Sequential intellectual recovery after near-drowning.

Sequential neurological and intellectual recovery after childhood near-drowning is discussed. Decisions concerning the persistence and intensity of resuscitation require a knowledge of the natural history of intellectual improvement after rescue from near-drowning. A severe case of fresh-water immersion, leading to recovery, is described. Evidence is presented to suggest that the time interval of one hour before the first spontaneous respiratory gasp forms the upper limit of the apnoeic time bracket after which survival can still be expected, and to indicate that intellectual improvement (to a measured IQ of 97) can occur even after initial decerebrate signs if vigorous therapy is prosecuted. The proportion of cases capable of sequential neurological improvement is unknown. A time base for sequential clinical and intellectual improvement after near-drowning is presented to form a yardstick with which future cases may be compared.