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There is growing evidence that colonic blood flow is controlled by both intrinsic and extrinsic factors. The existence of intrinsic vascular control mechanisms is evidenced by pressure-flow (and oxygen uptake) autoregulation, reactive hyperemia, vascular responses to acute venous hypertension, and a functional hyperemia. Although myogenic factors have long been considered to be solely responsible for the intrinsic ability of the colon to regulate its blood flow, recent developments indicate that metabolic mechanisms may be of equal importance in this regard. Both parasympathetic and sympathetic nerves play an important role in regulating colonic blood flow. The influence of circulating vasoactive agents and ischemia on colonic oxygenation are largely explained in terms of the relationship between oxygen uptake and blood flow. Colonic vascular dysfunction appears to be a major factor in the pathogenesis of inflammatory bowel diseases, chronic portal hypertension, and neonatal necrotizing enterocolitis. Future progress in this area will require the development of techniques for the measurement of colonic blood flow in man.
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PMID:Physiology and pathophysiology of the colonic circulation. 353 16

The pathogenesis of necrotizing enterocolitis remains unknown, but various factors have been postulated including, but not limited to, mesenteric ischemia, enteral alimentation, and infection. Since an understanding of circulatory physiology in developing intestine may provide insight into the role of mesenteric ischemia in the etiology of necrotizing enterocolitis, this review summarizes what is currently known about the regulation of blood flow and oxygenation in developing intestine and how it differs from that in adult intestine. The discussion is divided into intrinsic versus extrinsic factors. Phenomena which may be used to evaluate the capacity for intrinsic vasoregulation include pressure-flow autoregulation, reactive hyperemia, venous hypertension, arterial hypoxemia, and postprandial hyperemia. Extrinsic factors include neurologic and hormonal influences. Additionally, the susceptibility for tissue hypoxia as a function of age and the correlation with subsequent development of mucosal injury are discussed.
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PMID:Regulation of hemodynamics and oxygenation in developing intestine: insight into the pathogenesis of necrotizing enterocolitis. 808 91

Necrotizing enterocolitis (NEC) is responsible for substantial infant morbidity and mortality. NEC has been hypothesized to result from hypoxemia and mucosal injury, aggravated by feeding and bacterial proliferation. A study conducted at Kasturba Hospital Manipal in Karnataka, India, during 1990-94 attempted to further define risk factors for NEC. The 34 infants with NEC represented 1.38% of total admissions to the hospital's Neonatal Intensive Care Unit during the study period. The mean birth weight of NEC infants was 1584.56 g, with a mean gestational age of 33.53 weeks. 28 infants (82.35%) were preterm and 33 (97.05%) weighed under 2500 g. The most frequent clinic signs in infants with NEC were abdominal distension (79.4%), hyperbilirubinemia (67.6%), hypoglycemia (58.8%), and umbilical erythema (55.9%). When the 23 infants with NEC born within the hospital were compared with 46 weight-matched controls, there were no significant differences in birth weight, gestational age, or feeding patterns. However, NEC cases had a higher frequency of pregnancy-induced hypertension, low mean Apgar scores, polycythemia, hypothermia, and septicemia than controls. These findings suggest that poor gut blood flow may be another important etiologic factor in NEC.
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PMID:Neonatal necrotizing enterocolitis. 925 Dec 79

