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Letters to the Editor

SIR-I feel it is very important to point out that Query et al, (DMCN, 32, 119-128) made several incorrect and misrepresentative references to our manuscript’. The authors cite us as offering parents treatment for their infants with myelomeningocele ‘only after being given a realistic assessment of cost compared with expected returns’. Nowhere in our paper did we mention cost issues, nor did we prognosticate outcome for the parents. Rather, our study documented that there was time (several days) for parents to be involved and informed while discussing the care of their newborn. This conclusion was based on our observation that the time of surgical intervention did not influence either mortality or morbidity, including the eventual developmental or intellectual outcome. Query and colleagues nevertheless were led to ‘argue against’ us and urge early intervention to ‘optimize intellectual preservation ’ and ‘better social and psychological adjustment’. References for these conclusions are not provided. It is my own belief (based on the literature and personal experience) that the quality of lije for these children and families does not depend on how soon the surgeon intervenes in those early days of life. Rather, the quality of their life depends to a considerable degree on society’s willingness and ability to provide long-term educational, psychosocial and occupational opportunities. Only then should we be content with the enhanced survival that our medical and surgical technology has afforded these infants.