After Birth Ebook

Getting Back Into Shape After The Pregnancy

Getting Back Into Shape After The Pregnancy

Once your pregnancy is over and done with, your baby is happily in your arms, and youre headed back home from the hospital, youll begin to realize that things have only just begun. Over the next few days, weeks, and months, youre going to increasingly notice that your entire life has changed in more ways than you could ever imagine.

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Pregnancy Without Pounds

This proven program will get you through your pregnancy in better shape than most other women in as little as 27 minutes a day and with minimal effort. It contains all the information that I believe will Help you to look and feel like I did barefoot and beautiful! Inside you will learn Exactly how to avoid unwanted pounds, overcome your food cravings, care for your skin, dress to kill and look like one Hot Mama. Ive also put together Fifty simple, yet extremely effective pregnancy-friendly exercises and stretches to keep you and your body looking and feeling Great (includes 3 different fitness programs depending on Your fitness level)!

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The adrenal gland after birth

The fetal zone occupies 80 of the adrenal cortex at term. There is remodelling after birth, with a rapid diminution in the size of the FZ. Reduction in the size of the FZ is mirrored by a fall in DHEAS levels in infants born at term, but FZ androgen production persists in infants born prematurely, and may be linked to maturation rather than birth. The large number of circulating steroids in the newborn period can interfere with hormone assays, and this can make interpretation of results difficult.

Pulmonary Artery Pressure As Related To

Pioneering studies were performed by Peruvian investigators in healthy natives born and living at high altitudes (HA). Cardiac catheterization was undertaken in newborns, children and adults at 4540 m altitude (Morococha, Peru) and the results were compared with those already described at sea level (SL) 17,52,68 . The mean pulmonary artery pressure (mPAP) in newborns was around 60 mm Hg, a value similar to that described in SL newborns. After birth, the mPAP decreases slowly and persistent PH, of mild or moderate degree, is observed in adolescents and adults, contrasting with the fast decline of mPAP described in the postnatal period at sea level (Figure 1). HA children from 1 to 5 years have an average mPAP of 45 mm Hg, decreasing to 28 mm Hg in adolescents and adults. Table 1 shows the pulmonary hemodynamics in children and adults living at HA.

Arteriovenous fistulae and malformations

H Presentation is variable, depending on the site and size of the AVM and symptoms may be due to local, peripheral or systemic effects (see below). Congenital AVMs involving the skin are often visible from birth (haemangiomas appear 4 weeks after birth). Malformations usually grow with age, often during puberty or pregnancy in women, and those within internal organs may only be detected once complications develop e.g. brain AVMs may cause haemorrhage, epilepsy or a neurological deficit. Other presentations include varicose veins, limb swelling or pain.

Cardiac Terminal Differentiation Entails the Sequential Loss of Cell Proliferation Followed by Loss of DNA Synthesis

Although prevailing dogma holds that cardiac myocytes terminally differentiate soon after birth in mammals, little data exist that analyze this systematically. The most comprehensive study quantified cardiac myocyte DNA synthesis during murine development.6 In this model cardiac myocyte DNA synthesis occurs in two distinct phases. In utero, labeling indexes of 33 were observed, which rapidly tapered to near zero by postnatal day 1. During this phase, karyokinesis and cytokinesis were matched, resulting in cardiac myocyte proliferation. The second phase occurred early in the neonatal period, peaking 4-6 days after birth. However, in this phase, nuclear division occurred in the absence of myocyte cytokinesis, resulting in the hallmark binucleation of ventricular myocytes. Similar to temporal changes seen in skeletal muscle,7 as well as terminal differentiation in other lineages,8 cell cycle exit in ventricular muscle cells is accompanied by coordinated downregulation of positive-acting...

The haemoglobin Barts hydrops syndrome

The fetus is usually stillborn between 28 and 40 weeks, or, if liveborn, takes a few gasping respirations and then expires within the first hour after birth. Affected neonates show the typical picture of hydrops fetalis, with gross pallor, generalized oedema and massive hepatosplenomegaly. There is an increased frequency of congenital abnormalities and a very large friable placenta. All these findings are due to severe intrauterine anaemia. The haemoglobin is in the 6-8 g dL range and there are gross thalassaemic changes of the red cells, with many nucleated forms in the blood. The haemoglobin consists of approximately 80 Hb Bart's and 20 Hb Portland (Z2Y2). It is believed that these infants survive to term because they continue to produce embryonic haemoglobin. Apart from fetal death, this syndrome is characterized by a high incidence of toxaemia of pregnancy and obstetric complications due to the large placenta.

Historical Introduction

Of three cases of microsporidiosis reported in the first half of this century, only one (Torres, 1927) remains as a possibly correct identification (see Canning and Lom, 1986, for historical summary). Torres (1927) described Encephalitozoon chagasi as the cause of meningocephalomyelitis with myositis and myocarditis in a baby girl who died 2 days after birth. Unfortunately the material has been lost and confirmation of its

Abdominal XRay Air as a Contrast Agent

The plain film of the abdomen is still very useful in the evaluation of the neonate. Air can be used as a contrast agent since newborns will start swallowing air immediately after birth, and gas should be present in the stomach within minutes. After 3 h, air should be seen throughout the entire small

Preimplantation Genetic Diagnosis For Single Gene Disorders

The presented data demonstrate the acceptable diagnostic accuracy of both the PB and blas-tomere analysis for PGD of the above conditions. As shown by the follow-up analysis of the mutant embryos or those with insufficient marker information, the PGD results were confirmed in all resulting embryos available for the study, including 14 embryos in blastomere analysis and 48 embryos resulting from mutant ooocytes, detected by PB1 and PB2 analysis. The PGD diagnosis was also confirmed after birth of all 14 children, although as mentioned in the case of FAP, the use of cord blood for PGD confirmation should be avoided to avoid conflicting results due to contamination of cord blood by the maternal cells.

Normal And Abnormal Development Of The Nervous System

Exogenous and endogenous agents may have adverse effects on the nervous system long before birth. One can judge the time of their occurrence and to some extent the nature of the intrauterine diseases only after birth by comparing the physical findings and functional capacities

Steroid therapy in the perinatal period

Antenatal steroids prior to preterm delivery reduce mortality and the serious complications of prematurity, but steroid treatment after birth appears to have different effects. Randomized-controlled trials of early postnatal steroid administration have shown a reduction in lung disease, but at the expense of an increased risk of cerebral palsy. It is also possible that steroid therapy may have detrimental effects on alveolar development. Postnatal dexamethasone for the treatment of chronic lung disease was widely used in the 1990s following a study demonstrating a reduced duration of ventilation (but not hospital stay), and for historical reasons large doses of dex-amethasone were given. This practice has largely been abandoned since the publication of data linking postnatal dexamethasone to cereberal palsy in preterm infants. Treatment with more physiological doses of hydrocortisone are currently being investigated in the context of clinical trials.

