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Neonatal immunity
  1. G Millman

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    Constantin Bona, New Jersey: Published by The Humana Press, 2004, $135.00 (hardback), pp 400. ISBN 158829319X

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    Having thoroughly searched our modest special care unit library, I decided that there is most definitely a space on the shelf for this text on neonatal immunity. Whether or not it actually deserves such a resting place is a matter for debate. In the introduction the author states that the book aims “to present classical and current information and discuss cutting edge discoveries that will hopefully lead to new horizons in biological research and result in scientific progress in vaccination of infants, stem cells, gene therapy, and transplantation.” He does not mention whether or not it will help the busy physician. Undoubtedly the book is aimed at an audience with a more established immunological knowledge than I have, but I believe there is much to commend this text to the general paediatric and neonatal reader with an interest in the mechanisms of newborn sepsis. The Textbook of neonatology (Rennie and Roberton) contains approximately 16 pages on neonatal immunity, which provide a good summary of the key points. This book has 302 pages with over 1200 references. My first recommendation would be to spend a few more pence and buy a luminous green pen to help highlight the relevant text and key areas of data that you may wish to retain from some chapters which at times focus heavily on experimental evidence and are liberally dosed with confusing acronyms.

    Each chapter deals with a specific area of immunity except for the first, which provides a relatively concise account of the structure and function of the immune system in vertebrates in general. Sample headings are: the phenotypic characteristics of neonatal B cells, the effect of maternal antibodies on the B cell response, the neonatal cytokine network, fetal and neonatal tolerance. Throughout the text the author reaffirms classical proven knowledge on how the fetus and newborn fight infections through innate, humoral, and cell mediated mechanisms with informative sections on the transfer of maternal antibodies, expression of MHC molecules, T cell development, and tolerance. However, he challenges accepted wisdoms and offers new hypotheses to help explain why neonates exhibit increased susceptibility to antigenic challenge, while demonstrating that their T and B lymphocytes will produce effector and memory cells in certain conditions when correctly presented with antigen in a favourable cytokine environment. The protective and immunomodulatory capacities of maternal antibodies are discussed in detail, with experimental support for their potentially adverse effects on active immunisation of the neonate and infant. An excellent account of important autoimmune conditions including myasthenia gravis, lupus, alloimmune thrombocytopenia, and thyroid disease is given, which I am sure will provide succour to the clinical reader when struggling with some of the detailed research data on mice, monkeys, and zebra fish.

    Fetal and neonatal immunity is a fascinating but complicated topic, which this book addresses both thoroughly and expertly, but its experimental detail may appeal more to the specialist immunology community. It is difficult to know whether this text will prove successful in competing for that space on the NICU shelf; at £75 it represents a significant outlay for most paediatric budgets, but if you do take the plunge don’t forget your highlighter pen.