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Key topics in neonatology, 2nd edition
  1. S Thayyil,
  2. A L Ogilvy-Stuart

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    Edited by Richard H Mupanemunda, Michael Watkinson. London: Taylor & Francis, 2005, £28.95, pp 420. ISBN 1859962343


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    The second edition of Key topics in neonatology claims to provide a quick and very up to date summary of current concepts in neonatology, in a self contained and easily readable problem based format for neonatal trainees and nurses. The authors recommend the text as an ideal revision aid for MRCPCH and DCH candidates. The book is very compact and has just over 400 pages, with common neonatal problems arranged alphabetically, which we found easy to use.

    The authors do acknowledge that some topics reflect their personal practice; however each topic ends with a useful reading list and related topics of interest, which encompasses other contemporary views. References to family support groups are also helpful.

    The majority of sections give good, clear, concise advice and certainly fulfil the role of a revision text. However, we would like to have seen cardiac tamponade included as a cause, in the section on acute neonatal collapse, and the use of echocardiography in the list of investigations to exclude this. The session on ambiguous genitalia was weak, mainly because of the incorrect premise that 90% of cases are females with congenital adrenal hyperplasia. The authors have decided to cling on to outmoded terms such as “nesidioblastosis” and “hermophrodite”, and the “Papile” classification given for grading of intracranial haemorrhage.

    Because of the problem based format, some topics were necessarily repeated, and there were some inconsistencies in recommendations in different sections of the book. For example, hepatitis B immunoglobulin is recommended to be given within 24 hours in one section and within 48 hours in another. The normal anion gap is given as 6–14 in one place and as 8–16 in another. Inconsistencies were also noted in cord haemoglobin and bilirubin values for recommended early exchange transfusion.

    There was an excellent “special notes” section with a discussion of the appropriateness of different types of volume replacement and inotropes in hypotension. We would have liked to see similar sections surrounding some other controversial subjects and management issues. Despite suggesting that saline should be the usual fluid of choice, it appears that the authors’ practice is to use blood products in their clinical management, in other areas of the text.

    We decided to do a test run using the book to see if it matched up with the authors’ claims that it is a quick reference book in the neonatal unit, by referring to the book, to guide us in management on a few admissions to the neonatal unit.

    The first clinical scenario was a baby whose mother was diagnosed with maternal HIV after delivery. In less than a minute we had detailed information on perinatal HIV management along with web addresses of useful links—impressive indeed! Unfortunately in the five page chapter on HIV, only half a page was dedicated to neonatal prophylaxis. There is no mention about the ethical and legal issues when a mother refuses antenatal or postnatal HIV testing. The text did not help in the management of the baby in this case; however the cited excellent website of “Bhiva” came to the rescue in deciding what precise treatment need to be given.

    The second scenario was a baby with pulmonary hypertension where we wanted check formulas for oxygenation index and AaDO2. Again within seconds, everything was in front of us. Although we wanted to check the length to which umbilical arterial catheter should be inserted for this baby, we were disappointed as there was no mention of a formula anywhere.

    The third scenario was the counselling of a mother with antenatally diagnosed ventriculomegaly in the fetus. Unfortunately this was not mentioned anywhere in the book. However, there was very detailed information on the “Epicure study” and neurodevelopmental outcome of babies born at extremes of viability. This will be very handy information for neonatal registrars in counselling expectant mothers in preterm labour.

    The final scenario for the test run was to ascertain the investigation and drug therapy for an 8 week old premature baby with conjugated jaundice. The topic is described in great detail under both jaundice and liver disorders, and there is a huge list of causes of neonatal hepatitis. Inclusion of conditions such as erythrophagocytic lymphohistiocytosis and ARC syndrome made us acutely aware that the book is from Birmingham!

    In summary, this book would be a useful edition to neonatal units as a rapid reference guide, particularly for the excellent web links. The layout of the book is very practical and in a problem oriented style. The lists given under “aetiology” of most conditions are extensive and theoretical, but will be a helpful revision aid for junior doctors and nurses.

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