NeoReviews最新文献

Diarrhea in neonates is usually secondary to an infectious process or a food protein allergy. Once the infection is treated or the allergen is removed, the diarrhea resolves without lifelong sequelae. On the contrary, infants with anatomical disorders such as intestinal atresia, gastroschisis, malrotation with volvulus, or necrotizing enterocolitis can present with protracted diarrhea secondary to poor gut motility and short bowel syndrome. A small group of infants who present with severe diarrhea shortly after birth can have a congenital enteropathy resulting from a monogenic disorder. This group poses clinical challenges that require intensive resuscitation and meticulous diagnostic evaluation aimed at optimizing interventions and outcomes. In this review, we will provide a diagnostic and management approach for infants with congenital enteropathies.

Neonates who require gastrointestinal surgery are a complex group of patients that require special consideration with regard to nutritional supplementation and growth. During the acute postoperative phase, a major stress response causes catabolism with degradation of the body's nutrient stores leading to poor growth. Following surgery, parenteral nutrition is often required to support the surgical neonate; although, enteral nutrition, if feasible, is critical because it helps improve intestinal adaptation. However, the best type, mode, and duration of feeding is not established in the current literature. It is important to factor in the individual patient anatomy and site of intestinal resection when considering intestinal absorptive ability because these patients are at high risk for nutrient malabsorption, with the risk persisting even when enteral autonomy is achieved. The neonate undergoing gastrointestinal surgery requires close growth and nutritional monitoring both during the neonatal period but also into later life because risks of abnormalities persist. In this review, we summarize the impact of gastrointestinal surgery and postoperative intestinal changes on infant growth and nutrition.

Breastfeeding is the ideal initial feeding method for providing nutrition to full-term infants and is recommended by major health organizations, including the American Academy of Pediatrics and the World Health Organization. Despite improvements in global breastfeeding rates, many infants still receive formula. Significant advancements have been achieved in the safety and nutritional content of modern formulas. Various functional additives, such as human milk oligosaccharides, milk fat globule membrane, docosahexaenoic acid, and lactoferrin, are used with the aim to replicate some of the benefits of breast milk. These additives enhance formula by providing benefits beyond basic nutrition. The aim of this review is to summarize these additives and their impact on infant nutrition and development.

The benefits of mother's milk are abundant and well known for both term and preterm infants (Note: Not everyone who provides human milk identifies as a woman or relates to the term "breastfeeding," but because this accompanies the majority of infant feeding experiences, we have made the decision to phrase it this way while also acknowledging that this language can be exclusionary). The American Academy of Pediatrics now supports longer breastfeeding duration through the first 2 years of age.1 United States legislation in the last 2 decades has made progress in supporting breastfeeding, with policies such as improved access to antenatal and postpartum lactation support, some improvements in double electric breast pump access, and protected time and private spaces to pump at work for many employees.2,3 Despite this progress, sustained breastfeeding beyond the early postpartum period remains challenging. Among all infants born in 2021, 84.1% received breast milk for some time after birth, but this rate fell to 59.8% by 6 months and 39.5% at 1 year.4 There are also striking disparities in which infants receive mother's milk, with fewer non-Hispanic Black infants (75.4%) ever breastfeeding compared with Asian infants (92.7%), non-Hispanic white infants (86.2%) and Hispanic infants (83.4%).4 Young mothers aged 20 to 29 years were also less likely to ever breastfeed than mothers 30 years and older.4 Similar disparities have been shown among racial and ethnic groups who have been marginalized, with lower prevalences of any human milk at discharge for non-Hispanic Black and Native American very low birth weight (VLBW) infants compared with white VLBW infants.5,67Through the case reviews we present, we will discuss the underlying drivers of these breastfeeding inequities in neonatal intensive care units (NICUs) by understanding the inherent costs of breastfeeding as well as the individual and institutional level factors that impact mother's milk provision.

Gastrointestinal (GI) motility disorders in term and premature infants may occur at different times of gestation. Knowledge of normal neuromuscular development can help clinicians determine the cause of GI dysmotility and prognosis in infants born with congenital anomalies. Various developmental abnormalities and premature gestational age can alter normal GI motility, requiring further advanced testing and management. A multidisciplinary approach is often needed to care for these patients.

The prevalence of infertility has increased in the United States over the past decade with 1 in 5 reproductive-aged women suffering from this diagnosis. The use of assisted reproductive technology (ART) to achieve pregnancy has correspondingly steadily increased. After examining the outcomes of ART births, clear trends of increased preterm birth rate, higher-order multiples, and imprinting disorders have been established among ART-related outcomes. However, the relationship between ART and birth defects, abnormal placentation, and stillbirth require further investigation. This review aims to highlight current literature surrounding ART and its relationship with key obstetrical outcomes, neonatal outcomes, and medical genetics.