The missing umbilical artery. II. Paediatric follow-up.

Bryan, E. M., and Kohler, H. G. (1975). Archives of Disease in Childhood, 50, 714. The missing umbilical artery. II. Paediatric follow-up. Of 143 infants with single umbilical artery detected by routine examination of the placenta, 25 had major malformations at birth; 3 of these survive. Another 6 were stillborn and 2 died during the first year of life. At follow-up 14 children could not be traced. 18 were assessed on the basis of reports by family doctors or parents ('report group'); 14 of these were considered normal. The remaining 78 infants and children were given a clinical examination ('examination group'); 64 were found to be normal. Malformations found in 10 children (6 from the examination group and 4 from the report group) are discussed. Most of the abnormalities detected were less severe and less conspicuous than those revealed at birth, and in a few instances only might have been diagnosed by a more thorough examination in the perinatal period. Failure to detect these 'less severe and less conspicuous' malformations is generally unlikely to be detrimental to the infant, with the exception of urinary tract anomalies which are known to predispose to infection. Included in the examination group were 16 children (out of an original 22) who had been 'normal' but small-for-dates at birth; 14 of these had now caught up. The remaining 2 were found to have abnormalities that had not been manifest at birth. The finding of single umbilical artery at birth commits the paediatrician to an intensive search for malformations which are not immediately apparent, but prolonged surveillance for this reason alone is not advocated.