinguish this as a case of true sunstroke.It is, of course, possible to have these symptoms occur in a case of apoplexy. There may he sudden loss of consciousness with high temperature in apoplexy, but very rarely does the temperature go up as rapidly as it does in sunstroke. In apoplexy the temperature may ascend two, three, or four, or more degrees, according to the seat of the clot, but the rise occurs in a few hours instead of a few moments. The completeness of the recovery, so far as the general symptoms are concerned, shows that this was a case of sunstroke and not one of apoplexy. In any case you should at ouce look for symptoms of a local lesion. You see whether or not the face is drawn to one side, or a leg has lost its power.If in a case of supposed sunstroke it is found that there is a gradual rise of temperature, with a distinct and decided loss of power in one part, there is good reason for making a diagnosis not of sunstroke but of apoplexy. This matter is of some importance, for I have seen sunstroke diagnosticated as apoplexy with fatal consequences. The distinctive symptoms of suustroke are, the suddenness of the onset, the completeness of the loss of consciousness, and the high temperature without local palsy. The next point in the history of this man to which I shall call attention is that there were some prodromes before the appearance of the unconsciousness. It is commonly thought that sunstroke comes on a man like a lightning flash out of a clear sky, and that under its influence a man drops at once ; but I believe that in the majority of cases there is some indication of the coming dangerthat there is a little cloud, although it may be 1 Reported by William H. Morrison, M. D. no bigger than a man's hand, showing the ap...