Lesson of the Week: Who spots the spots? Diagnosis and treatment of early meningococcal disease in children

cephaly and the Dandy-Walker malformation or variant-may develop late in pregnancy and may not be diagnosed from a scan at 18-20 weeks.Ultrasound scanning in experienced hands is a powerful diagnostic tool.To maximise its role in clinical practice, appropriate training, good equipment, and access to expert referral when necessary are all required.New knowledge and improved equipment lead to new diagnoses-for example, the many "markers" of chromosome abnormality-which need to be appropriately investigated to find their true importance and to reduce the anxiety caused to parents when they are identified.7The publication of leaflets giving honest information to health professionals and pregnant women about screening tests in pregnancy is a step in the right direction.However, if evidence based practice is to achieve its goal health professionals need appropri-ate, up to date evidence to be collected and collated.Such evidence is not yet available.