Sonic Hedgehog Mutation

In our first case, the couple presented for PGD with two children showing the clinical signs of HPE 71 (Figure 3.32). One of them, a female with severe HPE and cleft lip and palate died shortly after birth. The chromosomal analysis performed using peripheral blood lymphocytes of both this child and the parents was normal, but DNA analysis in the child's autopsy material demonstrated the presence of SHH nonsense mutation due to GAG> TAG sequence change leading to premature termination of the protein at position 256 (Glu256 stop) 70 (Figure 3.33). SHH protein is an intercellular signalling molecule, which is synthesised as a precursor undergoing autocatalytic internal cleavage into a highly conserved domain (SHH-N) with signalling activity, and a more divergent domain (SHH-C), which, in addition to precursor processing, acts The same mutation was found in their 5-years-old son, who was born after a full-term, normal pregnancy weighing 6 pounds, with a birth length of 183 inches. This...

Definitions of important terms

Birth weight is the first weight of the infant obtained after birth (1). For live births, birth weight should preferably be measured within the first hour of life before significant postnatal weight loss has occurred, with measurement accuracy of at least 10 g, and a correct reading technique. While statistical tabulations include 500 g groupings for birth weight, weights should not be recorded in those groupings but to the degree of accuracy to which it is measured.

What to tell parents

Some of the steroids in the mother's bloodstream are transferred to the baby. Occasionally this can be sufficient to switch off the baby's own production of steroids. The baby's steroid production will return, but rarely the baby may require steroid treatment until this happens. It is important to look out for signs of steroid deficiency in the baby in the first 2-3 days of life, which includes measurements of blood sugar and blood pressure. It is therefore important that the baby stays in the hospital for monitoring for 2-3 days after birth. Although pregnancy is rare in maternal Cushing's syndrome due to ovu-latory disturbance, it does occur, with adrenal adenoma being more common than pituitary-dependent adrenal hyperplasia. ACTH-independent, pregnancy-induced Cushing's syndrome has also been described. A review of 65 pregnancies in 58 patients with Cushing's syndrome reported maternal pregnancy complications of hypertension (64.5 ), pre-eclampsia (9.3 ), glucose intolerance (32.3...

Immunization strategy

BCG vaccination of the new-born is widely practised in the tropics. Overall, the evidence suggests that it confers considerable protection against tuberculosis in infants and young children. The strategy introduced recently in expanded immunization programmes, is to give BCG vaccination a few months after birth. The implications of this different timing have yet to be assessed.

Effects of Regionalization and NICUs on Mortality

The main arguments in favor of regionalized care rested largely on improved neonatal survival after its introduction into a geographically defined region (McCormick and Richardson, 1995). Low-birth-weight infants born in hospitals without a NICU had higher risk-adjusted mortality rates than those born in hospitals with an intermediate- or high-level NICU, and the mortality rate only marginally improved with subsequent transfer of the infant to a NICU (Cifuentes et al., 2002). The advantage of the earlier identification of high-risk pregnancies and referral to tertiary perinatal centers before delivery is supported by the more favorable outcomes for infants whose mothers were transported to perinatal centers before delivery compared with the outcomes for infants transported after birth (Doyle et al., 2004 Kollee et al., 1988 Levy et al., 1981).

Lungs and Respiratory System

About 24,000 infants a year and 80 percent of infants born before 27 weeks of gestation will develop respiratory distress syndrome (RDS). RDS is associated with surfactant deficiency. The incidence of RDS increases with decreasing gestational age and is higher among white infants than African-American infants at each week of gestation (Hulsey et al., 1993). Although respiratory distress is less common in infants born at 33 to 36 weeks of gestation and is rare in full-term infants, it can be severe, with a 5 percent mortality rate (Clark et al., 2004 Lewis et al., 1996). Antenatal administration of glucocorticoids to women at risk for preterm delivery reduces the incidence and severity of RDS as well as the rate of mortality (NIH, 1994) (see Chapter 9). Soon after birth, preterm infants with RDS develop rapid breathing, grunting, poor color, and crackling or diminished breath sounds breathing requires increased work. Respiratory failure because of fatigue, apnea, hypoxia, or an air...

Gastrointestinal Changes

The effects of gastrointestinal changes that occur during pregnancy were studied with ampicillin, a drug that is only 40 absorbed orally (8). Women were studied while they were pregnant as well as after pregnancy, thus serving as their own controls. The absolute bioavailability of ampicillin was evaluated by administering ampicillin both orally and intravenously to each woman during pregnancy and again postpartum. Pregnancy did not appear to change the extent of ampicillin absorption or the time to peak drug concentration (tmax). However, peak drug levels were found to be lower during pregnancy.

Gastrointestinal System

The earliest coordinated reflexes are related to stimulation around the mouth, with mouth opening in response to perioral stimulation occurring at 9.5 weeks of gestation and head turning occurring by 11.5 weeks of gestation (Hooker, 1952 Hooker and Hare, 1954 Humphrey, 1964). The fetus swallows by 10 to 12 weeks of gestation and can suck by 20 weeks of gestation. After birth, the newborn's GI tract becomes colonized with bacteria, which aids with food digestion. Antibiotics alter this process. The safety and efficacy of giving preterm infants favorable bacteria (i.e., probiotics) for GI tract colonization is being studied (Bin-Nun et al., 2005).

Infections and the Immune System

Preterm infants have immature immune systems that are inefficient at fighting off the bacteria, viruses, and other organisms that can cause infections. The most serious manifestations of infections with these agents commonly seen in preterm infants include pneumonia, sepsis, meningitis, and urinary tract infections. As many as 65 percent of infants with birth weights of less than 1,000 grams have at least one infection during their initial hospitalization (Stoll et al., 2004). Neonates contract these infections at birth from their mothers or after birth through their immature skin, lungs, or GI tract, which lack fully developed immunoprotective functions. They have difficulty confining infections to where they arise and forming abscesses, so sepsis (i.e., a blood-borne infection) frequently develops. Septic infants are generally critically ill, and infection can spread to other parts of the body (resulting in, for example, meningitis, an infection of the membranes that surround the...

