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Fetal and neonatal brain injury: mechanisms, management and the risks of practice, 3rd edition
  1. M Smith
  1. Newcastle General Hospital, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK; martin.smithncl.ac.uk

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    Edited by D K Stevenson, W E Benitz, P Sunshine. Cambridge: Cambridge University Press, £140.00, pp 926. ISBN 0521806917

    Brain injury remains a common theme in a large proportion of survivors of extreme prematurity and/or neonatal encephalopathy. The headline rates of significant disability have been largely unchanged despite the enormous advances in neonatal intensive care of the post-surfactant era, and more subtle educational difficulties are later declared in many others. It is essential that clinicians continue to strive for a deeper understanding of the mechanisms of brain injury to not only guide conventional management, but also look ahead to the future strategies in which neuroscientific advances may translate into plausible clinical strategies—for example, promoting the regrowth of damaged axons from intact cortical neurones across an area of periventricular leucomalacia.

    The strength of a textbook such as this is to give an in depth overview of many aspects of brain injury. This is accomplished well by a distinguished list of mostly United States based contributors, who consider the many aspects of neonatal brain injury in terms of aetiology, epidemiology, diagnosis, management, and long term outcome. A section on medicolegal issues makes interesting reading, although is not directly applicable to the British judicial system. Surprisingly little mention is made of the controversies surrounding the use of postnatal corticosteroids to treat chronic lung disease and the risk of cerebral palsy, but otherwise the range of topics is exhaustive. Particular care is also taken to relate the bedside management to the background neuroscience—for example, the neuroprotective effect of brain cooling. Readers will be encouraged to catch up with subsequent developments as they emerge in the journals.

    Weaknesses are few. The section on imaging of brain injury is thorough, and as expected well illustrated. However, it leaves the reader wishing for more information on the prognostic value of MRI in particular. Other sections would have been enhanced by greater use of illustrations—for example, I was disappointed that a section on congenital malformations fails to include a single illustrative image.

    In summary, this is a comprehensive account of an area of vital importance to obstetricians, neonatologists, and paediatric neurologists. It should prove to be a useful reference for specialists in these fields.

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