Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Placental Function in Intrauterine Growth Restriction

Acknowledgments We thank the previous authors, Yi-Yung Chen and Thomas Jansson, for their foundational work and expertise in writing the previous version of this chapter, many of the sections and figures which have been preserved in this revision. Introduction Definitions of Intrauterine Growth Restriction Intrauterine growth restriction (IUGR) remains one of the leading causes of perinatal and neonatal morbidity and mortality worldwide, with significant implications for…

Fetal Origins of Adult Disease: A Classic Hypothesis With New Relevance

Introduction In the late 1980s the late Dr. David J. P. Barker used historical birth records to pioneer the concept that the origins of adult disease could be strongly associated with fetal environmental exposures in pregnancy that resulted in low birth weight (BW) and modified both structure and function of tissues regulating human diseases later in life. Over the past several decades the fetal programming or…

Intra-Amniotic Infection/Inflammation and the Fetal Inflammatory Response Syndrome

Introduction Infection is the greatest killer in human history. The microbial theory of disease is probably the greatest advance in medicine, for it has made possible the identification of the cause of many diseases, the development of diagnostic modalities (i.e., cultivation of microorganisms), treatment with antimicrobial agents, and the development of vaccines. The achievements of the microbial theory of disease in medicine and public health are…

Endocrine and Paracrine Function of the Human Placenta

Introduction The placenta produces a greater diversity of hormones in greater quantity than any other single endocrine tissue. Near term, steroid hormones (primarily estrogens and progestins) are being made at the rate of 0.5 g/day, and protein hormones (lactogens, growth factors, and other hormones similar to those of the hypothalamic-pituitary-adrenal axis) are being made at more than twice this rate. Although the secretory nature of the…

Mechanisms of Transfer Across the Human Placenta

Introduction Transfer of solutes across the placenta is essential for fetal growth and development. Placental transfer occurs in both directions, with maternal nutrients transferred to the fetus and fetal wastes to the mother. A wide range of nutrients and wastes must be transported across the placenta requiring multiple different transport processes. Insufficient placental transfer of nutrients or wastes can impair fetal growth and development. When poor…

Regulation of the Placental Circulation

Acknowledgments Research on which this chapter is based was supported by National Institutes of Health grant HD-008783-39 and the George L. MacGregor Professorship in Pediatrics. I thank the many co-investigators and students who, while in my laboratories, facilitated many of our studies. Overview Pregnancy is associated with numerous alterations to the maternal cardiovascular system; however, it is the development of the low-resistance, high-flow placental vascular bed…

Placental Development

Acknowledgments This chapter is a rewritten and updated form of a chapter appearing in a prior edition of this work, written by Dr. Hans-Georg Frank. Portions of the figures and writing remain Dr. Frank’s words. The authors are indebted to Dr. Frank’s contribution to the knowledge of placental structure, histopathology, and development as the scientific community understands it today. Introduction For millennia, the remarkable ability of…

Prenatal Diagnosis

Introduction The prenatal diagnosis of a fetal genetic disorder or a chromosome abnormality generally requires invasive testing; all of the invasive tests carry small but recognized risks of miscarriage. Accordingly, an important aspect of prenatal care is screening to identify those women who face an increased risk of a pregnancy complicated by aneuploidy, genetic syndrome, or congenital malformation. Screening modalities include review of the clinical history…

Angiogenesis

Introduction Embryologically, the cardiovascular system is the first to develop. The vasculature, composed of endothelial cells and their support cells, is critical not only for circulation of blood, but also for the organization, maintenance, and regeneration of multiple organ systems. The embryo forms a primary vascular plexus so that blood vessels first arise through a process called vasculogenesis. Further vessels are generated via sprouting and nonsprouting…

The Extracellular Matrix in Development

Introduction During embryonic patterning, individual cells divide, migrate, differentiate, and respond to environmental cues. The extracellular matrix (ECM) is effectively involved in all these dynamic processes during development, maintenance, and disease. Cells are continuously connected with the ECM, a latticework of glycoproteins that provides structural support and spatial arrangement and directs tissue morphogenesis. The ECM provides a specialized microenvironment that regulates cell behavior by interacting with…

