Neurological Assessment of the Preterm and Full-Term Newborn Infant, Vol. 148

Author: Lilly M. S. Dubowitz
Published: April 2000
Publisher: MacKeith Press
ISBN: 1898683158
Hardcover Book
Number of Pages: 155

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The book contains black-and-white illustrations.This is the second edition of the manual describing this popular and practical tool for the clinical neurolgical examination of the newborn. In addition to a number of developments on the original scheme in the light of clinical and research experience, the new manual also facilitates the recording and performance of the examination by providing clear information on its administration aided by illustrative diagrams. This is the second edition of the manual describing a popular and practical tool for the clinical neurological examination of the newborn. In addition to a number of developments on the original scheme in the light of clinical and research experience, the new manual also facilitates the recording and performance of the examination by providing clear information on its administration, aided by illustrative diagrams. A new feature is the inclusion of useful scoring tables at the back of the book. Other new sections include a simplified version of the examination suited to inexperienced staff, applicable both for screening and for use in developing countries, and a revised proforma which may be used for the follow-up of infants beyond the neonatal period. There is also a new section describing clinical patterns in newborns with brain lesions and their correlation with imaging and neurological findings. This volume, an update of the first edition published over 20 years ago, is a good description of the clinical neurological examination of the newborn and preterm infant, with one of the seven chapters devoted to description of abnormal examinations of neonates. The authors' purpose is to address details of neonatal examination technique and to emphasize what they regard as the salient features. This is directed to an audience of pediatricians, neonatologists, and pediatric neurologists. The introductory pages include 13 quotations on neonatal neurological examination from mainly British authorities in neonatal neurology, from 1960 to 1981. We would have liked, in addition, a couple of the many quotable statements of Andre Thomas and Claudine Amiel-Tison of France and of contemporary North American neonatal neurologists such as Joseph Volpe of Boston and Alan Hill of Vancouver. The authors carefully develop their well-known scheme of systematic neurological examination with a strong emphasis on muscle tone and posture. To illustrate the examination of posture, tone, recoil, and neonatal reflexes, they effectively use photographs of infants, together with the stick figures they use as shorthand notation; the juxtaposition helps clarify the significance of each stick figure. They barely mention, however, the cranial nerve examination, which may be altered by brainstem infarcts, or olfactory reflexes that may be deficient in some cerebral malformations. Also not emphasized is the head circumference, particularly in infants with posthemorrhagic hydrocephalus. There are abundant useful tables of developmental changes with maturation, many of which use the famous Dubowitz stickfigures. In Chapter 6 (examinations in brain-damaged neonates) detailed descriptions of the clinical expression of germinal matrix hemorrhage, periventricular leukomalacia, cerebral infarctions, and hypoxic-ischemic encephalopathy are given. The authors do not discuss cerebral malformations as a cause of abnormal neurological examination in the newborn. They barely mention hydrocephalus, though they do illustrate ventriculomegaly in several ultrasound, CT, and MR images. It might be useful to remind readers that not all alterations in muscle tone and posture result from brain lesions, but that myopathies, neuropathies, spinal muscular atrophy, chromosomal abnormalities such as Down syndrome, endocrinopathies such as hypothyroidism, and various metabolic diseases also affect tone and posture from the neonatal period. An index is not provided. The 3-1/2 pages of references are mainly older citations from the 1970s and early 1980s, but these classics are not balanced with more recent publications, even by the same authors. We feel that despite some shortcomings, this is a useful and unique book for teaching systematic neonatal neurological examination, and a worthy, creative effort that is a practical tool for the clinician involved in neonatal care. Dubowitz, Lilly M.S. , MD, FRCP, FRCPH (Hammersmith Hospital, London); Dubowitz, Victor, MD, PhD, FRCP (Hammersmith Hospital, London); Mercuri, Eugenio, PhD, MD (Hammersmith Hospital, London)

Table of Contents
Authors' Appointments
Preface to the Second Edition
Introduction to the First Edition
1 Historical Review 1
2 Evolution of the Present Neurological Scheme and Its Applications 5
3 The Neurological Assessment 20
4 The Neurological Profile of Normal Preterm and Term Infants 68
5 The Term Infant: Development of an Optimality Score 85
6 The Neurological Examination in Preterm and Term Infants With Brain Lesions 105
7 Adaptation of the Neurological Proforma 137
8 References 152

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