Difference between revisions of "Gastrointestinal Tract - Postnatal"

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===Necrotizing Enterocolitis===
 
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| * (NEC) is a disease affecting infants born prematurely (mortality rate of 15-30%)
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* (NEC) is a disease affecting infants born prematurely (mortality rate of 15-30%)
 
* usually occurs in the second week of life after the initiation of enteral feeds
 
* usually occurs in the second week of life after the initiation of enteral feeds
 
* pathogenesis is multifactorial
 
* pathogenesis is multifactorial
 
* appears to involve an overreactive response of the immune system to an insult.
 
* appears to involve an overreactive response of the immune system to an insult.
 
* increased intestinal permeability, bacterial translocation, and sepsis.
 
* increased intestinal permeability, bacterial translocation, and sepsis.
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| Neonate necrotizing enterocolitis bacteria colonizing intestinal tissue.<ref><pubmed>21486476</pubmed>| [http://www.biomedcentral.com/1471-2180/11/73 BMC Microbiol.]</ref>
 
| Neonate necrotizing enterocolitis bacteria colonizing intestinal tissue.<ref><pubmed>21486476</pubmed>| [http://www.biomedcentral.com/1471-2180/11/73 BMC Microbiol.]</ref>
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Revision as of 17:29, 2 May 2011

Introduction

This page is an introduction to postnatal gastrointestinal tract development. This nutritionally involves a change from prenatal placental vascular nutrition to postnatal oral colostrum/milk enteral nutrition (enteral = nutritient delivery as fluid into the gastrointestinal tract). Also look at the topic of Milk in relationship to neonatal nutrition. The postnatal gastrointestinal tract development is also about increased activity of the tract and associated organs as well as the populating with intestinal flora in the tract. This is also the pathway for initial passive immunity through absorption of maternal immunoglobulin from breast milk.

These notes should be read in conjunction with the related page on Milk and an understanding of prenatal Gastrointestinal Tract Development.

Some Recent Findings

  • Gram negative bacteria are associated with the early stages of necrotizing enterocolitis.[1] In a mouse model of the disease "Citrobacter, Klebsiella, and Tatumella are associated with Necrotizing enterocolitis (NEC). Differential colonic bacteria were identified despite the lack of inflammatory mediator elevation traditionally associated with NEC. This suggests a temporal relationship between bacteria and inflammatory mediators such that alterations in gut microbiota are associated with early NEC, while inflammatory mediator elevation is associated with advanced NEC."

Lipid Signalling

Lipids present in the intestine leads to a reduction in nutrient intake. Recent research has shown that lipids present in the intestine can also regulate endogenous nutrient production.[2]

Signalling pathway: presence of ingested lipids - intestinal lipid sensors - signal to the brain - liver - reduction in endogenous glucose production

Insulin-like Growth Factors

Some evidence to suggest that in preterm infants IGFBP-2 and IGF-II present in breast milk may have an important role in their early development.

  • insulin-like growth factors (IGFs) and IGF binding proteins (IGFBPs)

Gut Microorganism Population

The normal newborn gastrointestinal tract contains little if any microorganisms (commensal intestinal microbiota, microbiota, flora, microflora). Postnatally, the tract has to be populated by microorganisms, which are mainly anaerobic bacteria and then aerobic bacteria, but may also include yeast and fungi. The foregut comparatively has few microorganisms when compared to the midgut and hindgut.

Infections

There are several infectious pathogens that can populate the postnatal gut leading to a number of different diseases:

  • Escherichia coli (enterotoxigenic)
  • Shigella a gram-negative, non-spore forming rod-shaped bacteria infectious through poor hygeine and ingestion, fecal–oral contamination. (More? Dysentery)
  • Vibrio cholerae
  • Listeria

Antibiotics

Treatment of other neonatal infections systemically with antibiotics can alter the bacterial population.


Links: Medical Microbiology - Microbiology of the Gastrointestinal Tract


Meconium

As introduced in fetal development, meconium is formed from gut and associated organ secretions as well as cells and debris from the swallowed amniotic fluid. Meconium accumulates during the fetal period in the large intestine (bowel). It can be described as being a generally dark colour (green black) , sticky and odourless.

  • In fetal development, meconium is formed from gut and associated organ secretions as well as cells and debris from the swallowed amniotic fluid.
  • Meconium accumulates during the fetal period in the large intestine (bowel).
  • It can be described as being a generally dark colour (green black) , sticky and odourless.

Normally this meconium is defaecated (passed) postnatally over the first 48 hours and then transitional stools from day 4.

Abnormally this meconium is defaecated in utero, due to oxygen deprivation and other stresses.

Abnormalities

Meconium Aspiration Syndrome

  • Premature discharge into the amniotic sac can lead to mixing with amniotic fluid and be reswallowed by the fetus.
  • This is meconium aspiration syndrome and can damage both the developing lungs and placental vessels.
  • Absence or delayed passage of meconium may indicate conditions associated with meconium plugs or more seriously, Hirshsprung's disease (aganglionic colon, megacolon).
  • Delayed conversion to transitional stools may indicate a feeding issue.

Infections

There are several infectious pathogens that can populate the postnatal gut leading to a number of different diseases:

  • Escherichia coli (enterotoxigenic)
  • Shigella a gram-negative, non-spore forming rod-shaped bacteria infectious through poor hygeine and ingestion, fecal–oral contamination. (More? Dysentery)
  • Vibrio cholerae
  • Listeria


Necrotizing Enterocolitis

  • (NEC) is a disease affecting infants born prematurely (mortality rate of 15-30%)
  • usually occurs in the second week of life after the initiation of enteral feeds
  • pathogenesis is multifactorial
  • appears to involve an overreactive response of the immune system to an insult.
  • increased intestinal permeability, bacterial translocation, and sepsis.
Neonate necrotizing enterocolitis bacteria colonizing intestinal tissue.jpg
Neonate necrotizing enterocolitis bacteria colonizing intestinal tissue.[3]

Mouse - analysis of colonic microbiota.jpg

Links: PubMed Health | MedlinePlus

References

  1. <pubmed>21445365</pubmed>| PLoS One.
  2. <pubmed>18401341</pubmed>
  3. <pubmed>21486476</pubmed>| BMC Microbiol.


Search Pubmed

Search Pubmed Now: postnatal gastrointestinal development


Glossary Links

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Cite this page: Hill, M.A. (2019, November 23) Embryology Gastrointestinal Tract - Postnatal. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Gastrointestinal_Tract_-_Postnatal

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© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G