The Newborn Infant: One Brain for Life.

Amiel-Tison C, Stewart A, eds. Portland, OR 97213-3644, ISBS, 1994, hardback, 307 pp, illus, $120.

Although there is no clearly stated purpose for this book, which was edited by two world-renowned physicians in the area of neonatal care and follow-up, the back cover states that it "deals with cerebral adaptation and function in the human infant, before birth, at birth and shortly after, including factors which ma influence them. It also considers the immediate and later consequences when disturbances occur, and how to recognize them."

The intended audience for this book includes neonatologists, pediatricians, child neurologists, general practitioners, medical students, nurses, and public health administrators. The book is organized around six specific questions, with multiple perspectives (chapters) written in response to each of the questions: What is the optimal length of infant gestation? Does the birth process trigger extrauterine adaptation? Can safety of full-term birth be assured and at what cost? Is normal development possible after birth at extremely short gestation? Can mild degrees of neonatal brain damage be recognized? Does the threat of litigation influence perinatal practice?

In spite of the attempt to provide an organizational framework by including several chapters that respond to each of the six questions, the chapters seem to represent a potpourri of unrelated topics--both within and across the six stated areas. It is difficult to conclude what the actual theme or intended purpose of the book really is.

The scope of the book appears broad but includes somewhat diverse subject matter that, unfortunately, lacks a common theme. Because it is difficult to determine the book's purpose, it is equally difficult to conclude whether or not the treatment of the subject matter is truly comprehensive. On a more positive note, the authorship is quite multidisciplinary and includes many well-known researchers in the area of neonatology and pediatric neurology, such as Claudine Amiel-Tison, Albert Grenier, Charles Njiokiktjien, and Ann Stewart.

Although the majority of chapters include recent and relevant research references, there are a few chapters that have limited or no reference support. A number of chapters appear to be based more on clinical, anecdotal experiences of the authors rather than on actual research findings. Consequently, the reliability and validity of the information presented is not always documented.

There is great diversity in writing style, with some chapters being exceptionally well written and others more difficult to follow. Although the book is intended to be organized around the six questions posed, there is no rationale provided for the questions chosen, nor is there a logical progression from one question to the next. The organization or choice of chapter topics within each of the six sections is similarly problematic.

The text includes a number of clear and nicely drawn figures, most particularly those in the chapter by Grenier (chapter 13), which discusses prevention of muscle shortening deformities through adaptive positioning of infants while in the neonatal intensive care unit (NICU). The summary tables in the chapter describing long-term outcome of infants with extremely low birth weight (chapter 11) would also be of particular interest to physical therapists who work in high-risk infant follow-up programs.

Part 4, which addresses the outcomes of infants born at extremely short gestation (23-27 weeks' gestation), is probably of greatest value and interest to pediatric physical therapists, especially those who work clinically or in research settings with this population. Of particular importance is the summary by Stewart and Pezzani-Goldsmith of the scholastic performance of children who were infants with extremely low birth weight (<1,000 g), which suggests a high frequency of difficulties in school performance, particularly in cognitive and motor domains. The chapter by Grenier about optimal positioning in the NICU would be of great interest to therapists who work in these settings and includes some recent research substantiation for the positioning strategies suggested.

In summary, this book may have limited appeal for pediatric physical therapists who work in neonatal settings or for those who practice or conduct research in high-risk infant follow-up programs. Susan R Hams, PhD, PT, FAPTA Univ of British Columbia Vancouver, British Columbia, Canada

Dr Harris is Professor and head of the Division of Graduate Studies in the School of Rehabilitation Sciences at the University of British Columbia, and is a practicing clinician in the Infants and Children at Risk Program at Sunny Hill Health Centre in Vancouver, British Columbia. She bas been involved in clinical assessment and longitudinal research of high-risk infants for more than 15 years.