Perinatal Physiology

I: Growth and Physiologic Changes at Birth.- 1: Intrauterine Growth.- 1. Introduction.- 2. Growth and Maturation.- 3. Components of Fetal Growth.- 4. The Placenta.- 5. Perinatal Mortality in Relation to Fetal Growth and Maturation.- 6. References.- 2: The Placenta: An Overview.- 1. Introduction.- 2. “Growth and Development” of the Placenta.- 3. Placental Metabolism.- 4. Endocrine Functions.- 5. Immunologic Functions.- 6. Placental Transport.- 7. The Fetal “Parasite”.- 8. Maternal-Placental-Fetal Interaction.- 9. References.- 3: Maturation, Adaptation, and Tolerance.- 1. Introduction.- 2. Maturation.- 3. Adaptation.- 4. Stimulation.- 5. Birth Stress and Tolerance.- 6. Perspectives.- 7. References.- 4: Postnatal Growth.- 1. Introduction.- 2. Velocity.- 3. Length.- 4. Body Weight.- 5. Other Patterns.- 6. Norms.- 7. The Infant of Low Birth Weight (ILB).- 8. Addendum: Normative Growth Data References.- 9. References.- 5: The Skeleton.- 1. Introduction.- 2. Weight of the Total Osseous Skeleton in Relation to Age.- 3. Length of Long Limb Bones.- 4. Density of Long Limb Bones.- 5. Percentage Ash Weight of the Total Skeleton and Its Parts.- 6. Conclusions.- 7. References.- II: Respiration, Circulation, and Blood.- 6: Respiration and the Respiratory System.- 1. Fetal Respiration.- 2. Development of the Fetal Respiratory System.- 3. Initiation of Respiration at Birth.- 4. Maintenance of Breathing after Birth.- 5. References.- 7: Lung Maturity and Pulmonary Phospholipid Metabolism.- 1. Introduction.- 2. Substrate Utilization in the Lung.- 3. Phospholipid Composition.- 4. The Choline Pathway.- 5. The Methylation Pathway.- 6. The Lysolecithin Pathway.- 7. Phosphatidylglycerol.- 8. Enzymatic Regulation.- 9. Clinical Considerations.- 10. Glucocorticosteroids and Fetal Lung Metabolism.- 11. Questions and Perspectives.- 12. References.- 8: The Fetal Circulation and Its Alteration at Birth.- 1. Introduction.- 2. Fetal Circulation.- 3. Neonatal Circulation.- 4. Conclusion.- 5. References.- 9: Blood Volume.- 1. Introduction.- 2. Blood Volume in the Pregnant Woman.- 3. Circulatory Alterations in the Placenta.- 4. Placental Transfusion.- 5. Blood Volume in Newly Born Infants.- 6. Special Clinical Considerations.- 7. Conclusions.- 8. References.- 10: Formed Elements of Human Blood.- 1. Introduction.- 2. Development of Blood Cells in the Fetus.- 3. Erythrocytes.- 4. Leukocytes.- 5. Platelets.- 6. References.- 11: The Hemoglobins.- 1. Introduction.- 2. Hematopoiesis in the Human Embryo and Fetus.- 3. Hemoglobin—Quantitative and Qualitative Aspects.- 4. Hemoglobin Types in Man.- 5. Ontogeny of Human Hemoglobin.- 6. Future Outlook.- 7. References.- 12: Respiratory Gas Transport Characteristics of Blood and Hemoglobin.- 1. Introduction.- 2. Oxygen Transport.- 3. Carbon Dioxide Transport.- 4. References.- 13: Blood Coagulation Factors and Fibrinolysis.- 1. Introduction.- 2. Current Concepts of the Mechanism of Hemostasis.- 3. Coagulation Factors and Fibrinolysis in the Fetus.- 4. Coagulation Factors and Fibrinolysis in the Premature Infant.- 5. Coagulation Factors and Fibrinolysis in the Full-Term Newborn.- 6. Transitory Deficiencies of the Coagulation Factors in the Newborn.- 7. Hereditary Deficiencies of the Coagulation Factors.- 8. References.- 14: Maturation of Cellular and Humoral Immunity.- 1. Introduction: Antibody-Mediated Immunity and Cell-Mediated Immunity.- 2. Identification of T and B Lymphocytes.- 3. Development of T and B Lymphocytes in the Fetus.- 4. Human Immunoglobulins.- 5. Immunoglobulins in Pregnant Women.- 6. Immunoglobulins in Fetal Blood.- 7. Development of the Postnatal Immunoglobulin Pattern.- 8. Immunoparalysis and Immune Tolerance.- 9. References.- III: Metabolism.- 15: Digestion and Absorption.- 1. Introduction.- 2. Structural Development of the Digestive Tract.- 3. Motility of the Digestive Tract.- 4. Digestion and Absorption of Carbohydrates.- 5. Digestion and Absorption of Protein.- 6. Digestion and Absorption of Lipids.