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Pediatric and Neonatal Tests and Procedures.
  1. MARY WHEATER, Consultant paediatrician

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    Pediatric and Neonatal Tests and Procedures.Edited by H William Taeusch, Robert O Christiansen, and E Stephen Buescher. (Pp 685; £65 hardback.) W B Saunders, 1996. ISBN 0-7216-5159-3.

    There is no substitute for direct experience in learning practical techniques, but a logical and reasoned written account backed up by clear diagrams is an invaluable aid in turning the apprentice into a confident professional. Pediatric and Neonatal Tests and Procedures was written to instruct on common, non-specialist procedures and to inform about specialised ones. It aims at a wide audience from medical students to paediatric specialists. There are 59 contributors to 48 chapters on subjects ranging from venepuncture to ECMO, and bandaging to developmental assessment. Four chapters appealed particularly to me: a clear account of ECG interpretation, a brief but useful description of cardiac ultrasonography, a well illustrated piece on diagnostic ultrasound screening, and a reasonably up to date section on high frequency oscillation ventilation. Most chapters are well referenced up to 1993, although references are not always cited in the text.

    There are many interesting differences between UK practice and some of the assertions in this book. The American Academy of Pediatrics recommends screening at surprisingly frequent intervals, eight visits in the first two years alone, and there is sometimes an aggressively interventionist attitude: ‘In the newborn child with difficulty breastfeeding, a frenulectomy can be performed in the office setting’. Presumably these examples reflect different financial arrangements in the American and British health care systems. There is an attitude towards children’s distress which would be unusual here: ‘A papoose board is helpful to securely restrain toddlers’ (for bronchoscopy). Some advice is potentially dangerous: the risk of infection from blood is no greater here than in the USA, yet the chapter on venepuncture does not mention gloves, illustrates ungloved hands, and talks without adverse comment about using mouth pipettes to collect capillary blood samples. The British paediatrician may also find the preference for butterfly needles rather than plastic cannulas for intravenous infusions quaintly old fashioned.

    For practical techniques I know of no other book with such extensive coverage, but for investigations I would prefer Addy’s book. It seems to me that £65 is a lot to pay for the four chapters which I found useful.