Book Review

Infants and Children

Perinatal and Pediatric Pathophysiology: A Clinical Perspective

N Engl J Med 1994; 331:410August 11, 1994

Article

Perinatal and Pediatric Pathophysiology: A Clinical Perspective
Edited by Peter D. Gluckman and Michael A. Heymann, with five others. 760 pp., illustrated. London, Edward Arnold, 1993. $125. ISBN: 0-340-55268-9

The title of this book suggests a daunting task: to review perinatal and pediatric pathophysiology. I must say I was doubtful that this could be done comprehensively in only 760 pages. However, Peter Gluckman and Michael Heymann, the editors, have efficiently squeezed reviews of membrane physiology, cellular physiology, and developmental biochemistry and metabolism into one compact, easy-to-read book. In addition, they have woven concepts of basic science into the chapters on specific organ systems. For the clinician, this is a distinct advantage. Instead of having to pull out separate books on biochemistry and cell physiology, the clinician can use the concise reviews in this book to become acquainted with concepts and vocabulary in these areas of basic science, which have changed dramatically over the past 20 years.

The book begins with concise reviews of the molecular biology of membrane and cellular physiology. No specific references are given for the information in these chapters, but instead there is a list of selected readings. As an example of the type of information provided in these early chapters, there is a discussion of cell-membrane receptors that contains an overview of the purpose of cell receptors, followed by a description of specific types of receptors and their functions. Most clinicians have not stayed abreast of this information unless they happen to have been conducting research in these areas. Therefore, this book provides a valuable service. Some may feel shortchanged because of the lack of specific references or because of the sometimes sweeping summaries of complex processes.

The chapters on prenatal and postnatal growth concentrate on hormonal regulation. There is relatively little here on growth patterns and changes in body composition. The chapters on the organ systems begin with embryologic development and then discuss various physiologic aspects of the system. The chapter on the central nervous system, the most extensive, provides information on the development of pain pathways and the auditory and visual systems and on sleep and perinatal asphyxia.

This book is more succinct than other textbooks on perinatal physiology. For example, Dr. Gluckman's section on prolactin takes up about half the space that he required for a similar section in Richard A. Polin and William W. Fox's Fetal and Neonatal Physiology (Philadelphia, W.B. Saunders: 1992). He accomplishes this by omitting information on work in animals and by sticking closely to the human condition. This format, followed throughout the book, makes for a compact presentation of information that is elaborated on extensively in other books. Some will think that complexities of the material are understated, but the book does give a clean first cut, and the topics can be explored in more detail elsewhere.

About half of the 135 contributing authors are from institutions in the United States, with the remainder from New Zealand, England, and Northern Europe. The editors have done an excellent job, and the book is printed in large type and a readable font. I would recommend it to medical students interested in pediatrics; to pediatric house staff and general pediatricians looking for a basic understanding of the pathophysiologic aspects of clinical situations; and for neonatologists looking to refresh their memory of basic pathophysiologic concepts. It cuts to the heart of subjects that may be difficult to understand in books that provide more extensive information.

Michael H. Malloy, M.D., M.S.
University of Texas Medical Branch, Galveston, TX 77555-0526