SHP1 Negatively Regulates Hematopoietic Cell Signaling

The impact of imbalances between the PTKs and PTPs on immune function is evident in the phenotypes of motheaten (me) and motheaten viable (mev) mice. These mice carry naturally occurring point mutations in the SHP-1 gene that result in improper splicing of RNA transcripts. Homozygous me me mice are null mutants because the splicing defect results in a complete absence of SHP-1 expression, whereas the mev mev mice express a form of the enzyme that has 10-20 of normal activity. Hence, the mev mev mice have a less severe phenotype and a longer life span (approx 9 wk after birth) than the me me mice (2-3 wk after birth).

Germ Cell Migration

After specification and just before or during the early stages of gastrulation, germ cell migration occurs. PGCs migrate out of the embryo proper and reside in extraembryonic tissues until gastrulation is complete. PGC migration in the mouse occurs between embryonic days 7.5 and 13.5, when the PGCs travel through the developing gut to become incorporated into the primitive gonad (see Figure 8.2). The migration of PGCs is a multistep process during which the cells migrate through different tissue types and environments (Anderson et al., 2000 Molyneaux et al., 2001 Molyneaux and Wylie, 2004 Santos and Lehmann, 2004). Both migratory and survival signals appear to be required during this period for successful PGC development. After embryonic day 7.5, there is a distinct population of cells that appear to have a germ-cell-specific gene-expression profile. Several factors are involved in germ cell survival as PGCs progress along their migratory route. For example, the gene Dead end, which...

Major Physiologic Variations In Pediatrics

In neonates, the gastric pH is biphasic, being high in the first few days after birth and decreasing by day 30, but it takes 5-12 years for the adult pattern and value to emerge (Signer and Fridrich 1975). On the other hand, the methylation pathway, unimportant in adults, is well developed in children. Furthermore, acetaminophen is less toxic to children than to adults, probably because it utilizes the sulphate metabolic pathway (Rane 1992).

Orphan Receptors that Bind as Monomers

Of normal development of midbrain dopaminergic neurons and die soon after birth. These findings implicate the NGFI-B family members as critical players in neuronal differentiation and function however, the exact roles need to be elucidated. NGFI-B and Nurr1 play a role in regulation of the hypothalamic-pituitary-adrenal (HPA) axis through the regulation of corticotropin releasing factor (CRF) and POMC (proopiomelanocorticotropin), a precursor for several neuropeptides including adrenocorticotropic hormone (ACTH). NGFI-B also regulates CYP21, a steroid hydroxylase gene encoding an enzyme involved in glucocorticoid and mineralocorticoid biosynthesis. In addition, NGFI-B plays a role in programmed cell or apoptosis of T cells following T-cell antigen receptor (TCR) stimulation. However, NGFI-B knock-out mice do not exhibit grossly abnormal functions of the HPA axis or TCR-mediated apoptosis, suggesting a possible redundancy among NGFI-B family members. These receptors may play a role in...

Assessment of severity in the newborn

This is much more useful than a sample taken a few hours after birth, when rapid haemodynamic changes are occurring. The normal range of cord Hb levels is 13.6-19.6 g dL. Most infants with levels in this range do not require therapy more than 50 of affected babies have a level in the normal range. Where the cord Hb is below 12 g dL, exchange transfusion will be necessary. It may also be indicated for a rising bilirubin level after birth, dependent upon the rate of rise and the maturity of the infant. Phototherapy may be given to reduce the rise in bilirubin levels but it is not a substitute for transfusion. Less severely affected infants may require small-volume transfusions of red cells at 2-3 weeks of age. In both of these instances, careful follow-up arrangements must be made as haemolysis may

Therapeutic Recommendations for Individual Conditions

Fic drug therapy, which might be harmful to the fetus due to toxic and teratogenic potentials. Vertical transmission of intestinal protozoa has not been described. Invasive protozoan infections can be lethal to the mother, making immediate drug therapy mandatory, even if the potentials of fetotoxicity or teratogenicity are known. Vertical transmission occurs independent of maternal symptoms, causing clinical disease in the child either directly after birth or during the first months of life. Knowledge of endemic regions and of the maternal travel history is essential for early diagnosis and treatment of protozoan disease in pregnancy and of congenital protozoan infections (Bialek and Knobloch, 1999).

Fetal Breathing Movements

Up to mid-pregnancy, breathing can be considered an either or event. Fetuses either breathe or move, swallow and hiccup. During the first half of pregnancy breathing and swallowing are not conjugated. This physiological phenomenon acquires pathological significance in the premature infant that is having to cope with the different requirements of extrauterine life. The fine coupling of these activities, necessary for feeding after birth, is not yet established by mid-gestation.

Maternal Emotions and Their Impact on the Twin Fetus

Uterine contractility is particularly elevated in twin gestations 48 . Uterine contractions have been also postulated to be the result of maternal anxiety and stress. According to this hypothesis, uterine contractions, by applying pressure to the amniotic sac, would produce increased tension in the amniotic fluid. This pressure would be perceived as disruptive by the fetus, which would then start to move more. However, even assuming that this increased pressure hypothesis were true, the vast majority of twins are contained in separate amniotic sacs also, the amniotic fluid is unequally distributed between the two. Additionally, pressure on sacs which are different from each other may well act differently on each twin. Basically, lively fetal motions are confounded once more with anxiety-driven hyperactive states after birth 3 .

Behavioral Individuality Begins to Be Shaped In Utero

As in life after birth, monozygotic twins may be considered behav-iorally alike at a macroscopic level of analysis, but can never be considered identical upon detailed examination during pregnancy. Individual propensities can be discerned in the variety of repeated fetal movement patterns, of preferred positions and activities. Although we can speak only of tendencies and inclinations-and clearly not of well-determined characteristics-nevertheless, individuality and uniqueness are shaped during gestation and are evident by the time the twins are born. All twins, including monozygotic twins, emerge from the troubled time of pregnancy as unique individuals with fairly distinct inclinations and behavioral manifestations.

Hypoxic Pulmonary Vasoconstriction

After birth, HPV may occur as a result of a localized area of alveolar hypoventilation (e.g., atelectasis). This HPV diverts the flow of relatively desaturated, mixed venous blood to better ventilated areas of the lung. If HPV is inhibited, there is a reduction in systemic arterial oxygen tension, even in normal subjects, but particularly in patients with small airways disease 7 . Thus HPV in the presence of localized hypoxia is beneficial but generalized hypoxia can lead to pulmonary hypertension and remodeling. Acute HPV predominantly affects small pulmonary arteries and veins (< 500 in diameter) 23 . The executive mechanism of HPV has three components. The first requires hypoxic inhibition of K+ channels in the cell membrane of the pulmonary artery smooth muscle cells (PASMCs), membrane depolarization and calcium entry through the L-type calcium channel, just as occurs in the carotid body type 1 cell 18 13 . The second involves release of calcium from the sarcoplasmic reticulum...