- 7. Absorption of Minerals and Vitamins.- 8. References.- 16: Nutrition of the Newborn.- 1. Fetal Nutrition.- 2. Experimental Intrauterine Growth Retardation.- 3. Neonatal Nutrition.- 4. Late Effects of Early Nutrition.- 5. References.- 17: Carbohydrate Metabolism and the Regulation of Blood Glucose.- 1. Introduction.- 2. Development of Metabolic Pathways.- 3. Regulation of Blood Glucose Levels.- 4. Summary and Conclusions.- 5. References.- 18: Protein and Amino Acid Metabolism.- 1. Introduction.- 2. The Fetus.- 3. The Premature Infant.- 4. The Full-Term Infant.- 5. References.- 19: Lipids.- 1. Introduction.- 2. Fatty Acids.- 3. Neutral Fat (Triglycerides or Triacylglycerols).- 4. Phospholipids.- 5. Cholesterol.- 6. Adipose Tissue.- 7. Regulatory Factors.- 8. Perspectives.- 9. Conclusions.- 10. References.- 20: Functions and Metabolism of Trace Elements.- 1. Introduction and Background.- 2. Perinatal Metabolism of Trace Elements.- 3. Functions of Individual Essential Trace Elements with Special.- Reference to the Perinatal Period.- 4. Interactions of Trace Elements.- 5. References.- 21: Heat Production and Temperature Regulation.- 1. Introduction.- 2. Heat Production.- 3. Heat Exchange with the Environment.- 4. Regulation of Body Temperature.- 5. Ontogenetic and Adaptive Alterations in the Thermoregulatory System.- 6. Pathophysiology and Clinical Aspects.- 7. References.- 22: Liver Enzymes.- 1. Introduction.- 2. Growth, Structure, and Composition of the Liver in the Perinatal Period..- 3. Enzyme Activities and Metabolic Potentials.- 4. Enzyme Development.- 5. Initiation of Enzyme Formation in the Perinatal Period.- 6. Conclusions.- 7. References.- 23: Bilirubin Metabolism.- 1. Introduction.- 2. Bilirubin Metabolism.- 3. Bilirubin Metabolism in the Fetus.- 4. Bilirubin Metabolism in the Neonate.- 5. Pathologic Hyperbilirubinemia in the Neonate.- 6. Prevention of Bilirubin Encephalopathy.- 7. Conclusion.- 8. References.- 24: Development of the Ornithine-Urea Cycle.- 1. Introduction.- 2. Concentrations of Urea in the Fetus and the Fetal Fluids.- 3. Overall Synthesis of Urea by the Human Fetal Liver.- 4. Development of the Urea Cycle Enzymes in the Human Liver.- 5. Conclusion.- 6. References.- 25: Hepatic Drug Metabolism.- 1. Introduction.- 2. Mechanisms of Drug Transport and Metabolism.- 3. Perinatal Drug Metabolism and Excretion.- 4. Clinical Pharmacology of Perinatal Hepatic Drug Metabolism.- 5. References.- IV: Body Fluids and Renal Function.- 26: Electrolyte and Water Metabolism.- 1. The Fetal Fluids.- 2. Changes in Body Water Compartments and Electrolyte Contents During Growth:.- 3. Body Fluid Homeostasis in the Newborn.- 4. Conclusions.- 5. References.- 27: The Kidney.- 1. Introduction.- 2. Technical Problems of Studying Perinatal Renal Function.- 3. Anatomic Maturation of the Mammalian Kidney.- 4. Renal Hemodynamics in the Perinatal Kidney.- 5. Glomerular Filtration Rate in the Perinatal Animal.- 6. Tubular Transport in the Perinatal Kidney.- 7. Excretion of Sodium by the Perinatal Kidney.- 8. Excretion and Conservation of Water in the Perinatal Kidney.- 9. Acid Excretion by the Perinatal Kidney.- 10. Summary and Conclusions.- 11. References.- 28: Calcium and Phosphorus Metabolism.- 1. Introduction.- 2. The Antenatal Period.- 3. The Postnatal Period.- 4. Summary.- 5. References.- V: The Neuromuscular System.- 29: Physiology and Pharmacology of the Central Nervous System.- 1. Introduction.- 2. Brain Constituents.- 3. The Blood-Brain Barrier.- 4. Metabolism.- 5. Electrophysiologic Activity.- 6. Pharmacology of the Neonate.- 7. References.- 30: Function of the Nervous System During Prenatal Life.- 1. Introduction.- 2. Historical Background of the Investigations of Human Fetal Activity.- 3. Effects of Anoxia, Asphyxia, Narcotics, and Anesthetics on Fetal Reflexes..- 4. Significance of Different Types of Stimuli.- 5. Theories on the Development of Fetal Behavior.- 6. Determination of Fetal Age.