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Textbook of neonatal resuscitation, 4th edn (multimedia CD-ROM)
  1. S Richmond

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    Edited by Dana A V Braner. Published by American Heart Association and American Academy of Pediatrics, 2004, £21.00, pp 224. ISBN 1581100566

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    This A4 sized book together with its CD contains the seven lessons that constitute the Neonatal Resuscitation Program (NRP), a course teaching resuscitation at birth, devised jointly by the American Academy of Pediatrics and the American Heart Association. Lesson one provides an overview and presents the principles of resuscitation, and lesson two describes the initial steps. The remaining five lessons deal with the use of a bag and mask, how to do chest compressions, a description of endotracheal intubation, a lesson on medications, and the final lesson deals with special considerations such as congenital malformations, pneumothorax, post-resuscitation care, and dealing with situations outside hospitals. The text is liberally scattered with line drawings illustrating techniques and equipment.

    Each chapter deals with its subject in smaller sections, and after each is a series of questions relating to that section to be answered by the candidate before proceeding to the next. The entire series of questions are asked again at the end of the chapter. In the centre of the book are two pages of colour photographs of a number of different babies, full term, preterm, growth retarded or not, blue, pink, meconium stained, floppy or vigorous. There is also a group of four photographs of the view of the oropharynx and larynx during laryngoscopy. At the end of the book are two structured scenarios used for testing those undertaking the NRP course. Finally the text includes a reprint of the International Guidelines for Neonatal Resuscitation as published in Pediatrics in September 2000.

    The CD takes one through the text, questions and all, and intersperses this with diagrams, short animated sequences, and occasionally video sequences of action with real babies or training dummies. Some of these are helpful, but others are perhaps confusing. For example, there are some excellent video clips of the view down a laryngoscope during intubation, but only the last of the four colour photographs of laryngoscopy in the text is helpful. In one animated sequence, a dummy is shown breathing at exactly the same rate and in the exactly the same manner during both normal breathing and the gasping phase after primary apnoea. A later attempt to illustrate gasping by a similar animated drawing is equally ineffective.

    Overall my feelings about this text are mixed. Used as designed, as part of a training programme and with supervision from an experienced colleague trained in the niceties of this programme I am sure it works well. As a stand alone text for learning about resuscitation at birth, I feel it is less successful. The physiology of asphyxia is inadequately explained, thus reducing the value of the overview and encouraging rote learning rather than understanding. Compared with the complexities of resuscitation at other times of life, the resuscitation of the newborn is simplicity itself. This text makes it seem complicated and full of traps for the unwary. International guidelines on all aspects of resuscitation are currently being drawn up and will be published at the end of 2005. The facility on the CD which allows one to update the programme from the AHA website will then be able to prove its worth.

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