Regulation of Embryogenesis

Introduction Embryogenesis results from the divergent proliferation, migration, survival, and differentiation of cells derived from a single cell, the fertilized egg. Regulatory signals, applied to successive generations of cells, establish the architecture of the early embryo. The same processes are recapitulated during the subsequent development of limbs, organs, and craniofacial structures. Consequently, disruption of these reiterative mechanisms distorts seemingly unrelated structures, as observed in human malformation…

Basic Embryology

Acknowledgments We thank Dr. Stanley Kaplan for his valuable contributions to the previous edition of this chapter. Introduction The human embryo begins as a single large cell, approximately 0.1 mm in diameter, just visible to the unaided eye. During the 266 days of gestation after fertilization, this cell increases in size, weight, and surface area in a rapid and markedly nonlinear fashion. From newly fertilized egg…

Epigenetics

Principles of Epigenetics Introduction to Epigenetics The publication of the majority of the human genome sequence in 2001 , was the precursor to many important discoveries. However, the human genome sequence has not provided researchers with the codex to fully understand the genome’s functionality or to predict its response to environmental cues (such as nutritional challenges). One reason why this is the case is that the…

Basic Genetic Principles

Introduction The human genome refers to the complete set of human DNA (with the suffix -ome arising from the Greek for “all” or “complete”). A copy of our genome comprises approximately 3 billion base pairs (bp) and about 20,000 protein-coding genes. The Human Genome Project was a significant contribution toward understanding the organization, structure, and sequence of the human genome. , With these developments, genomic medicine…

Schedule for Immunization of Preterm Infants

Keywords immunizations hepatitis B vaccine All Preterm Infants Vaccine doses should not be reduced for preterm infants. Use thimerosal-free vaccines. Intramuscular injections to preterm infants might require a shorter needle than the standard 5/8 to 1” needle. Immunizations may be given during corticosteroid administration. Palivizumab (synagis) should be given according to the respiratory syncytial virus policy. Preterm infants should receive a full dose of diphtheria and…

Tables of Normal Values

Physiologic Parameters Blood Pressure TABLE B.1 Blood Pressure Values in Neonatal Period after Two Weeks of Age, by Gestational Age Modified from Nickavar A and Assadi F. Managing hypertension in newborn infants. Int J Prev Med . 2014;5(Suppl 1):S39-S43. Gestational Age (weeks) Blood Pressure (mm Hg) Percentile Systolic Diastolic Mean 26-28 50th 55-60 30-38 38-45 95th 72-75 50-50 57-58 99th 77-80 54-56 63-63 30-32 50th 65-68…

Congenital Abnormalities of the Upper and Lower Extremities and Spine

Upper Extremities Congenital abnormalities of the upper extremities are those that occur during the embryonic period. Developmental deformities are those that occur primarily in the fetal or neonatal period. Because a developmental deformity may have a prenatal association, such as in utero positioning, it could be misinterpreted as a congenital abnormality. Congenital and developmental disorders of the upper extremities are less common than those affecting the…

Bone and Joint Infections in Neonates

Bacterial infections of the neonatal skeletal system are potentially disabling because of damage to the articular cartilage and epiphysis. Prompt diagnosis and treatment are imperative to prevent sequelae. Unfortunately, neonates with skeletal infections do not usually have the classic symptoms or laboratory findings of sepsis early on because of their immature immune systems. Feeding intolerance, reduced movement, and/or irritability may be the only early signs of…

Musculoskeletal Disorders in Neonates

Musculoskeletal abnormalities of the extremities, spine, and pelvis are common in the neonate. Some are pathologic and others physiologic in origin from normal in utero positioning. The congenital absence of all or part of a limb, deformities of the feet or hands, and abnormalities of the spine are rarely diagnostic problems, whereas others, such as developmental dysplasia of the hip (DDH), may escape diagnosis even after…