Complete auriculo-ventricular heart block in the foetus and newborn.

Case Reprts Cae 1. R.T. was born on July 29, 1947, of healthy parents. On July 18, 1947, antenatalexaminationshowed that the foetal heart was slow andiregular. Amurmurwas audible and it was thought to be a ' funic souffle.' The irregular pulse was interpreted as evidence of foetal dises, and on July 26, 1947, the membranes werepunctured to induce labour. The child was born three days later after a normal labour. The foetal pulse remained at 80 throughout labour. At birth the baby appeared to be normal; there was no cyanosis and feeds were taken well, but examination of the heart showed a rate constantly below 60. The beat was regular. No murmur was audible in the praecordium, but the first heart sound to the left of the sternum was blurred and indisfinct, in companson with the clear-cut second sound. The child was sent home, but was brought in again on Dec. 18, 1947. Up to this time his progress and gain in weight had been satisfactory. The slow pulse rate persisted. An electrocardiogram at this time showed a complete auriculoventricular block. The child was next seen when six months old in January, 1948, when he was admitted to hospital because of a severe attack of bronchitis. His history in the meantime was that he had gained weight satisfactorily until he was three months old and 12 lb. in weight, at which time the breast milk failed and he was put on arificial feeding, From this time onwards he was difficult to feed, and only weighed 11 lb. 4 oz. on admission. Other evidences of nutritional failure were his small size (height 231 in., head 161 in., fontanelle 1 finger's breadth)