I first became attracted to the idea of producing a color atlas of neonatology many years ago. However, the impetus to synthesize my experience and compile this current collection was inspired by the frequent requests from medical students, pediatric house staff, nurses and others to provide them with a color atlas of the clinical material provided in my "slide shows." For the past few decades I have used the medium of color slides and radiographs as a teaching tool. In these weekly "slide shows" the normal and abnormal, as words never can, are illustrated.
"I cannot define an elephant but I know one when I see one."1
The collection of material used has been added to constantly with the support of the pediatric house staff who inform me to "bring your camera" whenever they see an unusual clinical finding or syndrome in the nurseries.
A thorough routine neonatal examination is the inalienable right of every infant. Most newborn babies are healthy and only a relatively small number may require special care. It is important to have the ability to distinguish normal variations and minor findings from the subtle early signs of problems. The theme that recurs most often is that careful clinical assessment, in the traditional sense, is the prerequisite and the essential foundation for understanding the disorders of the newborn. It requires familiarity with the wide range of normal, as well as dermatologic, cardiac, pulmonary, gastrointestinal, genitourinary, neurologic, and musculoskeletal disorders, genetics and syndromes. A background in general pediatrics and a working knowledge of obstetrics are essential. The general layout of the atlas is based on the above. Diseases are assigned to each section on the basis of the most frequent and obvious presenting sign. It seems probable that the find ings depicted will change significantly in the decades to come. In this way duplication has been kept to a minimum. Additional space has been devoted to those areas of neonatal pathology (e.g., examination of the placenta, multiple births and iatrogenesis) which pose particular problems or cause clinical concern.
Obviously, because of limitations of space, it is impossible to be comprehensive and include every rare disorder or syndrome. I have tried to select both typical findings and variations in normal infants and those found in uncommon conditions. Some relevant conditions where individual variations need to be demonstrated are shown in more than one case.
As the present volume is essentially one of my personal experience, it is not intended to rival standard neonatology texts, but is presented as a supplement to them. It seems logical that references should be to standard texts or reviews where discussion on patho-genesis, treatment, and references to original works may be found.
Helen Mintz Hittner, M.D., has been kind enough to contribute the outstanding section on neonatal ophthalmology.
I have done my best to make the necessary acknowledgements to the various sources for the clinical material. If I have inadvertently omitted any of those, I apologize. My most sincere appreciation and thanks to Donna Hamburg, M.D., Kru Ferry, M.D., Michael Gomez, M.D., Virginia Schneider, PA, and Jeff Murray, M.D., who have spent innumerable hours in organizing and culling the material from my large collection. We wish to thank Abraham M. Rudolph, M.D., for his assistance in reviewing the material. We also wish to thank the following people for their photo contributions to this work: Claire Langston, Helen Mintz-Hittner, Rose Wolfson.
It is hoped that this atlas will provide neonatologists, pediatricians, family physicians, medical students and nurses with a basis for recognizing a broad spectrum of normal variations and clinical problems as well as provide them with an overall perspective of neonatology, a field in which there continues to be a rapid acceleration of knowledge and technology. One must bear in mind the caveat that pictures cannot supplant clinical experience in mastering the skill of visual recall.
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