Book Review
Assessment and Care of the Well Newborn
Patti Thureen, Daniel Hall, Jane Deacon, and Jacinto Hernandez
ISBN: 978-0-721603-93-3 2004 432 pages Saunders
Linda Sweet
Onkaparinga Clinical Education Program (OCEP); Clinical Education, Rural Clinical School, School of Medicine, Flinders University, Adelaide SA
This book, of which the first edition was published in 1999, is a valuable resource for midwives, neonatal nurses and junior medical staff. This book is written by a group of medical staff and neonatal nurse practitioners from Denver, Colorado in the United States of America (USA). Written predominantly in a notation style, formatted as bullet points and lists of information, this book is very easy reading. The intended audience is the health care professional providing professional care and support for the well newborn baby and their families, providing statistics, some research evidence and many basic clinical guidelines. Throughout the book there are simple line drawings as well as nice clear colour photographs to illustrate assessment and care issues. The book is not a detailed discussion of physiology or pathophysiology but rather a desk-top reference for quick access to pertinent information.
The authors cover many topics in a short, concise manner. While addressing the assessment and care of the well neonate there is sufficient information and detail of abnormalities, both common and uncommon, that may be present in the infant anticipated to be well. The book is organised into 7 sections and 24 individual chapters. Sections covered include 1) Obstetric considerations in the management of the well newborn; 2) delivery room management; 3) Evaluation and care of the newborn infant during the transitional period and beyond; 4) post-transitional care; 5) warning signs of common problems in the well newborn; 6) Management of the infant at risk for perinatal infections; and 7) Discharge planning and follow-up care. Each chapter lists the references used to support the work, which makes it easy for the reader to locate the sources of information. The references used vary from authoritative texts, research papers, to articles of anecdote and routine practice not necessarily research based, some of which is quite dated. The book is concluded with a number of appendices including example forms, laboratory values and brief advice guidelines.
Whilst the authors have covered many topics in a clear and easy to find format it is directed for a North American audience with a primarily bio-medical orientation - which is of no surprise given the authorship. It is interesting to note the 'standard orders' (p.390) which outline the admission of all infants to 'transitional care' and the frequency of vital sign assessment for the 'normal newborn', including routine blood pressure measurement for all infants prior to discharge, which, at least in mainstream Australian practice is now considered unnecessary. In Australia normal newborns are not admitted to any form of transitional care unless there is deviations to 'normal' and all infants do not receive 8 hourly temperature, heart rate and respiratory rate assessment until discharge from hospital.
In addition, all of the statistics and discussion of prevalence are based on USA data. The clinical guidelines given, use USA standard measurements and terms although the authors have acknowledged and provide metric equivalents and alternative terminology in most instances. Whilst the assessment and care of neonatal deviations from normal are good and correspond with Australian standards, some aspects of the basic care of the well newborn do not. For example, this book advocates the use of 70% alcohol for regularly cleaning the umbilical cord until separation occurs (p.371, 390); a practice which is not longer advocated within the tenets of evidence based practice. Similarly, the authors recommend that the newborn be sponge bathed until the cord has separated as emerging the cord in bath water may cause infection and delay in cord separation (p.370). This again is in contrast to the most recent evidence based practice guidelines available through the Cochrane database.
Despite the above limitations, I still recommend this book as a useful reference for staff assessing and caring for neonates, requiring easy to access information particularly in relation to deviations from normal. Experienced staff will be able to integrate pre-existing and new knowledge contained in this book for each newborn they care for, thus ensuring their transition to extrauterine life is uneventful and appropriate management is instituted as required.
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