Neurophysiology of Nursing Integrated with Psychoanalysis

It seems plausible that the formation of neurophysiological connectivity between the different subcortical nuclei and cortical areas begins right after birth. However, due to the low level and undifferentiat-ed character of the EEG activity of the newborn, the findings obtained so far from newborn infants need to be taken as preliminary and require further confirmation.

Additional Effects On Drug Metabolism

The effects of age on drug metabolism are discussed in specific chapters dealing with pediatric (Chapter 23) and geriatric (Chapter 24) clinical pharmacology. The most significant age differences are expressed developmentally in that drug-metabolizing enzyme systems frequently are immature in neonates. An important example of this is provided by UDP-glucuronosyltransferase. Particularly in premature infants, hepatic UDP-glucuronosyltransferase activity is markedly decreased and does not reach adult levels until 14 weeks after birth (52). This results in increased serum levels of unconjugated bilirubin and a greater risk of potentially fatal kernicterus, which is likely when the serum bilirubin levels exceed 30 mg dL. Low conjugation capacity can be exacerbated by

The Barker hypothesis Barker 2003

The ''thrifty phenotype'' was popularized by Professor Barker in Southampton, England (Cheung et al., 2004). From large epidemiological studies it has been recognized that IUGR children have an increased risk of developing some types of adult-onset disease. Diabetes, hypertension, myocardial events and stroke are all increased in IUGR infants when they become adults. The ''Barker hypothesis is that fetal programming in-utero, which leads to an IUGR infant, causes the resetting of normal physiological and biochemical development in the fetus as a survival technique. This is beneficial in the relatively hostile intra-uterine environment during pre-eclampsia, but becomes a problem when the child encounters different nutritional circumstances after birth. The concept of a ''thrifty phenotype'' child describes a child who will ''hoard'' fat when available in case of subsequent ''famine''. The initial observations by Barker were from data collected on English men born at the start of the...

Scrotum Air Inflation

Scrotum Air Inflation

Idly, in some cases as early as 24 h after it leaves the intestinal lumen. Yellow-green nodules form on the bowel wall and the perforation may be sealed off so well that at birth there may not be any macroscopic evidence of the leak. However, if the perforation is still present after birth and meconium still escapes into the peritoneal cavity, secondary septic peritonitis will develop. Very often a pseudocyst is formed by adjacent loops of the intestine, which tend to wall off the perforation. The wall of this pseudocyst is lined by a thick plaque of greenish-yellow material with areas of calcification (Reynolds et al. 2000) (Fig. 1.24). The intrauterine perforation may be due to any obstructing lesion such as atresia, meconium ileus, volvulus, Meckel's diverticulum, internal hernia, or bands. In such cases the causative lesion will be found at laparotomy. Frequently, however, no obvious cause for the perforation can be found. Such idiopathic perforations may be produced by localized...

Benign vascular anomalies of the orbit

Capillary haemangiomas occur in 1-2 of infants and are more common in females and children of low birth weight most appear soon after birth, can enlarge dramatically and then undergo a spontaneous involution - with 75 resolving within five years. Involvement is usually unilateral and the intradermal eyelid lesions are bright red and dimpled (so called, strawberry naevus Figure 12.4), whereas the deeper orbital lesions have a blue colouration and spongy texture both may increase slightly in size with crying or straining.

Intrauterine growth restriction

After birth examination shows a baby with a large head relative to body size. There is soft tissue wasting, reduced muscle bulk and large hands and feet. IUGR newborns are at risk of both early and late complications. Initial problems are an increased risk of perinatal asphyxia, polycythemia, hypoglycemia and hypothermia. The late complications of short stature and fetal programming of adult-onset disease will be discussed later in this chapter.

Calmodulin Action in Cells

Insulin Secretion

Quences occurred only when the antagonist peptide was directed to the growth cone. A similar strategy was used in the mouse to target expression of a conca-temerized MLCK antagonist peptide to the lung using the lung cell specific surfactant promoter. This peptide was targeted to the nucleus due to the creation of a bipartite nuclear localization sequence. Mice expressing this peptide died within 15 min after birth and demonstrated extensive cyanosis coupled with little or no movement. Histological examination of the lung revealed markedly dilated cysts. Thus, even when expressed as a part of a fusion protein in vivo, the antagonist peptide is sufficiently potent to specifically disrupt calmodulin signaling either in the cytoplasm or in the nucleus.

The clinical phenotypes of hereditary membrane disorders

The functions of the spleen become mature only after birth, so severe anaemia in utero is rare. Erythropoiesis is highly active before birth but enters a phase of reduced activity in the neonatal period. Severe anaemia, developing over 5-30 days post delivery and requiring transfusion, may result from this double physiological development of reduced production and increased destruction, but the anaemia may greatly reduce during the first year of life as compensatory erythropoiesis develops. Decisions about splenectomy do not need to be taken during this time.

Discovery of Neural Stem Cells

Fifty years ago it was dogma that neurogenesis ceased after birth in the CNS of mammals. Then, in the early 1960s, 3H-thymidine labeling studies in adult rats revealed cells actively synthesizing DNA in the hippocampus, leading to the hypothesis that maintenance regeneration is taking place in this region of the brain (Messier et al., 1958 Smart, 1961 Altman, 1962, 1963). The idea of maintenance regeneration in the CNS of any vertebrate was not accepted, however, until Nottebohm and colleagues showed in the 1980s that in male canaries there is a tremendous increase each spring in the number of neurons in their vocal control brain nuclei. These neurons are recruited into song-learning circuits and die when the mating season is over (Goldman and Nottebohm, 1983 Paton and Nottebohm, 1984). Thus, it was shown conclusively that there is neuron turnover and replacement in the adult canary brain, but the dogma of no new neurons remained in force for the mammalian brain.

