Book Review
Effective Care of the Newborn Infant
N Engl J Med 1993; 328:1577-1578May 27, 1993
- Article
Effective Care of the Newborn Infant
Edited by John C. Sinclair and Michael B. Bracken. 650 pp. New York, Oxford University Press, 1992. $150. ISBN: 0-19-261737-0“'Organized skepticism' is alive and well in neonatal medicine and in obstetrics.” So states William Silverman in the foreword to Effective Care of the Newborn Infant, edited by John Sinclair and Michael Bracken. Indeed, this collection of reviews of the present evidence for and against interventions used in the neonatal period provides numerous examples of why skepticism is warranted.
In this book, 37 authors review observational studies and clinical trials of interventions currently used by neonatologists. The reviews are organized into a section on interventions and a section dealing with specific disease entities. The first section, which deals with methods of assessing the therapies used in neonatal medicine, sets the tone and clarifies the goals of the book and differentiates it from others on the newborn period.
That the methods of epidemiologic research have made their way into a review of neonatal care reflects the timely recognition that practitioners of neonatology must gain a greater appreciation of the need to evaluate their therapies in an era of rapidly advancing technology. Sinclair begins by reviewing the criteria for considering a therapy effective, measures of association, the issue of bias, and precision and generalizability. These discussions are relatively brief, but the points are made adequately. The editors could have provided a further service by including references to epidemiologic textbooks for further reading, rather than journal articles that lack broad coverage. In this first chapter, Sinclair also sets up an interesting procedure for assessing the validity of the studies that are presented in the succeeding chapters. At the conclusion of each chapter, a table lists the studies reviewed, the method of assigning subjects, and whether the administration of the intervention was blinded.
The second chapter, by Bracken, reviews the statistical methods used in analyzing individual trials and in meta-analyses. It is brief and provides the basic formulas for the calculation of measures of association. Subsequent chapters generally maintain consistency by expressing outcomes in terms of the measures presented in chapter 2.
The interventions that are reviewed include all the tough ones, those characterized by controversy and a paucity of controlled clinical trials. For example, the chapter on the immediate care of the newborn reviews the issues of intubating infants for the removal of meconium-stained amniotic fluid and routinely intubating all very-low-birth-weight infants immediately after delivery. On reading this chapter, one feels a certain amount of despair because of the limited amount of systematic research on the subject. Other chapters on topics that have been more thoroughly researched -- for example, thermoregulation and oxygen administration -- provide examples of how much time and care must go into the examination of specific interventions if we are to begin to understand the implications of their use in the nursery.
The section on studies of specific diseases reviews all the common diseases in the newborn period, not just those for which some form of proved therapy has become available. The chapters on patent ductus arteriosus and respiratory distress syndrome are testimony to the value of controlled clinical trials in developing an intervention. The chapter on neonatal jaundice, in contrast, is testimony to the difficulty of understanding the effect of an intervention, be it phototherapy or exchange transfusion, when the relation between an outcome of disease (kernicterus) and its indirect measure (serum bilirubin) is so uncertain. Chapters dedicated to periventricular-intraventricular hemorrhage and necrotizing enterocolitis point to the quandary in which clinicians find themselves because of the lack of effective means of preventing these diseases.
As Sinclair and Bracken point out in their preface, this book complements rather than replaces standard neonatology textbooks. The book will disappoint the clinician looking for a recipe for treating a particular problem, although it provides an excellent and detailed critical review of the bases of therapy in the neonatal period. As a teaching tool for house staff and fellows, it performs a valuable service by giving examples of the uncertainty with which we apply many of our therapies.
Michael H. Malloy, M.D., M.S.
University of Texas Medical Branch, Galveston, TX 77555-0526- Citing Articles (1)
Citing Articles
1
Tracey Irvine, Ian S Fentiman. (2007) Biology and treatment of ductal carcinoma in situ. Expert Review of Anticancer Therapy 7:2, 135-145
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