Book Review

Indian Pediatrics 1999; 36:533-535

Surfactant Therapy: Basic Principles, Diagnosis, Therapy.

Enormous amount of literature has accumulated on the use of surfactant in newborns with respiratory failure. The present book is an excellent compendium on surfactant use as borne by scientific research till date. The book is divided into three sections - clinical diagnosis of surfactant dysfunction, surfactant therapy in neonatal RDS and newer indications for surfactant therapy. The initial chapters provide some excellent description of the molecular structure of surfactant and its production, activity and degradation. It provides comparative data of the propriety preparations of surfactants currently available. The chapter on pulmonary function testing in newborns provides some very good information on the methods that have been used to assess pulmonary functions in mechanically ventilated newborns. The clear line diagrams are good aids to understanding this not so easily comprehendible subject. The subsequent chapters deal with the effect of surfactant in neonatal RDS. The chapters on ventilatory changes subsequent to surfactant therapy are sup- ported by some excellent serial chest radiographs to illustrate the changes brought about by surfactant therapy in clinical practice. The responses to artificial surfactant have been classified into four distinct groups and illustrated radiographically.

The book also discusses newer uses of surfactant such as in neonatal pneumonia, meconium aspiration syndrome, ARDS and also its status when combined with alternative therapies such as HFOV, ECMO, Nitric Oxide, etc. The book presents the basis of surfactant dysfunction in a variety of conditions which form the rationale for its use in the above situations. The increased use of surfactant outside of neo- natal RDS increases the interaction of the immune lung system and sufactant, raising concerns about allergy. This entire issue has been dealt with in a separate chapter comprehensively.

The book has 50 tables and 80 very good illustrations, which are of excellent quality and greatly help in understanding the subject of surfactant therapy. The book is a good reference work on surfactant therapy and all those currently involved in surfactant therapy would find this a very valuable resource book.

Siddarth Ramji,
Professor of Pediatrics,
Maulana Azad Medical College,
 New Delhi 110 002,
India.
 

The First Five Years: A Critical Perspective on Early Childhood Care and Education in India. Editor: Mina Swaminathan. Sage Publications, New Delhi, 1998, Price: Rs. 450 for cloth bound edition, and Rs. 225 for paperback.

The First Five Years - a critical perspective on early childhood care and education in India, opens up the context within which the medical profession and pediatricians in particular, have to wage the battle for the survival and growth of children in India. Shifting the focus from disease and morbidity, the spread and combating of infections, and delivery of primary health care, the book broadens the canvas by raising a range of closely linked social, economic, educational and policy issues which affect the growth and development of children. The First Five Years will therefore be of interest to all those in the medical profession who go beyond fighting disease in the hospital and are keen to wage the wide battle for health and development of children.

Eight case studies of child care programs (condensed from an earlier series of published case studies, the Suraksh Series) developed by the voluntary sector and by NGOs in partnership with government, form the core of the book. The editor's interest in documenting these programs arose from the growing awareness that child care support - creches and day care services are a vital need of millions of women workers in the informal sector and can be an important intervention in fighting poverty, infant malnutrition, disability, etc. It is also seen as a basic strategy for pro- viding essential care for children during the foundational years of life, especially for children of poverty groups where the adult care givers are away for long hours leaving their children in the care of siblings often not more than four years of age. The book, is therefore, not only for child development specialists but also for health professionals and a wide range of people who are concerned about the worsening trends in women's and children's health and also the linked problems of illiteracy, child labor and the marginalization of girls. The provision of a wide network of child care services is seen as a focal point to reach women, children and girls and the editor raises vital issues like what kind of services, who will provide it, how will it be resourced . and managed. Hence, the value of the case studies.

Drawn from geographical areas as widely disparate as the construction sites of big urban cities (In Site-On Site: Care for Construction Workers Children. Mobile Creches); the tobacco fields of Gujarat (Children of the Union: Creches for Women Tobacco Workers. SEW A); the Garhwal hills (Little School on the Hill: Child Education in community development. SIDH), the case studies not only document the varied child care needs of communities but also innovative and flexible approaches required for the care of young children.

While raising childcare as a National issue, the editor has made sure to establish through the case studies that the care of young children is an intimate matter involving the mother, her working hours, proximity to home or workplace especially during the first two years of breastfeeding. Young children should ideally be dealt with by small groups, be personalized and small scale. The kind of child care would naturally vary according to the nature of the women's occupation (women who sell fish in the market place or are waged agricultural labour, etc.), and need to be responsive to the kind of family structure and cultural patterns prevalent.

Large scale, monolithic government programs like the ICDS therefore need to be redesigned and provide for flexibility and response to regional needs. The case studies- For the sake of the children, the NGO-Government interface (Urmul) and Working Hand in Hand; NGO-Government Partnership in Child Care (Bal Niketan Sangh, Indore) are valuable for precisely highlighting what is required to make the government program responsive to the needs of women and children.

The study on Urban Daycare in Bombay raises the question of the neglect of children's developmental needs, the effect of cramped space and lack of activity and the importance of quality in a fast proliferating urban service for children.

All in all, the documentation provides a valuable input into the issues of the growth and development of young children. "This is a micro perspective", writes the editor in her introduction, "the close and loving look at detail, but which touches on most of the key issues, though indirectly".

The editor, Mina Swaminathan, has been a tireless crusader for the importance of early childhood care and. development as a foundation for lifelong growth and for providing the basis for the dignity of a full life. She has gathered a formidable array of distinguished contributors to examine different vital aspects of the current situation of Early Childhood Care and Development in India and to address the questions thrown up by the micro studies. All are well-known names in the field of early childhood. This group of professionals have a sensitivity to the socio-economic realities of women and children in India as well as a profound grasp of the unique needs of early childhood - the factors that affect growth and development. They have in their own right also contributed during the last few decades to raising awareness of the needs of the young child at policy level and brought into policy documents the need for the non-formal approach, the importance of play, the link between early childhood development, emotional stability and the later capacity for learning and education.

A comprehensive and analytical look at is- sues ranging from costs, training of workers, the historical perspective are provided by Margaret Khalakdina, Venita Kaul, Frances Sinha whereas reflective and sensitive in- sights into the cultural context of childhood in India is provided by S. Anandlakshmi. To complete the picture, Rajalakshmi Sri ram writes on the links between women's empowerment and childcare and Adarsh Sharma dwells on the future challenges.

The editor is to be complemented on the conceptualization of this book, the clear analytical framework, and the in-depth under- standing of early childhood. The First Five Years has been published at a most opportune time when discontent at India's failure in education and health is gathering into a storm. The book provides an insight into both the micro and macro issues, the ground realities and the grudging attention the young child has received in policy and resource allocation.
 

Devika Singh,
Consultant FORCES,
c/o Mobile Creches,
D.I.Z. Area, Raja Bazar, Sector IV,
(Near Gale Market), New Delhi 110 001,
 India.