In a review of 43 cases, the phenotypic spectrum of the Wolf-Hirschhorn syndrome is analyzed and the frequency of clinical anomalies is tabulated. The characteristic features are intrauterine growth retardation, severe psychomotor retardation, typical facies, and various major and minor congenital anomalies suggestive of a midline fusion defect. Diagnosis is established by karyotyping- deletion of the short arm of chromosome No. 4. All cases so far reported are de novo occurrences with no sibling involvement and normal parents. Prognosis is poor, with death in the first 2 years of life in 34% of cases, usually due to cardiac decompensation or infection. Psyhomotor retardation is profound, so that heroic medical efforts probably need to be reconsidered.