A review of the records of all live-born neonates with a birth weight below 1000 g born in 1993-96 at National Taiwan University Hospital was conducted, with emphasis on outcomes and risk factors for mortality. There were 81 extremely-low-birth-weight infants (0.59%) among the 13,835 live births recorded during the 3-year study period and, after exclusion of infants with major anomalies, 73 cases were enrolled for study. The mean gestational age was 27.2 weeks (range, 24-34 weeks). The most common complications of pregnancy leading to premature delivery were antepartum hemorrhage (44%) and pregnancy-induced hypertension. Respiratory distress syndrome occurred in 64%; exogenous surfactant therapy was provided to 47% and 85% received intermittent mandatory ventilation. Symptomatic patent ductus arteriosus occurred in 34% of infants, septicemia in 30%, chronic lung disease in 48%, grade III-IV intraventricular hemorrhage in 27%, stage III-V retinopathy of prematurity in 33%, and necrotizing enterocolitis in 8%. 54 infants (74%) survived the neonatal period and 44 (60.3%) survived until discharge. The survival rate was 40% for infants with a birth weight of 501-750 g and 68% for those weighing 751-999 g. Survival was 27% for infants with a gestational age under 26 weeks compared with 75% for those with a gestational age of 26 weeks and above. Cox regression analysis of survival indicated that Apgar scores at 1 minute, pulmonary hypertension, and severe intraventricular hemorrhage were the most significant contributing factors to mortality.
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PMID:Early outcome of extremely low birth weight infants in Taiwan. 970 Feb 44

We studied the maternal and neonatal profile and outcome of extremely low birth weight (ELBW) babies at the level III neonatal intensive care unit (NICU) in Delhi. Case records of ELBW inborn babies delivered between August 2000 and August 2001 were analysed by using a pre-set proforma. A total of 52 ELBW babies were admitted to the NICU in the relevant period, of whom 30 (57%) survived. Maternal anaemia, previous preterm delivery and pregnancy-induced hypertension (PIH) were the common predisposing factors for preterm delivery. Mean gestational age was 27.8 weeks and mean birth weight was 831 g. The highest mortality (55%) was seen in babies with 26-28 weeks'gestation and those in the birth weight category of < 800 g. Neonatal hyperbilirubinaemia (78%) and hyaline membrane disease/respiratory distress syndrome (65%) were the most common causes of morbidity. A total of 25 babies were mechanically ventilated while 24 (46%) received total parenteral nutrition. Sepsis, pulmonary haemorrhage, intracranial haemorrhage and necrotizing enterocolitis accounted for the deaths in the study population. Retinopathy of prematurity screening was performed in 35 babies (68%), of whom 22 were found to be normal. According to the International Classification of Retinopathy of Prematurity, most babies (72%) had involvement of zone 3 and stage I (63%). The incidence was highest in 26-28 weeks'gestation babies (71%) and the < 800 g birth weight category (62%). Maternal risk factors such as anaemia and PIH commonly predispose to preterm delivery. There is an alarmingly high mortality in this population. Effective steps are required not only to avoid extreme prematurity but also to reduce morbidity and mortality of all newborns weighing <1000 g at birth.
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PMID:Maternal and neonatal profile and immediate outcome in extremely low birth weight babies in Delhi. 1526 50

Thrombocytopenia (platelets <150 x 10(9)/L) is one of the most common haematological problems in neonates, particularly those who are preterm and sick. In those preterm neonates with early thrombocytopenia who present within 72 h of birth, the most common cause is reduced platelet production secondary to intrauterine growth restriction and/or maternal hypertension. By contrast, the most common causes of thrombocytopenia arising after the first 72 h of life, both in preterm and term infants, are sepsis and necrotizing enterocolitis. The most important cause of severe thrombocytopenia (platelets <50 x 10(9)/L) is neonatal alloimmune thrombocytopenia (NAIT), as diagnosis can be delayed and death or long-term disability due to intracranial haemorrhage may occur. Platelet transfusion is the mainstay of treatment for severe thrombocytopenia. However, the correlation between thrombocytopenia and bleeding is unclear and no studies have yet shown clinical benefit for platelet transfusion in neonates. Studies to identify optimal platelet transfusion practice for neonatal thrombocytopenia are urgently required.
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PMID:Neonatal thrombocytopenia. 1837 8

Abnormal umbilical artery flow with absent or reversed end-diastolic velocity (AREDV) during pregnancy is a strong indication of placental insufficiency. When AREDV occurs prenatally, a close follow-up or expeditious delivery should be contemplated. AREDV in the umbilical artery is associated with intraventricular hemorrhage, bronchopulmonary dysplasia, and perinatal mortality. It may be associated with respiratory distress syndrome, necrotizing enterocolitis, and long-term neurodevelopmental impairment. Available data suggest that women with high-risk pregnancies, such as preeclampsia, gestational hypertension and intrauterine growth restriction, should be evaluated with umbilical artery Doppler velocimetry to reduce the possibility of perinatal mortality and morbidity.
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PMID:The effects of absent or reversed end-diastolic umbilical artery Doppler flow velocity. 1979 10

