Book Review

Intensive Care of the Fetus and Neonate

N Engl J Med 1996; 335:213July 18, 1996

Article

Intensive Care of the Fetus and Neonate
Edited by Alan R. Spitzer. 1244 pp., illustrated. St. Louis, Mosby, 1996. $149. ISBN: 0-8016-7711-4

A number of excellent textbooks are available for perinatologists who care for high-risk obstetrical patients or neonatologists who care for newborns. In practice, perinatologists and neonatologists collaborate closely to optimize the outcome for mother and infant. Practitioners of the two specialties can benefit from a greater understanding of the pathophysiology and management of conditions that are specific to the mother or the neonate but have implications for both. Intensive Care of the Fetus and Neonate attempts to bridge the disciplines of perinatology and neonatology in a textbook that provides a common understanding in a format accessible to practitioners in both disciplines.

This multiauthored textbook represents a massive undertaking. The 105 chapters, organized in 21 sections, were written by 149 contributors, many of whom are well-recognized experts in their fields. The sections in the first part of the book address the assessment and management of fetal conditions, including maternal conditions that affect the outcome for the fetus or neonate. The remaining sections focus on the newborn and are organized primarily according to major system, although there are also sections on general aspects of neonatal intensive care, including commonly used techniques and ethical considerations.

The obstetrical sections are comprehensive and more “neonatologist-friendly” than standard obstetrical textbooks. The review of the literature on the management of maternal conditions is often presented in tabular form. The chapter on hydrops fetalis is an excellent example of a review that should be useful to both perinatologists and neonatologists. The contributors frequently provide helpful algorithms to guide management. However, the chapters vary considerably in the provision of specific aspects of care, such as drug doses, which may affect how the book is used.

Most of the chapters on neonatology are excellent. Especially strong are those on hyperbilirubinemia, intrauterine and intrapartum infections, and thyroid disorders. The excellent chapter on fetal echocardiography exemplifies the theme of the book in its discussion of the identification and management of fetal conditions that affect the outcome for the neonate. In contrast, the discussions of apnea and the control of breathing pay little attention to breathing as part of the assessment of fetal well-being or to apnea in premature infants — a far more common problem than apnea in full-term infants, which is discussed in detail.

The chapters on neonatal pulmonary disease constitute the largest section. The size of this section is justified by the importance of pulmonary problems in the newborn intensive care unit, as well as the editor's expertise in this area. The chapter on the differential diagnosis of respiratory disorders is an excellent review with useful tables and figures. However, the proportion of the text devoted to rarely used or experimental therapies, such as liquid ventilation and inhaled nitric oxide, is striking. It would have been helpful to neonatologists and essential to perinatologists to place these treatments in proper context and avoid an imbalanced presentation. Similarly, a large table on intracardiac injection is included in the chapter on resuscitation in the delivery room, with no comment on whether and, if so, when this rarely used technique is acceptable.

This book would have been greatly improved by better editing. In part because of the reliance on multiple authors, discussions of a number of topics appear more than once, often with no cross-references. In at least one case, the same figure is included in two chapters. Other, minor problems can be addressed in future editions. For example, it is unclear why there is a chapter devoted to neonatal nurse practitioners, without a similar discussion of personnel from other disciplines who collaborate in providing care.

Despite these criticisms, this book will be valuable to neonatologists, but whether perinatologists will find the detailed discussions of neonatal conditions equally valuable is questionable. It remains to be seen whether this book accomplishes the editor's broader goal of promoting a discipline in which one physician cares for both the woman with a high-risk pregnancy and her critically ill newborn.

Ann R. Stark, M.D.
Harvard Medical School, Boston, MA 02115