Book Review

From Heredity to Anatomy

Workbook in Practical Neonatology

N Engl J Med 1994; 331:886-887September 29, 1994

Article

Workbook in Practical Neonatology
Second edition. Edited by Richard A. Polin, Mervin C. Yoder, and Fredric D. Burg. 380 pp., illustrated. Philadelphia, W.B. Saunders, 1993. $45. ISBN: 0-7216-4292-6

In neonatology, as in all of medicine, one learns in different ways and from several sources. There is on-the-job training, which is really sink or swim; there are the sage words of trusted mentors and the practical tips of colleagues; there are encyclopedic textbooks and detailed journal articles; there are pocket manuals and practical handbooks; there are lectures, meetings, seminars, slide shows, videos, and computer programs. The interplay between the modes of education and one's initiative and desire for learning results in what the doctor knows. Yet inherent in each of these methods is the potential for passive learning: it is easier for someone to tell us what he or she knows than to cultivate what we might know. One solution to this problem is to have at hand the tools necessary for active learning. One such tool is the workbook, the problem-solving book, the book that, if used properly, requires active participation and allows one to address one's deficiencies and master a given body of knowledge. Workbook in Practical Neonatology provides this opportunity on a small but relevant scale to all who care for premature infants and sick newborns.

For the most part, this multiauthored book reads like the work of a single author. It is truly a workbook: there are tables to be filled in, questions to be answered, case studies to be scrutinized, and management decisions to be made.

The book begins with a chapter on the principles of neonatal resuscitation that asks the reader to make diagnostic and therapeutic decisions based on specific case scenarios and tests and refines the reader's knowledge of neonatal resuscitation. Subsequent chapters maintain this pattern of questions and answers, decision making and evaluation. The reader deals with problems related to fluid and electrolyte disturbances, mineral and glucose balance, hyperbilirubinemina, feeding, anemia, respiratory and cardiac disease, sepsis, renal disease, seizures, intraventricular hemorrhage, multiple anomalies, and surgical emergencies in the newborn.

Because of the book's format, the reader, who must work through the basic issues at hand, develops an approach to each clinical situation. For example, the chapter on anemia provides six case studies that, by illustrating both normal and abnormal hematologic values, provide a framework with which to evaluate the anemic newborn -- from the classification of anemia by red-cell volume and heterogeneity to the effective use of the reticulocyte count, Coombs' test, mean corpuscular volume, and peripheral smear; from evaluating pallor to distinguishing the characteristics of acute and chronic blood loss or those of ABO and Rh hemolytic disease. There is a strong focus on understanding what is normal and contrasting it with what can go wrong. This point of view is especially clear in the chapter on cardiac disease, which stresses how an understanding of prenatal, transitional, and neonatal circulatory physiology allows the physician to treat an infant with cyanotic heart disease and heart failure, and in the chapter on respiratory distress syndrome, which makes clear the link between fetal lung development and the effects of premature birth.

Throughout, the book challenges its readers to rethink their knowledge base and patterns of medical management. For example, I found that I did not fully understand the anatomical and physiologic features or the clinical manifestations of congenital heart disease; indeed, I did not appreciate completely even the simple patent ductus arteriosus. I learned other things: how to manage fluid balance better in infants with respiratory distress syndrome and bronchopulmonary dysplasia, how to think about neonatal hypocalcemia, how to approach dysmorphic infants, and how the nonsurgeon can approach surgical issues in the care of newborns. I learned a great deal that I thought I already knew.

This is not a comprehensive textbook of neonatology, and in that very fact lies its appeal. With its mixture of anatomy, physiology, pathology, pharmacology, radiology, and research, it presents one with an enormous amount of information -- all very readable and all very learnable.

If you take care of neonates, you should read this book. If you like enjoyable learning, you should read this book. I doubt that any other book on neonatology will compel you to boost your knowledge of the subject so effectively and with so much pleasure.

Jonathan D.K. Trager, M.D.
Children's Hospital of Pittsburgh, Pittsburgh, PA 15213