Benign cystic anomalies of the orbit

Interhemispheric Dermoid Imaging

These lesions arise from surface epithelium implanted at sites of embryological folding and, if situated anteriorly within the orbit, are commonly noted soon after birth. Due to the accumulation of epithelial debris and sebaceous oil in the lumen of the cyst, the cysts slowly enlarge and leakage of the contents into the surrounding tissues may cause marked inflammation - with deeper dermoid cysts tending to present in this

Hh Signaling In Prostate Development

Shh is the most abundantly expressed Hh ligand in the developing mouse prostate (18). Ihh is also expressed but at comparatively low levels. Dhh expression has not been observed. Shh gene expression in the urogenital sinus (UGS) increases before the initiation of ductal budding at embryonic day 17.5 (E17.5). Expression is most abundant during the period of ductal budding in late gestation. Shh expression gradually diminishes through the first l0 days after birth, a period characterized by continued bud formation and by outgrowth and branching of newly formed ducts. Shh gene expression declines progressively, and, by 30 days postnatal, has approached the low level of expression seen in the adult. This decrease parallels the completion of the ductal branching process. A schematic illustration of how Shh expression fits in the timeline of key morphogenetic events in prostate development is presented in Fig. 2. Fig. 2. (A) The mouse lower urogenital tract at embryonic day 15 (E15) and at...

Fetal Wounds Have a Minimal Inflammatory Response

PU.1 null mice lack a hematopoietic lineage transcription factor that results in the absence of both macrophages and neutrophils. These mice die within 24 hr after birth unless they are given a wild-type bone marrow transplant because they are prone to infection, showing the importance of these cells for phagocytic and bactericidal functions (Dovi et al., 2004). Antibiotics can be used to prolong the lives of neonate PU.1 mice. Martin et al. (2003) investigated excisional wound repair in PU.1 mouse neonates maintained on antibiotics. Not only were excisional wounds repaired in antibiotic-maintained PU.1-null mice at the same rate as wounds in wild-type mice, they were repaired by regeneration, not scar (Martin et al., 2003 Redd et al., 2004 figure 2.8.) Regeneration was associated with greatly reduced expression of IL-6 and TGF-P mRNA (Redd et al., 2004). These results suggest that PU.l-null mice do not undergo the transition from the fetal to adult wound healing response Whether the...

Specifiers for Mood Disorders

Specifiers allow for a more specific diagnosis, which assists in treatment and prognosis. A postpartum onset specifier can be applied to a diagnosis of major depressive disorder or bipolar I or II disorder if the onset is within four weeks after childbirth. Symptoms include fluctuations in mood and intense (sometimes delusional) preoccupation with infant well-being. Severe ruminations or delusional thoughts about the infant are correlated with increased risk of harm to the infant. The mother may be uninterested in the infant, afraid of being alone with the infant, or may even try to kill the child while experiencing auditory hallucinations instructing her to do so or delusions that the child is possessed. Postpartum mood episodes severely impair functioning, which differentiates them from the baby blues that affects about 70 percent of women within ten days after birth.

Current Experience of PGD with Preimplantation HLA Matching

Patients transfusion-dependent starting from six months after birth, so bone marrow transplantation is the only option for radical treatment. At present, 371 different mutations have been described in the (-globin gene, located in chromosome 11 (11p15.5), causing congenital anaemia of variable severity 15 . Prenatal diagnosis has been applied widely for more than two decades resulting in considerable reduction of new cases of thalassemia in many populations 16 . Considerable progress also has been achieved in treatment of the disease by bone marrow transplantation 17 , the application of which is still limited to the availability of HLA-matched stem cells, making PGD an attractive option for couples with thalassemic children. PGD for thalassemia has already been provided for a few years 18 , so HLA typing is presently offered in the same framework, allowing couples not only to avoid the birth ofanother child with thalassemia, but also to produce an unaffected child who may be an HLA...

Blood Pressure

3) Patent ductus arteriosus (Fig. 2-1). Before birth, blood largely bypasses the lungs and flows from the pulmonary artery directly into the aorta via the ductus arteriosus, because the collapsed lungs resist pulmonary blood flow the fetus does not oxygenate its blood via the lungs. Normally the ductus closes after birth. If this does not occur, blood flows from the aorta

Theory Of Hemoglobin Genotype

The primary source of phenylalanine is our diet. The kk homozygotes typically have normal mental abilities at birth. While in utero, the kk homozygote is not eating but is obtaining its nutrients directly from the mother. Typically, the mother is a carrier of PKU with the genotype Kk, which means that she can catalyze phenylalanine to tyrosine. After birth, the kk homozygote cannot metabolize the phenylalanine found in a normal diet, and mental retardation will likely soon develop. If a baby with the kk genotype is identified soon after birth and placed on a diet with low phenylalanine, the baby will usually develop a normal level of intelligence. Thus, the same kk genotype can give radically different phenotypes depending upon the dietary environment. Because of the responsiveness of the kk genotype to environmental intervention, many countries require genetic screening of all newborns through a simple urine test to detect the kk homozygotes (Levy and Albers 2000). The PKU screening...

Neonatal Intestinal Obstruction

Knowledge of the many variations in both the distribution and quantity of intestinal air in infants is useful in the interpretation of pathologic findings. In a healthy neonate, air can usually be identified in the stomach within minutes after birth, and reaches the proximal portion of the small bowel during the first 6 h of life. By 6-12 h the entire small bowel usually contains air, and after 12-24 h normal neonates show rectosigmoid air in a plain abdominal radiograph.

Estrogen Imprinting Effect on the Development of Prostate

The neonatal period after birth is very fundamental for the rodent prostate development in which the prostate involves branching morphogenesis followed by functional differentiation. In this period, brief exposure of male rats or mice to high-level estrogens will cause irreversible alterations in As early as 1978, Rajfer and Coffey reported that if high dose of 17 -estradiol at 500 pg per day, or estradiol benzoate at 250 pg per day, or estradiol dipropionate at 100 pg per day, is administered to intact male rats for 2 days during the 1st week after birth, the prostate, at adulthood, is diminutive in size and is inert to the action of exogenous androgens. If immature rodents are exposed to exogenous estrogen before puberty, the aging animals develop prostatic epithelial hyperplasia50 or even dysplasia if androgen is given together with estrogen.61 A series of studies by McLachlan et al. demonstrated that perinatal exposure to the synthetic estrogen, DES, results in an assortment of...

Central Nervous System

Imaging of white matter injury is more difficult than imaging of IVH or IPH (deVries and Groenendaal, 2002). Ultrasounds should be repeated at 3 to 4 weeks after birth and at 34 to 36 weeks of postmenstrual age to detect signs of white matter injury, which evolve over time. The first sign may be an uneven density of the white matter that resolves (transient echogenicity) or that evolves into cystic lesions. Cystic lesions can collapse, so the timing and the quality of the ultrasound examinations are crucial for the detection of white matter injury. MRI is helpful for the detection of patchy or nonhomogeneous echogenicity.

