Hot off the presses! Apr 01 NeoReviews

The Apr 01 issue of the NeoReviews is now up on Pubget (About NeoReviews): if you're at a subscribing institution, just click the link in the latest link at the home page. (Note you'll only be able to get all the PDFs in the issue if your institution subscribes to Pubget.)

Latest Articles Include:

• International Perspectives: Nasal Ventilation in Preterm Infants: An Israeli Perspective
  - NeoReviews 10(4):e157-165 (2009)
  NRS is a noninvasive method of maintaining functional residual capacity without endotracheal ventilation. NRS, which includes nasal continuous positive airway pressure (NCPAP) and nasal ventilation, is an effective mode of treatment for preterm infants, especially in the era of prenatal corticosteroids. NRS has been used for the initial treatment of RDS, after extubation as a "bridge" to spontaneous unsupported breathing, and for the treatment of apnea of prematurity. However, NRS may not be sufficiently effective alone as the primary therapy for preterm infants who have RDS, especially for extremely preterm infants who have severe RDS. A significant number of such infants still need endotracheal ventilation, possibly due, in part, to not using surfactant. A new approach involves administration of surfactant during brief intubation followed by immediate extubation to NRS. This review examines recently developed noninvasive ventilatory strategies and offers a logical ph! ysiologic and evidence-based flow chart to aid in bedside decision making from the delivery room to the point of spontaneous unsupported breathing. Also discussed are issues that may be especially pertinent to outlying facilities that have limited personnel and equipment resources.
• Intestinal Microbiota: Does It Play a Role in Diseases of the Neonate?
  - NeoReviews 10(4):e166-179 (2009)
  Humans maintain a diverse, dynamic, and complex intestinal microbiota that performs a multitude of vital functions, such as growth and development of the epithelial barrier, stimulation of intestinal angiogenesis, regulation of nutrition, metabolic functions, and education of naive neonatal innate immunity. After birth, host environment and attributes lend and opt for a stable intestinal microbiota for long-term symbiosis. Dysregulation (dysbiosis) of this process during the early postnatal period can form the basis for later inflammatory, immune, and allergic disorders. The initial immunologic exposure of neonates has long-term consequences. Because of this remarkable influence of microbiota on health and disease, learning about characteristics of microbiota and the factors that modulate it has become the focus of ongoing research. Further knowledge in this field should assist in developing strategies to promote health and prevent diseases. This article reviews recent! advances in the understanding of microbiota.
• The Intestinal Immune Barrier
  - NeoReviews 10(4):e180-190 (2009)
  As the largest interface with the external environment, the mature intestinal epithelium has remarkable physiologic responsibilities. The intestine must function first as an organ of absorption and digestion while simultaneously protecting itself from the vast bacterial flora, array of food antigens, and physiochemical stresses caused by digestive and microbial products. Thus, the intestinal epithelium must be permeable to nutrients and fluids, yet remain impermeable to potentially injurious chemicals and pathogens. The intestine also must differentiate between commensal organisms whose growth is encouraged and enteric pathogens that need to be suppressed or eliminated. The single layer of cells comprising the intestinal epithelium is critical for maintenance of this dynamic barrier. The developing neonatal gut faces an additional daunting challenge of successfully negotiating the transition from a sterile lumen devoid of digestive and microbial metabolic products to t! he fully realized "bioreactor" of the adult gut. This review describes the unique structural features and elements of innate host defense elaborated by this dynamic tissue.
• Early Life Stress Induces Both Acute and Chronic Colonic Barrier Dysfunction
  - NeoReviews 10(4):e191-197 (2009)
  Exposure to stress in early life can have a profound impact on health in later life, including intestinal pathology. Maternal separation is a well-established and reproducible model of early life stress in rodents that leads to the development of mood disorders and altered intestinal function, including visceral hypersensitivity, colonic dysmotility, and increased intestinal permeability. In this article, we highlight the consequences of disruption of normal programming after exposure to maternal separation in neonates: the development of intestinal alterations in both neonatal and adult animals as well as the accompanying behavioral changes. Mechanisms of action include corticotropin-releasing factor (CRF) and nerve growth factor (NGF), which signal both in the brain and in the periphery. Exposure to stress in early life also can alter bacterial colonization, which is prevented by treatment with probiotic organisms. We conclude by highlighting the link between stress ! and colonic permeability in humans, including the increased risk of disease relapse in irritable bowel syndrome (IBS) and inflammatory bowel diseases (IBD).
• Index of Suspicion in the Nursery
  - NeoReviews 10(4):e198-200 (2009)
  
• Strip of the Month: April 2009
  - NeoReviews 10(4):e201-209 (2009)