Book Review

Infectious Diseases of the Fetus and Newborn Infant

N Engl J Med 1995; 333:531-532August 24, 1995

Article

Infectious Diseases of the Fetus and Newborn Infant
Fourth edition. Edited by Jack S. Remington and Jerome O. Klein. 1373 pp., illustrated. Philadelphia, W.B. Saunders, 1995. $185. ISBN: 0-7216-6782-1

Reflecting increasing interest and the accelerating pace of technical advances in the field, this book arrives in its fourth incarnation five years after the previous edition, after earlier gestations of seven years each. This is not a baby, however, and there is no implication that its birth was premature. The authors of each chapter have contributed to the scholarship on the subject of their chapter, most often having spent a large part of their careers on the subject. The discussions are comprehensive and for the most part authoritative. The references are extensive and include relevant articles as recent as 1993. One can anticipate that this edition will continue to be a “must have” for specialists in infectious diseases, neonatology, and perinatal medicine. It is also a much-needed reference for pediatricians, obstetricians, pediatric neurologists, infection-control officers in hospitals, pediatric ophthalmologists, and audiologists.

The 35 chapters include 21 organized around diseases caused by specific microbes and 6 around bacterial infections of specific organ systems; the remaining 8 include a valuable introduction and chapters on newborn immunity, prenatal and postnatal diagnosis of infection, antibacterial pharmacology, obstetrical factors, and nosocomial infections. Sometimes the structure of the book seems determined more by the interests of the authors than by the structure of the field. For example, the pharmacology chapter covers antibacterial agents, whereas antiviral agents are found in the chapters on each of the specific viruses, antitoxoplasma treatment in the chapter on toxoplasmosis, all the other antiparasitic agents in a chapter about all the other parasites, and the antifungal agents in a chapter on fungal infections. Another example is that toxoplasma stands alone in a thoroughly authoritative chapter by Jack Remington, whereas all the other protozoans, helminths, and the perhaps-protozoan pneumocystis are lumped into a single short chapter 14 chapters away. I recommend that the editors reexamine the structure of the chapters for the fifth edition.

Another small complaint about the editing of the book concerns the index. The editors suggest that the book may be useful to audiologists, who may work with children whose deafness stems from congenital infection. A reader looking up “deafness” or “hearing impairment” in the index will find five causes, but they do not include bacterial meningitis, although the subject is discussed in the book. On the other hand, under the index heading “Transfusion(s),” cytomegalovirus shows up under “cytomegalovirus transmitted by,” “intrauterine, cytomegalovirus transmitted by,” and “neonatal, cytomegalovirus transmitted by” as separate and disconnected entries, rather than under a subheading. Similarly, the entries under “Transfusion(s)” include specific agents transmitted by transfusion and treatment of infection with transfusion in random order. Again, some logical editing of the index, as well as of the table of contents, would serve the user of the book well.

There are some redundancies that probably cause no harm — for example, discussions of staphylococcal osteomyelitis in both the staphylococcus chapter and the osteomyelitis chapter. Sometimes the redundancies are awkward, as when the obstetrician and the pediatrician differ in their recommendations concerning group B streptococcal prophylaxis.

But these are minor complaints. One generally uses this kind of reference book chapter by chapter or section by section. Each of the chapters captures its subject in a comprehensive and readable manner. To name a few of particular interest, the chapter on syphilis is particularly well written, whether the subject is its history and epidemiology or a careful analysis of the various diagnostic tests that can be used to clarify the status of an infant born to a woman who had syphilis during pregnancy and whose treatment, or response to treatment, is uncertain. This is a subject that has been written about in great detail, often without clarity, and here is a very careful, up-to-date review. The new chapters on Lyme disease and on parvovirus cover important, new, and sometimes controversial material in a very thorough and up-to-date fashion, each with hundreds of references with median dates of publication of about 1989 and 1991, respectively. The new chapter on laboratory aids for the diagnosis of neonatal sepsis covers a confusing field critically and well, providing a balanced perspective on everybody's favorite tests.

The classic perinatal infections caused by herpes simplex, cytomegalovirus, and rubella are expertly covered; it is a relief to see that there are not many recent clinical references in the rubella chapter, since the problem has diminished significantly.

One might quarrel with the title of the chapter “Acquired Immunodeficiency Syndrome in the Infant,” since it includes human immunodeficiency virus (HIV) infection sans AIDS, but within the limitations of a two-year-old review in a fast-moving field, the chapter spans the epidemiology, the range of available therapies, the multiple organ involvements, and the diagnostic tests. The publication calendar prevented the results of the AIDS Clinical Trials Group protocol 076 in the spring of 1994 — testing the prevention of vertical HIV transmission by zidovudine — from reaching the pages of this book. One might also wish that the authors were not so exuberant in recommending evaluations for infants of HIV-infected women, including HIV serologic studies and cultures or the polymerase chain reaction at least every three months for the first two years of life and developmental testing even more frequently. Such a schedule may be valuable for research protocols but may not be feasible or even useful in caring for these infants. At the time the chapter was written, it was already understood that cultures and the polymerase chain reaction were positive in all infected infants by six months of age and that HIV serologic studies are probably not useful until sometime after a year of age. Even allowing for honest differences of opinion, one might also imagine that such an ambitious schedule might be unnecessarily overwhelming to the practitioner looking for practical guidance.

Add to my wish list that the chapter on nosocomial infections might in the future include a more thorough discussion of transfusion-borne infections in newborns, as well as of some of the modern molecular epidemiology that has been used to trace outbreaks of viral and bacterial nursery infections.

A poignant editorial comment in the preface sounds almost like a eulogy for the system of research support that most of these authors have received during their careers (“through the 1980s”) and that has enabled them to provide such high-quality practical information to those who care directly for patients. Although we may share their anxiety, let us hope that in this particular case they are wrong and that, as in the case of Mark Twain, the reports of the demise of the system are premature.

Jane Pitt, M.D.
Columbia University College of Physicians and Surgeons, New York, NY 10032-3784