Infant Iron and Zinc Status

During the first 6 months, infant iron status is largely dependent on iron stores at birth, which are influenced by gestational age, birth weight, maternal prenatal iron status, and the timing of clamping of the umbilical cord. After birth, infant iron needs are influenced by the rate of growth and certain types of infections. Thus, although full-term, normal birth weight infants whose mothers had adequate prenatal iron status can generally maintain adequate iron status through > 6 months of exclusive breastfeeding, certain subgroups of infants may be at risk of iron deficiency prior to 6 months.

Proliferation Reactivation and Dedifferentiation

Mammalian cardiomyocytes remain proliferative during fetal development. Shortly after birth, the cell-cycle-perpetuating machinery shuts down, and cardiomyocytes lose their proliferative capacity. p38 MAPK was identified as a key negative regulator of mammalian cardiomyocyte proliferation through the regulating genes required for mitosis (including cyclin A and cyclin B). Recently, it was reported that a p38 inhibitor, SB203580, increased the growth-factor-induced S-phase progression and mitosis in both neonatal and adult cardiomyocytes indicated by BrdU incorporation and histone 3 phosphorylation. The proliferation in adult cardiomyocytes was also associated with the transient dedifferentiation of the contractile apparatus (Engel et al., 2005).

Incidence and Importance

In Qinghai-Tibet the incidence or prevalence of PHAHD or ISMS is corresponding higher. From 1978 to 1985, an epidemiological study on PHAHD among 6,823 Han infants and children (after birth to 14 years of age) was carried out on the Qinghai-Tibetan plateau. The diagnosis of PHAHD was based on history, symptoms, clinical examination, electrocardiogra-phy (ECG), echocardiography, chest radiography, blood count and arterial oxygen saturation (see below). Incidence was 3.66 among Han infants and 1.52 in Han children at 3050 to 5226 m. The incidence increased with increasing altitude and decreased with increasing age 41 .

The Eyes Optical Components Cornea

Human Power

The corneal endothelial cells number about one million per cornea at birth this number declines to 70 by 20 years and to 50 and 30 by 60 and 80 years, respectively. Normally, the pumping action of corneal cells removes water and helps keep the cornea transparent. Because these cells do not divide after birth, their loss due to aging or injury after surgical treatments of the cornea or lens can lead to a decline in corneal transparency. Endothelial cells also secrete the cornea's basement membrane. With aging, warts (cornea guttata) appear in this membrane mainly in the cornea's periphery and cause marked increase in corneal permeability. Guttatas are observed with increasing frequency with aging 20 in youth, 60 in the sixth decade, and nearly 100 in very old age (8).

Cardiovascular System

The ductus arteriosus normally closes after birth, when the lungs expand air enters the lungs and blood is redirected from the right side of the heart, through the lungs, back to the left side of the heart, and out to the body. In preterm infants, the duct may not close properly, which results in a patent (open) ductus arteriosus, which can lead to heart failure and reduced blood flow to vital body organs (e.g., the kidney and the GI tract). Heart murmur, active precordium, and bounding pulses are clinical signs and an echocardiography performed at the bedside can confirm the presence of a patent ductus arteriosus and an otherwise normal anatomy. A patent ductus arteriosus can be asymptomatic and may close spontaneously in the first week of life, or it complicate a preterm infant's clinical course and increase the risks of intraventricular hemorrhage (IVH), NEC, BPD CLD, and death (Shah and Ohlsson, 2006).

Behavioral Influences On Preterm Birth

A special interest in behavioral influences on preterm birth is well justified, given that these are subject to change and could reduce the frequency of preterm birth directly. As previously reviewed in some detail (Berkowitz and Papiernik, 1993 Savitz and Pastore, 1999), a large number of observational studies of a range of health behaviors, including tobacco and alcohol use, nutrition, and physical activity, have been conducted. Although each of these behaviors poses specific challenges in discerning cause-and-effect relationships, two key, generic concerns crosscut them all. First, it is a challenge to measure many of these behaviors with accuracy because of their inherent complexity, the inability of individuals to completely recall past behaviors (e.g., diet and physical activity), or the stigma associated with the behavior (e.g., alcohol and illicit drug use). The challenge is especially heightened for women who are pregnant. This inaccurate recall ability is accompanied by the...

Prostate Evolution Growth And Differentiation

The human prostate is known to undergo several growth phases fetal growth, followed by limited regression after birth and growth cessation, then ultimately prostatic regrowth accompanying the androgen surge of puberty until adulthood at which time the process stops17 (Fig. 10.2). In man and dog, prostatic growth is reiterated during aging as part of benign or neoplastic proliferative processes. This has led McNeal to theorize a 'reawakening' of embryonic growth within the prostate.18 Studies of prostatic cellular proliferation demonstrate that prostate epithelial growth occurs early in a man's life, peaking in men 30-40 years old when prostate doubling times are 4-5 years. However, clinical benign prostatic hyperplasia (BPH) and prostate cancer are much more common during the seventh and eighth decades of life, when prostate epithelial growth is minimal and doubling times are significantly longer.17,19 These data suggest that for chemopreventative strategies to be maximally effective,...

Naturally occurring and immune antibodies

Antibodies are naturally occurring when they are produced without any obvious immunizing stimulus such as pregnancy, transfusion or injection of blood. These antibodies are not present at birth and, in the case of anti-A and anti-B, start to appear in the serum of children with the appropriate ABO groups at about 3-6 months of age. ABO antibodies are probably produced in response to antigens of bacteria, viruses and other substances that are inhaled or ingested many Gram-negative organisms have antigens that are structurally similar to the A and B antigens. Despite this probable antigenic stimulus, the term 'naturally occurring' is retained for these 'non-red cell-induced' antibodies. 'Immune' blood group antibodies are only produced after pregnancy or following transfusion or injection of blood or blood group substances.

The Role of Gender in Neonatology

For a cohort of individuals at a given point in life, the sex ratio (simple ratio of males to females) depends not only on the different rates of mortality between the sexes but also on the relative numbers of males and females present at birth. In humans, as in most mammalian species, a slightly greater number of males are born than females. At birth, the sex ratio is approximately 1.05, representing a proportion of male births of about 51.3 . After birth, the mortality of males is higher, and the sex ratio declines progressively. By the end of their first year, 120 males have died for every 100 females. Males continue to die at a higher rate throughout childhood and adulthood 1-4 .

