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Acquired damage to the developing brain—timing and causation
  1. Denis Azzopardi

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    Edited by Wanley Squier (Pp 227, £95.00 hb). Published by Arnold, London, 2002. ISBN 0 340 75930 5

    Brain damage is a major burden to the affected individuals, their families, and to society. When it occurs around the time of birth parents will often question the adequacy of clinical care and seek redress in the courts. This book discusses the causes and timing of neonatal brain injury and is therefore likely to be of great interest to clinicians caring for infants and children, and to parents, and members of the legal profession.

    The first few chapters deal with the clinical features and management of cerebral palsy, the epidemiology, aetiology, and genetic causes. The definition of what constitutes cerebral palsy can be confusing, which is probably why the definition is repeated in several of the chapters. Neuroimaging, genetic, and metabolic studies have identified disorders that were previously considered under the umbrella term ‘cerebral palsy’. A recent consensus statement from European cerebral palsy registers is helpful. Even more problematic has been the study of the timing of cerebral injury and the causes of cerebral palsy. Current publications emphasise the importance of prenatal factors in the aetiology of cerebral palsy, and this view is repeated in the book. However, when recognisable developmental and metabolic conditions are excluded, most full term infants who develop encephalopathy after birth have suffered hypoxic ischaemic injury, and the chapters on pathophysiology and pathology deal mainly with this type of injury. The patterns of damage that occur at different developmental ages are clearly described and the illustrative plates are superb. In infants who survive brain injury, the aetiology and timing of the injury must be assessed by clinical examination and investigations. MRI is currently the key technique and this is well described in two chapters with the aid of several images. The final chapter discusses the legal considerations that determine the outcome of litigation and will be of interest to many clinicians.

    In summary, this is a useful overview of brain damage in newborn infants. However, brain injury in the preterm is not discussed in sufficient detail and is mainly limited to the classical problems of haemorrhage and severe white matter injury, which are now less common. There is much repetition throughout the book and this gives the impression that the book is a collection of review articles rather than a cohesive account.