- Shopping Bag ( 0 items )
From The CriticsReviewer: Harvey B. Sarnat, MD, FRCPC (University of Washington School of Medicine)
Description: This volume, an update of the first edition published over 20 years ago, is a good description of the clinical neurological examination of the newborn and preterm infant, with one of the seven chapters devoted to description of abnormal examinations of neonates.
Purpose: The authors' purpose is to address details of neonatal examination technique and to emphasize what they regard as the salient features.
Audience: This is directed to an audience of pediatricians, neonatologists, and pediatric neurologists.
Features: The introductory pages include 13 quotations on neonatal neurological examination from mainly British authorities in neonatal neurology, from 1960 to 1981. We would have liked, in addition, a couple of the many quotable statements of Andre Thomas and Claudine Amiel-Tison of France and of contemporary North American neonatal neurologists such as Joseph Volpe of Boston and Alan Hill of Vancouver. The authors carefully develop their well-known scheme of systematic neurological examination with a strong emphasis on muscle tone and posture. To illustrate the examination of posture, tone, recoil, and neonatal reflexes, they effectively use photographs of infants, together with the stick figures they use as shorthand notation; the juxtaposition helps clarify the significance of each stick figure. They barely mention, however, the cranial nerve examination, which may be altered by brainstem infarcts, or olfactory reflexes that may be deficient in some cerebral malformations. Also not emphasized is the head circumference, particularly in infants with posthemorrhagic hydrocephalus. There are abundant useful tables of developmental changes with maturation, many of which use the famous Dubowitz stick figures. In Chapter 6 (examinations in brain-damaged neonates) detailed descriptions of the clinical expression of germinal matrix hemorrhage, periventricular leukomalacia, cerebral infarctions, and hypoxic-ischemic encephalopathy are given. The authors do not discuss cerebral malformations as a cause of abnormal neurological examination in the newborn. They barely mention hydrocephalus, though they do illustrate ventriculomegaly in several ultrasound, CT, and MR images. It might be useful to remind readers that not all alterations in muscle tone and posture result from brain lesions, but that myopathies, neuropathies, spinal muscular atrophy, chromosomal abnormalities such as Down syndrome, endocrinopathies such as hypothyroidism, and various metabolic diseases also affect tone and posture from the neonatal period. An index is not provided. The 3-1/2 pages of references are mainly older citations from the 1970s and early 1980s, but these classics are not balanced with more recent publications, even by the same authors.
Assessment: We feel that despite some shortcomings, this is a useful and unique book for teaching systematic neonatal neurological examination, and a worthy, creative effort that is a practical tool for the clinician involved in neonatal care.