Measurement Of Gestational

Any time after birth ** Other combinations have been proposed but are less well known and are used less frequently (See Allen, 2005a for references). The new Ballard Score is most accurate in infants with less than 26 weeks if performed before 12 h after birth (See Allen, 2005a for references).

Perinatal Mortality of Infants Born at the Limit of Viability

For infants born at the lower limit of viability, the aggressiveness of resuscitation at delivery varies considerably from region to region, as does the degree to which parents participate in the medical decision making (Hakansson et al., 2004 Haumont, 2005 Ho and Saigal, 2005 Lorenz and Paneth, 2000 Partridge et al., 2005 Appendix C). Infants born at 22 to 25 weeks gestation die if they are not resuscitated at birth and provided with neonatal intensive care. Many studies do not report the proportion of live births who were resuscitated. Concerns about the ultimate survival of infants born at the limit of viability to adulthood and the likelihood of significant disability or chronic illness, pain and suffering cause parents and health providers to question how these infants should be managed. Although most very immature infants die during the first day after birth, another concern is that further advances in neonatal intensive care may merely prolong their dying for days to weeks....

Anaphylactoid syndrome of pregnancy Amniotic Fluid Embolism

The clinical syndrome is diagnosed every 1 in 8000 to 1 in 80,000 pregnancies. A national registry of cases that has been opened in the USA is currently the most authoritative source of information about this condition. The condition usually presents during labor but may occur at the time of Cesarean delivery or immediately after birth. There are no demographic predisposing factors and obstetric practices, such as prior amniotomy and oxytocin administration do not seem to influence the risk of developing amniotic fluid embolus. The onset of the condition is abrupt and hypotension is universally present. Most patients develop pulmonary edema with cyanosis and a profound coagulopathy which should immediately give rise to a suspicion of the diagnosis.


Numerous studies of the human heart from 1850 to 1911 held the view that myocardial hypertrophy was the consequence of hyperplasia and hypertrophy of existing myocytes.6-15 However, subsequent reports from 1921 to 1925 have questioned the ability of myocytes to proliferate, suggesting that the increase in cardiac muscle mass in the pathologic heart was the result of pure cellular hypertrophy.16-18 The concept that myocytes cannot divide originated from the difficulty of identifying mitotic figures in vivo and from the inability to induce mitotic division in vitro.18'19 Thus, the dogma was introduced that no proliferation of ventricular muscle cells occurs once cell division has ceased, shortly after birth in the mammalian heart.20 However, to the best of our knowledge, there is not a single piece of evidence that cardiac myocytes are terminally differentiated in vivo. This contention implies the demonstration that after mitosis these cells have entered a physiologic state from which...


Anticipate hypoglycaemia in vulnerable babies and measure blood sugar as soon as possible after birth, within 2-3 h of birth and before feeding, or at any time there are symptoms or signs of hypoglycaemia. Blood sugar should be reassessed within 30 min to 1 h after intervention (which should be prompt ). Normoglycaemic babies should be reassessed approximately 4-6 hourly before feeds until the blood sugars are stable with at least two normal measurements.


Dr Koletzko Thank you, I agree this is very important for Viet Nam but also for many other countries around the world that are affected by this double burden of disease, where on the one hand you have a significant proportion of the population that is born with low birth weight under less optimal conditions and then exposed to a diet that predisposes to a high risk of obesity. As we have learned from a number of studies, it appears that if you are born with a low birth weight then at a later age you have a higher risk not only for obesity but also for the metabolic consequences of obesity. There are studies showing that at the same body mass index (BMI) populations born with a low birth weight have a higher body fat content and a much worse metabolic pattern, and a higher disease risk. This is particularly relevant for countries such as Viet Nam where you have this double burden of disease. Now the question whether the first week is relevant I have my doubts. I have discussed my...

Sickle cellHPFH

Approximately 1 out of 100 patients with HbSS has an elevated HbF level due to deletional or non-deletional mutations that maintain y-globin gene expression after birth. Such individuals have 20-30 HbF and < 2.5 HbA2. The haemoglobin level is normal with microcytosis, and target cells are observed in peripheral smear. The clinical course is benign, and vaso-occlusive complications are rare because of the inhibition of sickling by elevated HbF.


The studies currently available raise important questions. For example, when is the critical window for pollutant exposure during pregnancy This question has been addressed only recently in investigations of air pollutants, with no clear answer, and has not been examined for other pollutants. It is likely that the critical period would depend, in part, on the pathway through which the environmental pollutant initiates its action. Because pollutants have widely diverse chemical structures and biological activities, there may not be a single best time during gestation to assess exposure for all environmental pollutants. Furthermore, there may not be a single critical exposure period if multiple mechanisms can be activated. For some pollutants, critical exposures may occur before pregnancy or even during prenatal development or well after birth, say, during adolescence. The exposure assessment methodology will therefore require some understanding of the biological plausibility by which...


At birth cord blood calcium levels correlate with gestational age and are about 0.25-0.5 mmol L higher than maternal levels. With clamping of the cord, calcium levels fall rapidly in the first 6h, ionized calcium reaching a nadir of 1.2-1.45 mmol L at 24h. The newborn baby is now dependent on parathyroid PTH secretion, dietary calcium, renal calcium reabsorption, skeletal calcium stores, and vitamin D. PTH levels increase on the first day of life in response to the fall in serum calcium levels peaking at 48 h. However there is a nadir in serum calcium levels within the first 2 days of life. Calcitriol levels also rise. In the first 2-4 weeks after birth, there is increased efficiency In the preterm baby hypocalcaemia after birth is common. Possible mechanisms include a blunted increase in PTH, a prolonged increase in cal-citonin, rapid accretion of skeletal calcium and relative resistance to vitamin D-induced resorption of bone and absorption of calcium from the gut.


The innermost layer of tissue in the uterus is the mucous membrane, or endometrium. It lines the uterine cavity as far as the internal os, where it becomes continuous with the lining of the cervical canal. The endometrium contains numerous uterine glands that open into the uterine cavity and that are embedded in the cellular framework or stroma of the endometrium. Numerous blood vessels and lymphatic spaces are also present. The appearance of the endometrium varies considerably at the different stages in reproductive life. It begins to reach full development at puberty and thereafter exhibits dramatic changes during each menstrual cycle. It undergoes further changes before, during, and after pregnancy during the menopause and in old age. These changes are for the most part hormonally induced and controlled by the activity of the ovaries. The endometrium is divided into three layers, the stratum compactum, the stratum spongiosum, and the stratum basale, which are functionally distinct,...

