Neonatal Respiratory Disorders
Authors: Alison Leaf
Journal: Journal of the Royal Society of Medicine (2004)

Of the numerous advances in neonatal medicine over the past 25 years, better understanding of neonatal lung disease has probably had the greatest impact on survival and quality of life. The development and use of therapeutic surfactant, the harnessing of microprocessor technology to neonatal ventilators, elucidation of developmental physiology and pathological mechanisms, as well as responses to treatment, have all helped to improve outcomes for newborn infants. The second edition of Greenough and Milner’s Neonatal Respiratory Disorders tells us where we stand today. The editors, two of the UK’s leaders in this area, have recruited a host of well-respected international contributors.

The book is presented in four sections—development and physiology, antenatal and postnatal investigation, clinical management, and finally in section 4, eighteen chapters about specific pulmonary disorders. The coverage is certainly comprehensive, including both common and rare conditions affecting babies’ lungs as well as the effects on lung function of immaturity and of cardiac and neurological disease. Wider aspects of neonatal care which are important to lung function, such as fluid balance, circulatory support and nutrition, are also dealt with. So while this book focuses on the subject of the title, it does so in a very holistic manner.

In terms of the depth of coverage for individual topics there are some surprises. In a book over 500 pages long only 56 pages are devoted to ‘respiratory support’. Given the scope of high-frequency oscillation, different modes of patient-triggered ventilation, volume guarantee, and the resurgence of interest in CPAP this initially seemed too little. However, despite its brevity the chapter proved to be a useful summary of the advantages and limitations of some of the older and newer techniques. It is also exceptionally well referenced (451 references), so the way to further information is clear. By contrast, chapters on control of breathing and measurement of lung function offer sufficient depth to form the basis of understanding for engaging in research. Surfactant has been one of the major developments in neonatal respiratory care, providing very effective prevention and treatment for respiratory distress syndrome. The first section of the book contains a whole chapter devoted to surfactant physiology; this is helpful since many aspects of function, particularly of surfactant proteins, are only now being recognized. In the section on clinical management, however, surfactant is hardly mentioned: one has to go to the chapters on individual conditions such as ‘respiratory distress syndrome’ to find a summary of meta-analyses of the therapeutic options, and to chapters on meconium aspiration and pulmonary haemorrhage for alternative uses. Corticosteroids were widely used for treatment of bronchopulmonary dysplasia for two decades but this strategy has been undermined by concern about the increased risk of cerebral palsy in treated infants. This topic, of great concern to neonatologists in recent years, gets hardly a mention. It must be emphasized, however, that the whole book is efficiently cross-referenced, and that all chapters make excellent and comprehensive reference to relevant publications. The clinical and physiological areas that are explored in greatest depth are those for which published summaries and systematic reviews are otherwise less easily available.

So who is this book for? I would say that almost all those involved in neonatal care, from student to consultant, will find topics of interest. The day it arrived on my desk we were investigating a preterm infant with a mass in the thorax—suspected pulmonary sequestration. I decided to test the book, and there indeed were 4 pages devoted to the anatomy, pathophysiology and management of this rare condition. Apnoea, aspiration, airway problems, pulmonary hypoplasia, congenital abnormalities, pneumonia, air-leaks, pulmonary haemorrhage, pulmonary hypertension, broncho-pulmonary dysplasia—all are dealt with in a succinct yet detailed manner. This will be a welcome addition to any neonatal unit library, and in another ten years we shall be able to look back and say: well, that is how things were in 2003.