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Structure and Development of the Skin and Cutaneous Appendages

Acknowledgment The editors wish to thank authors David H. Chu and Cynthia A. Loomis for their excellent contribution to this text in the fifth edition. This chapter has been reproduced here in the sixth edition essentially unchanged. Introduction Skin is a complex organ that comprises many different cells and cell types; it forms a critical physical barrier that protects the body and maintains fluid homeostasis, temperature…

Temperature Control in Newborn Infants

Acknowledgment Based on a previous chapter by Karl Schulze, MD. Introduction This chapter is an updated revision of Dr. Kurt Brück’s comprehensive treatise on neonatal thermal regulation presented in earlier editions; it is not an original synthesis by the current author. Dr. Brück remains the senior contributor despite his death in 1995 in recognition of and with immense admiration for his many contributions to our understanding…

Placental Transfer and Fetal Requirements of Amino Acids

Introduction Placental uptake, metabolism, and transfer of amino acids to the fetus are critical for both placental and fetal development and growth to produce a successful pregnancy. Placental amino acid transfer is mediated by active transport and is performed by over 20 distinct amino acid transport systems that are present on the maternal facing apical, microvillous, and fetal facing, basal plasma membranes of the placental syncytiotrophoblast.…

General Concepts of Protein Metabolism

Introduction This chapter describes the methods used to evaluate dynamic changes in protein metabolism in the newborn infant. Throughout life, proteins not only form the key structural components of cells but also have key physiologic roles as, for example, transporters, immune mediators, receptor proteins, enzymes, and hormones. In a consideration of the relevant kinetics, the fundamental point of interest is that amino acids—the building blocks of…

Cell Glucose Transport and Glucose Handling During Fetal and Neonatal Development

Introduction Glucose is the primary substrate for the growing and developing fetus, and in normal human pregnancies there is little fetal gluconeogenesis. Glucose is required by most cells for oxidative and nonoxidative adenosine triphosphate (ATP) production and serves as a precursor for other carbon-containing compounds. It is the primary fuel used for several specialized cells and is the major fuel used by the brain. Its storage…

Role of Glucoregulatory Hormones in Hepatic Glucose Metabolism During the Perinatal Period

Acknowledgments The authors wish to thank Richard M. Cowett, MD, for his valuable contributions to this chapter in the fifth edition. Introduction After birth, the newborn must rapidly become capable of balancing glucose deficiency with glucose excess to maintain euglycemia. Development of carbohydrate homeostasis is essential to avoid both hypoglycemia and hyperglycemia, to which neonates (especially the sick, preterm, and growth restricted) are vulnerable. Both hypoglycemia…

Oxygen Consumption and General Carbohydrate Metabolism of the Fetus

Introduction This chapter reviews a number of factors that are involved in control of fetal metabolism, with reference to relationships between fetal energy balance and substrate uptake during the last trimester. This information relies heavily upon research data obtained from a variety of experiments in animals as well as some theoretical considerations. Data from human studies are now also becoming more available than in previous years…

Glucose Metabolism in the Fetus and Newborn, and Methods for Its Investigation

Acknowledgments The authors thank Satish C. Kalhan, MD, as we adapted portions of the text and several figures from his version of this chapter in the prior edition. Dr. Sarah Wernimont was supported by grant T32 DK112751. Dr. Andrew Norris and the previously unpublished data shown in this chapter were supported by grants R01 DK115791, R24 DK96518, and R01 DK097820. Introduction Glucose metabolism has been studied…

Long-Chain Polyunsaturated Fatty Acids in Neurodevelopment

Introduction The brain and retina contain large quantities of long-chain (20 and 22 carbon) n -3 and n -6 polyunsaturated fatty acids (LCPUFAs), particularly docosahexaenoic acid (DHA; 22:6 n -3) and arachidonic acid (AA; 20:4 n -6). , During the last intrauterine trimester , and the first 18 months of postnatal life, DHA and AA accumulate in neural tissue at a high rate, supported by selective…

Ketone Body Metabolism in the Neonate

Acknowledgments The authors are most grateful to previous edition contributors to this chapter, including Paul S. Thornton, whose leadership and input on the chapter’s themes and data (particularly within the tables) were invaluable. Introduction The metabolism of ketone bodies is evolutionarily conserved among all the domains of life on Earth. In mammals, ketone bodies are predominantly synthesized in the liver from acetyl coenzyme A (CoA) derived…