Articular System

Cranial Lymph Nodes

Sutura frontalis (sutura metopical) . Suture connecting the right and left halves of the frontal bone. It generally fuses within 2 to 3 years after birth, but persists in 7-8 of all Central Europeans. C 5 Posterior intraoccipital synchondrosis. Synchondrosis intra-occipitalis posterior . Developmental synchondrosis between the posterior and lateral ossific centers of the occipital bone. It usually disappears within 1-2 years after birth. A

Abnormal Bowel Loop

Pink Sock Inverted Colon

Colon atresia, similar to small bowel atresia, is believed to result from an intrauterine vascular insult. The colon is the least frequent location, representing 5 -15 of all intestinal atresias (Powell and Raffensperger 1982). Multiple atresia syndromes may involve the colon in addition to the small bowel. Proximal location is more common than distal, with atresia beyond the splenic flexure being unusual. Clinical presentation may be delayed up to 48 h after birth. The abdominal scout film, in particular when the atresia is in the ascending colon, is often indistinguishable from obstruction of the distal ileum. The colon proximal to the point of atresia is often massively dilated and a mottled pattern of air and meconium may be identified. Plain film is usually unclear prior to 12-24 h of age so that an adequate amount of air can reach the site of obstruction (Hajivassiliou 2003). Sonography can determine the cause of distension before air is present in the distal bowel. The...

Females Males

Syndrome Albright

In boys, two Sertoli cell proteins, inhibin B and antimullerian hormone (AMH) mullerian inhibiting substance (MIS), are produced in the early neonatal period. Inhibin B (human males have minimal inhibin A) increases soon after birth and peaks at 4-12 months of age, declines to low levels by ages 3-9, and then increases again with the onset of puberty (at lower levels than the neonate). AMH MIS is evident in the first month of life and peaks about 6 months of age, drops during childhood, and becomes very low with puberty, probably secondary to increased testosterone inhibition. These hormones are useful markers of testicular function in early childhood.

RET Genetic Analysis

A specific mutation in exon 16, at codon 918 (ATG to ACG) is almost invariably associated with MEN2B. The substitution of methionine with threonine causes alterations in the substrate recognition pocket of the catalytic probe determining the activation of the intra-signaling pathways. Other rare mutations of the intracel-lular domain have been reported in codon 883 of exon 15 132 . A double RET mutation at codon 804 and 904 has also been described 133 . The Met918Thr mutation is associated with a very aggressive MTC that usually develops during childhood, often only a few years after birth.

Innate Reflexes

Lation causes the infant to open his or her mouth and turn toward the point of stimulation. This reflex has obvious applications in helping the infant locate food. The infant's ability to hold on to objects is, in part, attributable to the presence of the grasp reflex. When an object touches the palm of a newborn's hand, the newborn's fist will close immediately around the object, thus allowing the infant to hold the object for a short period of time. The infantile reflexes disappear within a few months after birth and are replaced by voluntary responses. Most developmental researchers believe that the infantile reflexes are temporary substitutes for the voluntary responses. Apparently, the voluntary responses are not present during the first few months of life because various parts of the infant's nervous system, including the cerebral cortex, have not matured sufficiently to support the behavior. Therefore, the disappearance of the infantile reflexes serves as an important marker of...

Duodenal Obstruction

Pictures Duodenal Obstruction

Duodenal atresia. a Plain radiograph obtained 6 h after birth shows absence of air in the gastrointestinal tract of this neonate with severe lung disease. b Radiograph made after inflation of the stomach through a nasogastric tube demonstrates complete duodenal obstruction (double bubble sign) Fig. 1.4a,b. Duodenal atresia. a Plain radiograph obtained 6 h after birth shows absence of air in the gastrointestinal tract of this neonate with severe lung disease. b Radiograph made after inflation of the stomach through a nasogastric tube demonstrates complete duodenal obstruction (double bubble sign)


As mentioned previously, HbF production almost ceases after birth. However, some adult red cell precursors (F cells) retain the ability to produce a variable number of y-chains. Because the latter can combine with excess a-chains to form HbF, cells which make relatively more y-chains in the bone marrow of P-thalassaemics are partly protected against the deleterious effect of a-chain precipitation. Hence, they come under selection in the marrow and peripheral blood and thus relatively large amounts of HbF are found in the red cells. It is possible that there may also be a genuine increase in HbF production as well as selection of F cells the mechanism is not understood. Because S-chain synthesis is unaffected, the disorder is characterized by a relative or absolute increase in HbA2 (a2S2) production. These interactions are summarized in Figure 6.4.

Hematologic System

Hematopoiesis is the generation of blood cells from stem cell progenitors. It begins in the embryo 7 days after conception (Juul, 2005). Stem cells are active in the aortogonadomeso-nephron at 10 days and then shift to the liver and, finally, the bone marrow. There are developmental changes in the numbers and functions of hematopoietic stem cells and in the various differentiated blood cells (e.g., red blood cells, white blood cells, and platelets). Red blood cells in the fetus contain fetal hemoglobin, which is necessary for intrauterine gas exchange because it has a higher affinity for oxygen. Fetal hemoglobin levels decrease after birth. Fetal blood loss, fetomaternal hemorrhage, and hemolysis can all result in congenital anemia, but the most common hematologic complication in preterm infants is anemia of prematurity. Anemia of prematurity is an exaggeration of the physiological anemia of infancy because of suppressed hematopoiesis for 6 to 12 weeks after birth and is earlier in...

Kangaroo Care

Kangaroo care provides skin-to-skin care by placing the naked preterm infant in an upright position between the mother's breasts and allows unlimited breast-feeding. This concept of caring for preterm infants originated in Bogota, Columbia, as a low-cost way to assist preterm infants with temperature regulation, nutrition, and stimulation (Charpak et al., 1996). Kangaroo care is initiated after a routine period of stabilization after birth. A number of studies from developing countries, including a few randomized controlled trials, suggest that kangaroo care improves weight gain (an additional 3.6 grams per day), reduces the incidence of nosocomial (i.e., hospital-acquired), infections and reduces the incidences of severe illness and respiratory disease up to 6 months of age (Conde-Agudelo et al., 2003). Mothers who provided kangaroo care were more likely to continue to breast-feed and were more satisfied with the care that their infants received in the NICU.

Control Mechanisms

The interaction among nutrients and development of regulatory systems in determining effects in later life is complex and there are likely multiple mechanisms to explain the outcome. Altered gene expression is a likely factor. In addition, the development of regulatory systems in the GI tract continues after birth and depending on the composition of the food may have long-lasting effects.