Book Review

Neurology of the Newborn

N Engl J Med 1995; 332:1453-1454May 25, 1995

Article

Neurology of the Newborn
Third edition. By Joseph J. Volpe. 876 pp., illustrated. Philadelphia, W.B. Saunders, 1995. $85. ISBN: 0-7216-3690-X

The development of sophisticated intensive care techniques for use in newborn infants has increased the survival of many critically ill and frequently very tiny neonates. Nevertheless, the incidence of developmental handicaps in those who survive has not changed over the past decade. Several reports indicate that the frequency of cerebral palsy is rising, and the average cost of hospital care for a low-birth-weight infant was recently reported to be almost $140,000 in 1989 dollars (J.A. Mauskopf, M.E. Backhouse, D. Jones, et al. Synthetic surfactant for rescue treatment of respiratory distress syndrome in premature infants weighing from 700 to 1350 grams: impact on hospital resource use and charges. Journal of Pediatrics 1995;126:94-101). Thus, neonatologists, neurologists, and pediatricians alike will welcome the third edition of Neurology of the Newborn by Joseph J. Volpe, M.D.

When this erudite work first appeared in 1981, it lent formal recognition to the emerging concept that the neurologic problems of the developing brain were uniquely different from those of the brains of adults and older children. In this third edition of his work, Dr. Volpe beautifully demonstrates his very special ability to synthesize the effects on the developing brain of a wide array of insults, ranging from hemorrhage and ischemia to infection and metabolic defects.

To orient the reader, Dr. Volpe devotes his first two chapters to an extremely well-written discussion of neuroembryology. He begins with the formation of the neural tube and proceeds through neuronal proliferation, migration, and synaptogenesis. In subsequent chapters this background of neuroembryology improves the reader's understanding of how changes in cerebral blood flow affect the fragile germinal-matrix microvessels and result in intraventricular hemorrhage in preterm infants or in the failure of sufficient dendritic development during corticogenesis in full-term infants with the fragile X syndrome. Using this neuroembryologic basis, Volpe presents the pathophysiology of hypoxic–ischemic injury in full-term infants and contrasts the exquisite vulnerability with the unique plasticity of the brain at this point in its development. Throughout the book, Volpe cites basic-science and clinical studies that contribute to the understanding of the problem at hand.

Current treatment of the neonate really depends on peer-reviewed literature and consensus-conference statements, but Dr. Volpe's book also provides excellent practical advice for clinicians. His presentation of intracranial bacterial infections of the newborn and the comprehensive discussion of the effects of anticonvulsants on the fetus are commendable. In these chapters, as in the entire work, the data are well presented in easy-to-read tables, graphs, and flow charts.

As the formalized delivery of neonatal intensive care in this country approaches its 34th birthday, the third edition of Neurology of the Newborn validates the special impact of a wide variety of injuries on the developing brain and provides a welcome addition to the physician's shelf of often-used references.

Laura R. Ment, M.D.
Yale University School of Medicine, New Haven, CT 06510