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Early nutrition affects both the short-term and longer-term health and development of preterm infants. This chapter discusses the important differences in nutrient requirements in preterm infants compared with those in infants born at term. It provides the practicalities of meeting these requirements during the early postpartum period and following discharge. Despite greater appreciation of the importance of adequate nutrition for outcome in preterm infants and the existence of specific nutritional recommendations, it is widely recognized that these infants often exhibit suboptimal growth, which may persist for some time after hospital discharge and which may have adverse consequences for cognitive outcome. The use of breast milk is associated with a reduction in the incidence of necrotizing enterocolitis (NEC) and systemic infection and is associated with improved cognitive outcome, lower blood pressure, and more favorable plasma lipid profile during childhood and adolescence.
Many of the phenotypes associated with the large offspring syndrome (LOS) have features reminiscent of some naturally occurring human overgrowth syndromes, such as the Beckwith-Wiedemann syndrome (BWS), that are associated with errors in an imprinted cluster of genes on human chromosome. The major obstetric challenges facing those involved with assisted reproductive technologies (ART) continue to be preterm deliveries, low-birthweight babies and additional complications associated with multiple births. The alterations in genomic imprinting correlate with a varied range of aberrant fetal phenotypes that depend on the species in question, the type of insult during oocyte and/or preimplantation development, the gene(s) affected and the nature of the epigenetic modification. The process is known to involve active demethylation of paternal chromatin prior to syngamy in some but not all species, and may go some way to explain interspecies variation in imprinted gene expression following in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
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