This chapter focused on the unique aspects of fetal, term, and premature neonatal growth. In addition, we summarized recent advances in the fi elds of epigenetics, microbiome, and immunomodulators that might be able to alter both the fetal and neonatal development and growth as well as control their susceptibility to disease later in life.
As can be seen in Table 8.1 , in fl uences on fetal and neonatal growth are multi-factorial. Thus, when studying infant nutrition, special attention must be paid toward avoidance of confounding variables.
It would be optimal to have direct measurement of nutrients in human subjects compared using ran- domized controlled trials (RCT) whenever possible. When this is not possible, better animal models are needed. Fetal and neonatal growth is much more rapid than at any other point and future research is needed to establish frequent anthropometric measurements both during fetal and postnatal life. It is also important to use validated growth charts for research purposes. It has become clear that growth patterns and nutritional needs of preterm infants are unique and vary from that of the fetus and term infants. As such, better growth charts are needed that are speci fi c to preterm infants. Animal models are needed for better understanding of predictors of fetal and postnatal growth. As nutrient sources are variable, better and more direct measures of the intake of both macro- and micronutrients are needed in order to determine their effect on disease outcomes.
With regard to static measuring tools for fetal, preterm, and term growth, these should be accurate, readily available and cost-effective. To ease this process, more frequent use of the stadiometer is rec- ommended. In order to facilitate research, there should be increased availability and improved
techniques to measure total energy expenditure and body composition of term and preterm infants.
Dynamic tools should represent diverse, well-nourished populations with longitudinal, prospective measurements. One needs to use continuous sex-speci fi c reference z-scores among fetuses, preterm, and term infants for weight, length, head circumference, and weight-for-length.
Future research in the fi eld of epigenetics should focus on determining how epigenetic signatures are propagated, whether or not epigenetic modi fi cations are reversible throughout life, as well as to determine the “window” in which nutrient administration can alter the epigenetic code. As can be seen from the discussion in the chapter, the in fl uences of the microbiome on the health and development of neonates are vast. There is a need to further characterize how the microbiome is established and main- tained in the fetuses, preterm, and term infants. It is also important to determine which strains and doses of probiotics are protective against neonatal diseases. Finally, the chapter discusses the impor- tance of immunomodulators to neonatal health. It would be important to determine the associations of LCPUFA supplementation in pregnant women, preterm, and term infants and long-term neurodevel- opmental outcomes. Large RCT are needed to determine if arginine and glutamate supplementation can protect preterm infants from neonatal morbidities and mortality. With regard to oligosaccharides, there is a need to uncover mechanisms behind their ability to regulate the immune system.
Recent observations in the fi eld of epigenetics, microbiome, and immunomodulators suggest that both pre- and postnatal nutritional status have profound consequences later in life and affect one’s risk of a large number of childhood and adult on set diseases. In the future, it is essential to optimize both pre- and postnatal nutrition to prevent both under- and over-nutrition and to reduce the lifelong risk of chronic disease.
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