21st Edition Rudolph’s Pediatrics. By Colin D. Rudolph, Abraham M. Rudolph, Margaret K. Hostetter, George Lister, and Norman J. Siegel, editors. 2,688 pp. New York, McGraw Hill Medical, 2003. $130. ISBN 0-8386-8285-0

This authoritative textbook is a recognized standard in the field of pediatrics, and this 21st edition updates the previous version, published in 1996. Colin P. Rudolph has assumed the position of senior editor from his father, Abraham M. Rudolph, and has enlisted several other associate editors, as well as 495 individual contributors selected as authorities in their respective pediatric subspecialties. Ideally, a textbook is a compendium of the total current state of knowledge in a specific discipline or field of study. From the outset, this task is impossible. The size of the final product forces some constraints on the content, and the time elapsed between writing and publication ensures that some of the newest developments might not be included. The editors must strike a balance not only between thoroughness, size, rapidity of new developments, and costs of new editions but also between basic science and clinically applicable content. This new edition appears to have accomplished these goals.

Although this edition adheres to the basic style and format of its predecessor, it has some notable changes. The growth of pediatric knowledge is reflected in the increase of 351 pages, 170 contributors, and a whopping 4 1/2 pounds. Weighing in at 13 pounds, this book is definitely a reference text, not bedside handbook. Most sections have been revised and references have been updated since the previous edition. The bulk of the chapters remain organized by organ system, but new additions include sections on the acutely ill child, rehabilitation, and diagnostic techniques. These additions are beneficial. The section of the acutely ill child is weighted heavily toward basic physiology and is not simply a clinical cookbook.

The rehabilitation section includes such practical information as tracheostomy care, a selection of orthopedic appliances, and issues relating to the family’s adaptation to chronic illness. Much of this information is difficult to locate from other sources. The diagnostic technology chapter discusses advances in DNA testing, biochemical screening, and the gamut of new imaging studies, as well as some analysis of statistical reporting. Other revisions from the previous edition include a doubling of the section on asthma, with inclusion of the new National Institutes of Health guidelines; advances in neonatal care, such as the use of inhaled nitric oxide; a completely revised genetics section; and many others.

One notable change for the worse is in the Table of Contents. The previous edition and the primary competition text both have subheadings in the Table of Contents that make it easy to locate a specific topic. This version simply lists the chapter titles, so that to locate a specific item quickly, the reader must resort to the index. Two other deletions from the previous edition are the chapters on drug distribution and therapy and the medication tables previously included in the appendix.

This excellent reference is for both students and clinicians seeking an authoritative and comprehensive textbook on pediatrics. It is current and complete, as well as readable. Compared with some of the more clinically oriented textbooks, this one includes a thorough discussion of the basic science aspect of various conditions while it retains clinically useful information, such as diagnostic and therapeutic algorithms. The chapter on developmental and behavioral pediatrics continues to make available the basics of office-based pediatric practice by including the information necessary to counsel patients on everyday issues, such as colic, sleep disorders, and attention-deficit hyperactivity disorder. Each section has many charts and tables and current references.

For those who own the previous edition, the passage of 6 years and the extensive revisions in this new edition would make investing in this upgrade worthwhile. The size is imposing, and I suspect that future editions will grow to two volumes.