Over the past several years, with improved survival of critically ill and very small preterm infants, neonatologists are focusing on nutrition of these infants as a means to prevent morbidities associated with intensive care, such as chronic lung disease and the complications of neurologic injuries. The intestine is being looked upon as more than a digestive absorptive organ, with the recognition that it has a very large surface area which serves as a barrier to potentially dangerous microbes and food antigens. When this breaks down, there is a huge potential for translocation of bacteria to the bloodstream, sepsis, inflammation, and accompanying short- and long-term complications.
The microbes that reside within the lumen of the intestine are increasingly being recognized as mediators of growth with the provision of nutrients that are products of their metabolism, as well as major mediators of inflammatory processes in the intestine. They play a major role in modulation of innate immunity as well as development of adaptive immunity. Alterations of the normal microbiota in the developing intestine of these infants ("dysbiosis") are associated with diseases such as necrotizing enterocolitis (NEC).
New technologies are rapidly evolving that may help us assess inflammatory processes in the intestinal tract. Technologies that may assist the neonatologist to determine feeding readiness as well as propensity to develop diseases such as NEC and late onset sepsis are rapidly evolving. Methodologies to evaluate these as well as epigenetic mechanisms that lead to diseases such as metabolic syndrome are being developed and discussed.
In this revised edition, we continue to incorporate clinical neonatal gastroen-terology and nutrition with up-to-date research. We hope that it will not only provide guidance for clinical care with clarification of some of the controversies related to nutrition, feeding, and neonatal intestinal disease but also stimulate new avenues of research that will be pertinent to optimizing the care of these infants and providing them the opportunity to reach their full genetic potential. Josef Neu, MD

SECTION A Basic Science of the Intestinal Tract

CHAPTER 1 Overview of Digestion and Absorption 3

CHAPTER 2 Maturation of Motor Function in the Preterm Infant and Gastroesophageal Reflux 13

CHAPTER 3 Development of Gastrointestinal Motility Reflexes 27

CHAPTER 4 Development of the Intestinal Mucosal Barrier 39

CHAPTER 5 The Developing Intestinal Microbiome and Its Relationship to Health and Disease 59

CHAPTER 6 The Developing Intestine as an Immune Organ 67

CHAPTER 7 The Developing Gastrointestinal Tract in Relation to Autoimmune Disease, Allergy, and Atopy 91

CHAPTER 8 What Are the Controversies for Basic Intestinal Development and Where Will the Field Be Moving in the Future? 101

SECTION B Nutritional Requirements and Strategies

CHAPTER 9 Nutritional Requirements of the Very-Low-Birthweight Infant 107

CHAPTER 10 Controversies in Neonatal Nutrition: Macronutrients and Micronutrients 129

CHAPTER 11 Regulation of Protein Synthesis and Proteolysis in the Neonate by Feeding 157

CHAPTER 12 Lipids for Neonates 183

CHAPTER 13 Human Milk Feeding of the High-Risk Neonate 203

CHAPTER 14 Nutritional Requirements for the Neonate: What Are the Controversies and Where Will the Field Be Moving in the Future? 213

SECTION C Clinical Conditions

CHAPTER 15 Necrotizing Enterocolitis 217

CHAPTER 16 Special Nutrition of the Surgical Neonate 227

CHAPTER 17 Controversies in Short Bowel Syndrome 237

CHAPTER 18 Neonatal Cholestasis 251

CHAPTER 19 The Neonatal Gastrointestinal Tract as a Conduit to Systemic Inflammation and Developmental Delays 293

CHAPTER 20 Adult Consequences of Neonatal and Fetal Nutrition: Mechanisms 305

CHAPTER 21 Technologies for the Evaluation of Enteral Feeding Readiness in Premature Infants 339

CHAPTER 22 What Are the Controversies for These Clinical Conditions and Where Will the Field Be Moving in the Future? 349

中国医科院医学信息研究所