It is the position of the American Dietetic Association that exclusive breastfeeding provides optimal nutrition and health protection for the first 6 months of life and breastfeeding with complementary foods from 6 months until at least 12 months of age is the ideal feeding pattern for infants. Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality, improving maternal morbidity, and helping to control health care costs. Breastfeeding is associated with a reduced risk of otitis media, gastroenteritis, respiratory illness,sudden infant death syndrome,necrotizing enterocolitis, obesity, and hypertension. Breastfeeding is also associated with improved maternal outcomes, including a reduced risk of breast and ovarian cancer, type 2 diabetes, and postpartum depression.These reductions in acute and chronic illness help to decrease health care-related expenses and productive time lost from work. Overall breastfeeding rates are increasing, yet disparities persist based on socioeconomic status, maternal age, country of origin,and geographic location. Factors such as hospital practices, knowledge, beliefs, and attitudes of mothers and their families, and access to breastfeeding support can influence initiation, duration, and exclusivity of breastfeeding. As experts in food and nutrition throughout the life cycle, it is the responsibility of registered dietitians and dietetic technicians, registered, to promote and support breastfeeding for its short-term and long-term health benefits for both mothers and infants.
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PMID:Position of the American Dietetic Association: promoting and supporting breastfeeding. 1986 47

Although the benefits of breastfeeding in reducing morbidity and mortality from gastrointestinal and respiratory infections, sudden infant death syndrome, and (in preterm infants) necrotizing enterocolitis are well-established, long-term health effects are more controversial. The evidence is conflicting concerning the "programming" effect of breastfeeding in protecting against child obesity, hyperlipidemia, hypertension, type 2 diabetes, and atopic disease. Accelerated neurocognitive development has been associated with breastfeeding in many studies, although doubts remain about the potential for residual confounding due to cognitive and behavioural differences between mothers who breastfeed (or those who breastfeed for a longer duration or more exclusively) and those who do not. Most of this paper will summarize the methods and results of a large, cluster-randomized trial of a breastfeeding promotion intervention in the Republic of Belarus. Its experimental design and intention-to-treat analysis have yielded important findings bearing on several of these longer-term health and developmental outcomes.
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PMID:"Breast is best": The evidence. 2084 97

Fetal malnutrition is an important risk factor for both early and late neonatal outcome and adult diseases. In this study, we aimed to investigate the incidence and characteristics of fetal malnutrition and its impacts on early neonatal morbidity and mortality in preterm infants by using the clinical assessment of nutritional status score (CANSCORE). Preterm infants whose gestational ages were between 28-34 weeks were included in the study. Detailed prenatal and natal history, anthropometric measurements, and intrauterine growth status were defined, and CANSCORE was applied to all infants. Infants were separated into two groups according to total score as malnourished (total score < 25) and well nourished (total score > or = 25). Early and late neonatal morbidities, which were observed during the clinical progress, were noted in all infants. A total of 93 preterm infants were enrolled in the study. The incidence of fetal malnutrition was 54.8% (n = 51) in all infants. The incidences of maternal hypertension and preeclampsia, oligohydramnios and disturbed umbilical artery Doppler flow in the prenatal period and the incidences of neonatal hypoglycemia, polycythemia, feeding intolerance, and necrotizing enterocolitis in the postnatal period were significantly higher in preterm infants with fetal malnutrition. Fetal malnutrition contributes significantly to many early and late neonatal morbidities in preterm infants, and it should be identified in every preterm infant in the first days of life for predicting neonatal outcome, even though they are appropriately grown.
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PMID:Fetal malnutrition and its impacts on neonatal outcome in preterm infants. 2198 Aug 6


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