Lipids as an Energy Source for the Premature and Term Neonate

Acknowledgments The authors thank Dr. Peter Dodds for editing and linguistic revision of the manuscript. Preparation of this chapter was carried out in part with grants from the Universidad San Pablo—CEU, the Fundación Ramón Areces (CIVP16A1835) of Spain, and the Spanish Ministry of Science and Innovation (SAF2012-39273). Introduction In utero, the fetus receives a continuous supply of substrates for growth and oxidative metabolism, and produces large…

Brown Adipose Tissue: Development and Function

Introduction Mammals such as humans are exposed to their greatest temperature-related shock at birth. Coming from a protected and thermoneutral environment, the newborn infant is suddenly exposed to “cool” surroundings, where survival depends on self-generation of sufficient heat to keep warm. The development of the ability to regulate body temperature regardless of the temperature of the surroundings (and through this to ensure that activity of the…

Maternal-Fetal Transfer of Lipid Metabolites

Acknowledgments The authors thank pp-science-editing.com for editing and linguistic revision of the manuscript. Preparation of this chapter was carried out in part with grants from the Universidad CEU—San Pablo, and the Ministerio de Economía y Competitividad (SAF2015-70747-R) of Spain. CIBEROBN is an initiative of the Instituto de Salud Carlos III (ISCIII), Spain. Introduction Changes in maternal lipid metabolism during gestation control the availability of lipid metabolites…

Vitamin K Metabolism in the Fetus and Neonate

Introduction In his classic studies in the 1930s, Henrik Dam identified vitamin K as an essential fat-soluble antihemorrhagic factor. Later studies pinpointed the bleeding disorder caused by a dietary deficiency of vitamin K to a lack of four coagulation proteins, namely prothrombin (factor II) and factors VII, IX, and X, all of which are synthesized in the liver. Descriptions of a bleeding syndrome in newborns that…

Vitamin E Nutrition in Pregnancy and the Newborn Infant

Introduction Vitamin E, a micronutrient with antioxidant functions, has important actions in both intrauterine and postnatal life. Even in pregnant women with adequate vitamin stores, it seems that there is a transplacental barrier that limits its transfer to the fetus. Thus, physiologic concentrations of vitamin E are lower at birth, which makes newborns (especially premature infants) more susceptible to development of vitamin E deficiency (VED). This…

Vitamin A Metabolism in the Fetus and Neonate

Introduction Vitamin A (retinol) is an essential nutrient for all vertebrates. It was discovered in 1913 as an ether-soluble fraction present in certain fats and tissues, such as butter and egg yolk, that young rats required for growth and survival. Early in the history of vitamin A research, investigators demonstrated some of the fundamental properties of vitamin A, namely its indispensability for proper vision, immunity, reproduction,…

Zinc in the Fetus and Neonate

Introduction In a remarkably short time, the general perception of zinc has progressed from that of a rather obscure essential trace mineral of doubtful significance for human health to that of a micronutrient of exceptional biologic and public health importance. This is most evident in relation to early development, both prenatal and postnatal. Space allotted to an overview of trace minerals other than iron and zinc…

Fetal and Neonatal Calcium, Phosphorus, and Magnesium Homeostasis

Introduction Calcium, phosphorus, and magnesium are essential minerals that function in their physiologically active ionic forms in a wide range of cellular processes, and as key components of the bone mineral matrix. In utero, calcium, phosphorus, and magnesium are readily transferred from maternal to fetal circulations, and fetal mineral stores are predominantly accrued in the third trimester. In the postnatal period, the newborn must rapidly adapt…

Fetal and Neonatal Iron Metabolism

Acknowledgments Preparation of this chapter was supported by grants from the National Institutes of Health (NICHD) and the Scottish Government (Rural and Environmental Scientific and Analytical services, RESAS). Introduction Iron is the fourth most abundant element and constitutes approximately 0.0075% of human body composition. It is a cofactor in some of the most basic biologic reactions, yet its beneficial effects are tempered by the fact that…

Physiology of Lactation

Functional Anatomy of the Breast The human female breast is composed of a tubuloalveolar parenchyma embedded in a connective and adipose tissue stroma. The glandular component of the mature breast is composed of radially organized lobes, each connected to the nipple by a single milk duct. Each lobe is composed of multiple lobules containing the alveolar structures responsible for milk production and an associated network of…