Metabolic adaptation at birth

Newcastle Neonatal Services, Royal Victoria Infirmary, Department of Child Health, Queen Victoria Road, Newcastle upon Tyne NE1 4 LP, UK.
Seminars in Fetal and Neonatal Medicine (Impact Factor: 3.03). 09/2005; 10(4):341-50. DOI: 10.1016/j.siny.2005.04.001
Source: PubMed


After birth, the neonate must make a transition from the assured continuous transplacental supply of glucose to a variable fat-based fuel economy. The normal infant born at term accomplishes this transition through a series of well-coordinated metabolic and hormonal adaptive changes. The patterns of adaptation in the preterm infant and the baby born after intrauterine growth restriction are, however, different to that of a full-term neonate, with the risk for former groups that there will be impaired counter-regulatory ketogenesis. There is much less precise linkage of neonatal insulin secretion to prevailing blood glucose concentrations. These patterns of metabolic adaptation are further influenced by feeding practices.

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    • "The neonate must become independent after birth,[27] transitioning from a continuous intravenous supply of predominantly glucose as fuel to a variable and intermittent exogenous intake orally that is the hallmark of the neonatal period. This successful adaptation requires not only an immediate catabolic cascade but also adaptation to enteral feeding. "
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    ABSTRACT: Fetus exists in a complex, dynamic, and yet intriguing symbiosis with its mother as far as fuel metabolism is concerned. Though the dependence on maternal fuel is nearly complete to cater for its high requirement, the fetus is capable of some metabolism of its own. The first half of gestation is a period of maternal anabolism and storage whereas the second half results in exponential fetal growth where maternal stores are mobilized. Glucose is the primary substrate for energy production in the fetus though capable of utilizing alternate sources like lactate, ketoacids, amino acids, fatty acids, and glycogen as fuel under special circumstances. Key transporters like glucose transporters (GLUT) are responsible for preferential transfers, which are in turn regulated by complex interaction of maternal and fetal hormones. Amino acids are preferentially utilized for growth and essential fatty acids for development of brain and retina. Insulin, insulin like growth factors, glucagon, catecholamines, and letpin are the hormones implicated in this fascinating process. Hormonal regulation of metabolic substrate utilization and anabolism in the fetus is secondary to the supply of nutrient substrates. The knowledge of fuel homeostasis is crucial for a clinician caring for pregnant women and neonates to manage disorders of metabolism (diabetes), growth (intrauterine growth restriction), and transitional adaptation (hypoglycemia).
    03/2013; 17(1):60-8. DOI:10.4103/2230-8210.107851
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    • "For mothers with diabetes, breastfeeding may be more challenging than for mothers without diabetes. The initiation and establishment is often affected by birth related complications [10,11]; their newborns often show a premature sucking pattern [12] and often need early feeding because of a high risk of hypoglycaemia [13,14]. Early initiation of breastfeeding is shown to be a strong predictive factor for long-term breastfeeding of infants whose mothers have type 1 diabetes [10,11]. "
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    ABSTRACT: Background For mothers with diabetes, breastfeeding is a great challenge due to their struggle with potentially unstable blood glucose levels. This paper explores breastfeeding attitudes and impact of breastfeeding on the daily life of mothers with type 1 diabetes compared with non-diabetic mothers. Methods We performed a prospective cohort study of 108 mothers with type 1 diabetes and a reference group of 104 mothers in the west of Sweden. Data were collected through medical records and structured telephone interviews at 2 and 6 months after childbirth. Results Women in both the diabetes group and the reference group had high levels of confidence (84% and 93% respectively) in their breastfeeding capacity before childbirth, and 90% assessed breastfeeding as a positive and an important experience during the six months of follow-up. About 80% assessed breastfeeding as influencing daily life ‘very much’ or ‘quite a lot’ at 2 months as did 60% at 6 months, with no difference between the groups. In mothers with diabetes, the impact of breastfeeding on the priority of other duties decreased over time, as did feelings of time pressure and negative effects on patterns of sleep. Compared to the reference group, mothers with diabetes at 6 months remained more affected by disruptions in daily life and they felt more worried about their health both at 2 and 6 months after childbirth. For the reference group mothers’ sensitivity to unexpected disruptions in daily routines decreased between 2 and 6 months after childbirth, and they expressed a greater need to organize their time than mothers with diabetes. Conclusion Mothers with diabetes type 1 express more worry for own health and are more sensitive to distruptions. To balance their everyday life and to reduce the risk of stress and illhealth they are therefor, compared to other mothers, likely to need additional professional and peer support.
    International Breastfeeding Journal 12/2012; 7(1):20. DOI:10.1186/1746-4358-7-20
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    • "Lactate is commonly recognized as an important metabolic substrate during early development (Erecinska et al., 2004; Medina and Tabernero, 2005; Ward Platt and Deshpande, 2005). However, a very limited number of studies investigated the effects of lactate or other energy substrates (e.g., ketone bodies, pyruvate) on neuronal excitability. "
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    ABSTRACT: Although numerous experimental data indicate that lactate is efficiently used for energy by the mature brain, the direct measurements of energy metabolism parameters during neuronal network activity in early postnatal development have not been performed. Therefore, the role of lactate in the energy metabolism of neurons at this age remains unclear. In this study, we monitored field potentials and contents of oxygen and NAD(P)H in correlation with oxidative metabolism during intense network activity in the CA1 hippocampal region of neonatal brain slices. We show that in the presence of glucose, lactate is effectively utilized as an energy substrate, causing an augmentation of oxidative metabolism. Moreover, in the absence of glucose lactate is fully capable of maintaining synaptic function. Therefore, during network activity in neonatal slices, lactate can be an efficient energy substrate capable of sustaining and enhancing aerobic energy metabolism.
    Frontiers in Neuroenergetics 05/2011; 3(2):2. DOI:10.3389/fnene.2011.00002
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