Akhil Maheshwari, MD, Editor
Jonathan R. Swanson, MD, MSc, Editor
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Preclinical and human clinical studies show that fetal undernutrition can occur due to maternal undernutrition, altered placental growth, or impaired uteroplacental vascular perfusion.6
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In animal models, maternal undernutrition can cause perinatal/neonatal metabolic derangements; cause anatomical/functional changes in the liver, pancreas, and the intestine; predispose to neurobehavioral changes, possible loss of cognitive potential; and even introduce risk factors for long-term outcomes, such as obesity, insulin resistance, and diabetes.5
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After birth, feeding has been known to influence the functional programming of the gastrointestinal tract, including metabolic, endocrine, and neurologic responses.10
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Nutrition can also alter the neonatal microbiome: it can change the timing and proportion in which the microbial flora gets established in the developing gut.15
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It can induce and maintain epigenetic changes, which can manifest with subtle interindividual variations in expression of isoforms of digestive enzymes and enterocyte receptors.17
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In at-risk premature infants, nutrition has a direct impact on developmental or nutritional anemia and influences the inflammatory milieu.18
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In some infants, conditions such as necrotizing enterocolitis may cause loss of intestine, both anatomically and functionally, and can set up the infant for further dysfunctional feed-forward loops.25
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In the medium/longer term, the loss of intestine can restrict later growth and metabolic health.28
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In short, there is good justification for continued investigation of the importance of nutrition during the late-fetal and early-neonatal periods for immediate, medium-, and long-term clinical outcomes.In this issue, we have focused on the importance of maternal nutrition, metabolic/epigenetic impact of maternal milk lipids, systemic effects of milk-borne lipids and glucose, and the impact of diet on the immune system. Some articles describe the potential benefits and systemic effects of milk fortification and nutritional supplements. An important section discusses the impact and therapeutic strategies to manage altered function/anatomy in infants with swallowing dysfunction, intestinal dysmotility, malabsorption, and short bowel syndrome. We have also evaluated the best methods for nutritional assessment. Finally, there are sections that inform about the impact of inadequate feeding, and the long-term impact of early nutritional management.
Irrespective of your role in the NICU, be it as a consultant or a bedside clinician, this issue of Clinics in Perinatology will be of interest. From full-term infants to micropremies, optimal nutrition plays a significant role in the health and well-being of all our little patients.
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- Nutritional and metabolic programming during the first thousand days of life.Pediatr Med Chir. 2017; 39: 157
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- Regulation of gastrointestinal motility by motilin and ghrelin in vertebrates.Front Endocrinol (Lausanne). 2019; 10: 278
- The ontogeny of the small intestinal epithelium.JPEN J Parenter Enteral Nutr. 1999; 23: S3-S6
- Dichotomous development of the gut microbiome in preterm infants.Microbiome. 2018; 6: 157
- Comparison of gut microbiota in exclusively breast-fed and formula-fed babies: a study of 91 term infants.Sci Rep. 2020; 10: 15792
- Epigenome-wide association of infant feeding and changes in DNA methylation from birth to 10 years.Nutrients. 2020; 13: 1-22
- Integrated neural and endocrine control of gastrointestinal function.Adv Exp Med Biol. 2016; 891: 159-173
- Evidence for liver energy metabolism programming in offspring subjected to intrauterine undernutrition during midgestation.Nutr Metab (Lond). 2019; 16: 20
- The impact of human breast milk components on the infant metabolism.PLoS One. 2018; 13e0197713
- Early-life gut microbiota and its connection to metabolic health in children: perspective on ecological drivers and need for quantitative approach.EBioMedicine. 2021; 69: 103475
- Physiology of intestinal absorption and secretion.Best Pract Res Clin Gastroenterol. 2016; 30: 145-159
- Epigenetics and neonatal nutrition.Early Hum Dev. 2014; 90: S23-S24
- A murine neonatal model of necrotizing enterocolitis caused by anemia and red blood cell transfusions.Nat Commun. 2019; 10: 3494
- Trinitrobenzene sulfonic acid-induced intestinal injury in neonatal mice activates transcriptional networks similar to those seen in human necrotizing enterocolitis.Pediatr Res. 2017; 81: 99-112
- Copper deficiency presenting as metabolic bone disease in extremely low birth weight, short-gut infants.Pediatrics. 2012; 130: e695-e698
- Anemia, red blood cell transfusions, and necrotizing enterocolitis.Semin Pediatr Surg. 2018; 27: 47-51
- Microbiome composition in pediatric populations from birth to adolescence: impact of diet and prebiotic and probiotic interventions.Dig Dis Sci. 2020; 65: 706-722
- Short bowel syndrome in infancy: etiology and management.Clin Perinatol. 1986; 13: 163-173
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