- 7. First Reflexes Elicited by Exteroceptive Stimulation: Contralateral Total Pattern Flexion Reflexes.- 8. Ipsilateral Total Pattern Flexion Reflexes.- 9. Classification of Reflexes as Negative and Positive Reactions.- 10. Pathways and Areas Involved in the Total Pattern Reflexes.- 11. Characteristics of Reflexes from 8.5 to 10 Weeks of Menstrual Age (26.0–41.0 mm CR).- 12. Development of Head and Trunk Extension Reflexes.- 13. Development of Local Reflexes in Response to Stimulation of the Face...- 14. Mouth-Opening and -Closing Reflexes at 11 Weeks of Menstrual Age and Later.- 15. Tongue Movements.- 16. Swallowing Reflexes.- 17. Gag Reflexes.- 18. Lip Movements and Sucking.- 19. Respiratory Reflexes.- 20. Crying.- 21. Reflexes Associated with the Eyes.- 22. Reflexes Elicited by Stimulation of the Genital and Anal Regions.- 23. Tonic Neck Reflexes.- 24. Extremity Reflexes.- 25. Sequence of Development of Sensitivity to Light Touch.- 26. Other Types of General Sensation.- 27. Special Senses During Intrauterine Life.- 28. Closing Comments.- 29. References.- 31: Neonatal Brain Mechanisms and the Development of Motor Behavior.- 1. Introduction.- 2. Spinal Cord and Peripheral Nerves.- 3. The Rhombencephalic Reticular Formation and the Neuronal Control of Breathing.- 4. The Vestibular System and the Nucleus Ruber.- 5. The Cerebellum.- 6. The Basal Ganglia.- 7. The Cerebral Motor Cortex.- 8. Clinical Applications.- 9. Perspectives.- 10. References.- 32: Biochemistry of Muscle Development.- 1. Introduction.- 2. Myogenesis.- 3. Nucleic Acids and Protein Synthesis.- 4. Muscle Proteins.- 5. Water and Electrolytes.- 6. Peptides and Amino Acids.- 7. Conclusions.- 8. References.- 33: The Autonomic Nervous System.- 1. Introduction.- 2. Control of Cardiac Function.- 3. Peripheral Vascular Regulation.- 4. Pulmonary Vascular Regulation.- 5. The Cardiorespiratory Unit and the Sudden Infant Death Syndrome.- 6. Conclusion.- 7. References.- 34: The Visual System.- 1. Introduction.- 2. Visual Function.- 3. Retinal Development.- 4. Lower and Central Visual Pathways.- 5. Ocular Motility.- 6. Intraocular Pressure.- 7. The Pupil.- 8. The Lacrimal System.- 9. Refractive State.- 10. Summary.- 11. References.- 35: The Auditory Response.- 1. Introduction.- 2. Fetal Auditory Response.- 3. Neonatal Auditory Response.- 4. Clinical Aspects.- 5. References.- 36: Morphological and Functional Development of the Skin.- 1. Introduction.- 2. Morphology and Embryology of Neonatal Skin.- 3. Physiology of Fetal Skin.- 4. Physiology of Neonatal Skin.- 5. Physiology of the Dermis.- 6. Cutaneous Immunity.- 7. Conclusions.- 8. References.- VI: The Endocrine System.- 37: Steroid Hormone Formation and Metabolism.- 1. Introduction.- 2. Onset of Functional Capability in the Fetal Adrenal.- 3. Steroid Metabolism in the Perfused Previable Fetus at Midterm.- 4. Placental Contribution to the Metabolism of Steroids.- 5. The Maternal Compartment.- 6. Function of the Fetal Adrenal Cortex.- 7. Control of Fetal Adrenal Secretion.- 8. Adrenal Function in the Neonatal Period.- 9. Conclusion.- 10. References.- 38: The Anterior Lobe of the Hypophysis.- 1. Introduction.- 2. Human Growth Hormone (HGH).- 3. Adrenocorticotropin (ACTH).- 4. Thyrotropin (TSH).- 5. Gonadotropins.- 6. Prolactin (PRL).- 7. Summary.- 8. References.- 39: Insulin and Glucagon.- 1. Introduction.- 2. Synopsis of Insulin and Glucagon Secretion and Action.- 3. Embryonic Development of the Endocrine Pancreas.- 4. Metabolic Effects of Insulin in Utero.- 5. Glucagon in the Fetus.- 6. Insulin and Glucagon in the Immediate Neonatal Period.- 7. Infants of Diabetic Mothers.- 8. Transient Hypoglycemia in Premature and Small-for-Gestational-Age Infants.- 9. Transient Diabetes of the Newborn.- 10. Erythroblastosis Fetalis.- 11. Conclusions.- 12. References.- 40: Thyroid Hormones.- 1. Introduction.- 2. Maternal Thyroid Function.- 3. Development of the Fetal Thyroid.- 4. Fetal-Maternal Relationships.- 5. Neonatal Thyroid Function.- 6. Neonatal Thyroid Pathology.- 7. Conclusion.- 8. References.