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Recent Advances in Paediatrics 16.
  1. ROBERT SCOTT-JUPP, Consultant paediatrician      

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    Recent Advances in Paediatrics 16. Edited by T J David. (Pp 236 paperback; £35.) Churchill Livingstone, 1997. ISBN 0-443-05960-8.

    If a wealthy philanthropist wanted to improve the care delivered to children at a stroke he might consider sending a copy of Recent advances in paediatrics to every paediatrician; better still, he might accompany each with a letter purporting to come from the Archivesasking them to review it, thus ensuring that it would be read! As in previous editions, Professor David has managed to assemble a remarkably broad selection of topics and authors, striking a careful balance between science and clinical practice, between neonatal, general, and community areas, and between international themes and UK relevance. The diverse authors mostly produce an accessible and readable style, the illustrations are clear, and particularly helpful are the “key points” boxes at the end of each chapter.

    The first chapter on necrotising enterocolitis describes this still puzzling condition very thoroughly, noting that its pathogenesis remains elusive, and that early breast milk rather than formula feeds may be protective. The King’s team review biliary atresia, distinguishing the minority “embryonic” from the majority “perinatal” type, and reminding us of the importance of early diagnosis and referral to a tertiary centre; some more practical advice on local screening policies for prolonged neonatal jaundice would have been helpful here. The third chapter on screening for congenital dislocation of the hip (CDH) is thoroughly depressing: two thirds of children with CDH are currently missed by screening, there has never been good evidence to support either clinical or ultrasound screening, and many normal babies are splinted unnecessarily. Next, a multidisciplinary team from Montreal, Canada describe ways of helping the feeding impaired child from a largely behavioural perspective. In the fifth chapter, Lyme disease in children is comprehensively described by a team from Connecticut, USA where the disease first cropped up: diagnosis and investigation can be difficult but treatment is easy and we need to remain vigilant. Another worrying “new” pathogen is dealt with in chapter 6, Helicobacter pylori: its epidemiology and degree of association with symptoms are quite different in children from adults, and there are some huge international variations; this chapter would have been improved by some more practical advice on when and how to look for this organism in children with abdominal symptoms.

    The traditional chapter on a “tropical” subject this time deals with the convincing evidence in favour of the introduction of insecticide treated mosquito nets in malarious areas. Although of no relevance in the UK, I found it fascinating in the critical way it deals with comparisons of morbidity and mortality data from different studies, and the economic arguments.

    The next two chapters are related, dealing with the genetic basis of asthma and the immunopathogenesis of allergic disease. Both are complex with much science, but the principles are clearly explained, and the speculations about possible future prevention and treatment of atopic diseases are intriguing. Chapter 10 categorises psychosocial problems in epilepsy, reminding us of their extent and the need to refer difficult cases. In Chapter 11, Canadian authors compare their experience of attempts to prevent adolescent substance abuse with that of the USA and UK: they conclude that most programmes show little evidence of effectiveness, and suggest targeting identifiable groups of vulnerable young children. The final contribution reviews what has recently been learnt about sodium homeostasis from advances in molecular biology, allowing clearer classification of conditions such as Bartter’s syndrome and pseudohypoaldosteronism.

    Every edition of Recent advances in paediatrics ends with Professor David’s commendably wide ranging review of a year’s paediatric literature, this one 1996. His one line résumés may be galling to the authors who see years of labour summed up in a few words, but they are a boon to busy clinicians. He quotes many review articles, and it would be even better if he could attempt to precis these as well as the original papers.