Book Review

Pediatric and Neonatal Tests and Procedures

N Engl J Med 1996; 335:213-214July 18, 1996

Article

Pediatric and Neonatal Tests and Procedures
Edited by H. William Taeusch, Robert O. Christiansen, and E. Stephen Buescher. 686 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $89. ISBN: 0-7216-5159-3

The editors of Pediatric and Neonatal Tests and Procedures sought to fill a void with this textbook. Their goal was to present the type of book most requested by pediatricians, pediatric subspecialists, and those in training: an easy-to-read, concise, up-to-date reference book on the common tests and procedures performed in pediatrics. A scan of the table of contents indicates that this book is a comprehensive review of not only the most common tests and procedures but also those that are unusual yet important. The material is organized around two themes: tests and procedures typically associated with the care of the critically ill neonate or child (cardiopulmonary resuscitation, critical care, and emergency care) and tests and procedures applicable to specific body organs and systems (the lungs, heart, central nervous system, and so forth).

One of the strengths of this book lies in the numerous ways in which the chapter authors interject practical advice into the technical explanations of each test and procedure. It is obvious that the authors are expert practitioners and teachers who are willing to share their years of bedside experience with the reader. The first chapter, on neonatal resuscitation, is an excellent example. Pertinent background information about perinatal depression is provided. Professional etiquette is discussed: the authors encourage the pediatrician to talk with the members of the obstetrical team before delivery in order to gather as much information as possible about the patient and the patient's family. Practical medicolegal advice is offered: “Asphyxia should not appear as a diagnosis on a hospital chart.” The discussion of the technical aspects of neonatal resuscitation is detailed yet succinct. General recommendations, such as “check the resuscitation setup,” are followed by step-by-step instructions, covering such matters as appropriate gas flow rates, anesthesia bags, and proper levels of suction pressure. Another strength of this and other chapters is the discussion of less technical but crucial issues, such as the approach to the delivery of the neonate with a very low birth weight.

Each chapter highlights the indications for a test or procedure, as well as its risks, benefits, and limitations, blending just the right amount of anatomy, physiology, biochemistry, and information from other basic sciences into clinical discussions. The chapter on pulse oximetry is an example, with its clear, concise discussion of the oxyhemoglobin dissociation curve and the effects of the presence of carboxyhemoglobin. After reading this book, one will be well prepared to perform the tests and procedures properly, as well as interpret the test results.

Because this is a book for pediatricians and others caring for children, a common theme is the preparation and care of both the child and the family. It is vital to approach children from a developmental perspective and not expect them to understand or react to a test or procedure in the same manner that an adult would. It is also vital to ensure that the parents understand the potential risks and benefits of the test or procedure. The chapter on the evaluation of apnea is exemplary in this regard.

All textbooks are slightly dated by the time they are published. In this one, there is no explicit recommendation to coordinate chest compression and assisted ventilation, as recommended by the American Heart Association and the American Academy of Pediatrics in the most recently published guidelines for neonatal resuscitation. There is also the usual problem of overlap in multiauthored books. In addition, some rather narrow topics might have been better addressed as part of a more comprehensive discussion. For example, instead of an entire chapter devoted to high-frequency oscillatory ventilation, a review of all forms of high-frequency ventilation (oscillatory, jet, and flow interruption) would have been preferable. Topics not covered that would be desirable in future editions include pulmonary-function tests and the administration of surfactant. These criticisms, however, are minor in the face of the many strengths of this book.

To produce a textbook that reviews the majority of tests and procedures carried out in neonates and children is difficult; to do so with discussions that are succinct without being superficial is exceedingly difficult. The authors and editors of Pediatric and Neonatal Tests and Procedures have performed this task successfully.

Louis P. Halamek, M.D.
David K. Stevenson, M.D.
Stanford University, Palo Alto, CA 94304