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Fetal & Neonatal Brain Injury. Mechanisms, management and the risks of practice.
  1. MARTIN KIRKPATRICK, Consultant paediatric neurologist
  1. Ninewells Hospital and Medical School, Dundee

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    Fetal & Neonatal Brain Injury. Mechanisms, management and the risks of practice. David K Stevenson, Philip Sunshine, eds. [Pp 665; £175 paperback.] Oxford University Press, 1997. ISBN 0-19-262640-X

    I enjoyed delving into this book. The editors acknowledge that the series of chapters by individual authors had resulted in some overlap and repetition but that it allowed individual prose styles to come through. That is indeed the case and makes the narrative style easy to read.

    The foreword took me somewhat by surprise: the rationale is not how we best prevent or manage neonatal injury, nor is it a state-of-the-art review of multicentre trials telling us how to modify our management protocols; rather, it is a book for the courtroom “where these complex neurologic issues are regularly publicly debated. Opposing neuroscientists are in great demand as expert witnesses.” I would question whether this book really does serve that purpose. It might have achieved it rather better had some of the subjects been reviewed as a critical evaluation of the available scientifically valid studies. For example, there is scant recognition of the debate that rages over the treatment of neonatal electrographic seizures without clinical accompaniment. Do we really know whether treatment of these is of definite benefit?

    The final chapter on the appropriateness of intensive care application made particularly interesting reading and especially so in the light of the recently published Royal College of Paediatrics and Child Health guidelines on Withholding or withdrawing life saving treatment in children. It seems clear that financial considerations are beginning to figure more prominently in these matters, and in this country we are behind in that debate. The author admits that, in the USA, practical considerations such as litigation or even adverse media publicity may prevail over moral and medical judgment of physicians and, hence, parents.

    This book made me think about neonatal brain injury in some detail and examine my own understanding and practice. To this end it will be valuable to those of us privileged to be invited to attend the courtroom to discuss such issues. Of course, not all the answers are there: it is for paediatricians to provide those answers through peer reviewed research and not let legal precedents take the lead.