Neonatal and Laboratory Medicine, 2nd edition

Abstract

You can almost certainly find a copy of the first edition of Neonatal and Laboratory Medicine in your local biochemistry laboratory (it was sent to all members of the Association of Clinical Biochemists). If the book is well-thumbed, one of the staff has probably been studying for the MRCPath—an exam that usually contains at least one case history about a collapsed neonate with metabolic derangement. The first edition contained several illustrative case studies and became almost essential pre-exam reading. How does the second edition differ? The case studies have been removed, and chapters on infection and haematology have been added. The book will no longer be sent out to all ACB members, but the authors hope that the added chapters will give the book a broader appeal—perhaps escaping from the laboratory shelves and becoming popular with paediatric trainees and neonatal nurses. This is unlikely. Though laboratory scientists may continue to find it a useful guide to neonatology, few neonatal clinicians will find it an adequate guide to laboratory medicine. One chapter—about the organization of laboratory services—was illuminating. Neonates can deteriorate with almost alarming speed, so the authors (from Birmingham) provide a table of suggested turnaround times for various tests. I doubt whether many units outside dedicated children's hospitals currently achieve many of these goals (such as urgent clotting screen available within 30 minutes, urgent 17α-hydroxyprogesterone within 24 hours), but the suggestions could be usefully shown to managers who contemplate ‘rationalizing’ and centralizing services. Also in this chapter, the advantages and disadvantages of point-of-care testing are discussed, as is the importance of agreed protocols about communication of abnormal results. Birmingham clearly has an excellent system. Do most of the clinicians there now take it for granted, not realizing how much thought and experience has gone into establishing it and how much dedication it takes to maintain? Topics of other chapters include staples such as acid-base and electrolyte disturbances, jaundice, glucose homoeostasis, drugs and the neonate, and parenteral nutrition. The jaundice chapter is particularly short of basic science—something I would have welcomed much more of, but perhaps the authors were anxious not to patronize their laboratory-based readers. The book's main weakness is that it seems to have been edited and proofread by amateurs. The more errors I spotted the less I trusted it, until eventually I did not feel confident about anything without double-checking elsewhere. Many surprising things did turn out to be true, but I propose to wait for the third edition (with the case studies put back, the errors corrected, and a haematologist as fourth author) before buying a copy for our neonatal unit.