2 72

clinicians that the assessment of neonates is a complex process. We indicated a method for combining a number of variables to make such an assessment. Finally, we confined our remarks only to the fullterm neonate, deliberately omitting lo w-birth weight neonates. Both of us have also studied preterm neoante?. 3, but would direct attention to other variables (in addition to Apgar scores or, more usually, aside from them) which would be useful in those circumstances.

PATRICIA H . ELLISON, M.D. C . AMIEL-TISON, M.D.*

University of Denver, University Park, Denver,

CO 80208-0204.

*Department of Paediatrics, Hospital Baudelocque, Paris.

References I . Graham, F . K . , Matazarro, R . G., Caldwell, B.

M. (1956) ‘Behavioral differences between normal and traumatized newborns. 11: Standardization, reliability and validity.’ Psychological Monographs, 70, 17-33.

2. Amiel-Tison, C., Grenier, A . (1986) Neuro- logical Assessment During the First Year of Life. New York: Oxford University Press.

3. Ellison, P., Horn, J . L., Heimler, R., Franklin, S., Brown, P. (1986) ‘Prediction models for brain function in the preterrn neonate.’ In Oh, W., Friis-Hansen, B. (Eds.) Physiologic Foundations of Perinatal Care- Vol. I . Amsterdam: North-Holland/EIsevier.

Standardisation of Recording and Reporting Cerebral Palsy

SIR- We consider it unfortunate that, while many interested clinicians and epidemiologists in the United Kingdom and elsewhere have been moving slowly but surely towards a working consensus, Dr. Martin Bax has chosen to revert to the unilateralist approach ( D M C N , 28, 818).

of the form which he castigates in his letter is one which has now been superseded. A revised version was drawn up at the latest meeting of the

It is also unfortunate that the version

Castle Priory Working Group (of which Dr. Bax was regrettably a non-attending member) in September, 1986, following a pilot study of the form at three centres. A letter from Dr. Bax states that the latest version meets many of his objections (personal communication, November 1986). Copies of the latest version, which is currently being tested in another pilot study, may be obtained from Dr. A . Johnson. It is hoped to publish an account of the progress which has been made after the next meeting of the Group.

It is an inherent disadvantage of the consensus approach that individuals may be unhappy with certain elements of what has been agreed. However, the scourge of research into cerebral palsy in the past has been the multiplicity of approaches: the individual pursuit of idiosyncratic recording schemes, however excellent, will not further national and international co-operation and collaboration, so we are determined to move forward by the more cumbersome consensus approach. We trust that all those with expertise to contribute will direct their efforts towards moving the working group forward in the most profitable direct ion.

PAMELA EVANS EVA ALBERMAN ANN JOHNSON*

LESLEY MUTCH* Department of Clinical Epidemiology, The London Hospital, London El IBB.

*Oxford Region Child Development

Level 3, Maternity Department, John Radclyfe Hospital, Headington, Oxford OX3 9DU.

Project,

Dr. Bax has replied as follows: I thought that by publishing an open letter in DMCN I was encouraging multilateral discussion. I was sorry to miss the September meeting of the group, when a revised version was discussed, and look forward to seeing it in publication soon.

MARTIN BAX, Senior Editor, DMCN