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Selected Lectures of the 14Th International Workshop on Neonatology

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www.jpnim.com Open Access eISSN: 2281-0692 Journal of Pediatric and Neonatal Individualized Medicine 2018;7(2):e070238 doi: 10.7363/070238 Published online: 2018 Oct 23 Lectures Selected Lectures of the 14th International Workshop on Neonatology THE REVOLUTION OF MICROBIOMICS NUTRITION, BACTERIA AND PROBIOTICS IN PERINATAL AND PEDIATRIC HEALTH CAGLIARI (ITALY) • OCTOBER 24TH-27TH, 2018 The Workshop has been organized with the patronage of the Italian Society of Neonatology (SIN), the Italian DOHaD (Developmental Origins of Health and Disease) Society (SI-DOHaD), the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC), the Union of European Neonatal and Perinatal Societies (UENPS), the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), the Union of Middle-Eastern and Mediterranean Pediatric Societies (UMEMPS), the European Association of Perinatal Medicine (EAPM), the Italian-Romanian Pediatric Society (IRPS) and the Italian- Arabian Pediatric Society (IAPS). WORKSHOP’S PRESIDENTS Vassilios Fanos (Cagliari, Italy), Egbert Herting (Lübeck, Germany), Moshe Hod (Tel Aviv, Israel), Manuel Sánchez-Luna (Madrid, Spain), Michele Mussap (Cagliari, Italy), Sergio Bernardini (Rome, Italy), Antonio Ragusa (Massa Carrara, Italy), Ana Maria Ciubara (Galati, Romania), Gavino Faa (Cagliari, Italy), Giuseppe Floris (Leuven, Belgium) WORKSHOP’S HONORARY COMMITTEE S. Bernardini (Rome, Italy), P. Biban (Verona, Italy), M. Bruscagnin (Turin, Italy), G. Buonocore (Siena, Italy), P. Calò (Cagliari, Italy), A.M. Ciubara (Galati, Romania), G. Corsello (Palermo, Italy), G.C. Di Renzo (Perugia, Italy), C. Fabris (Turin, Italy), V. Fanos (Cagliari, Italy), G. Finco (Cagliari, Italy), M. Hod (Tel Aviv, Israel), V. Modica (Byblos, Lebanon), G. Monni (Cagliari, Italy), F. Mosca (Milan, Italy), R. Mura (Cagliari, Italy), G. Perricone (Palermo, Italy), D. Pisano (Cagliari, Italy), C. Romagnoli (Rome, Italy), M. Sánchez-Luna (Madrid, Spain), S. Vendemmia (Aversa, Italy), F. Vicariotto (Milan, Italy), P. Vezzoli (Cagliari, Italy) WORKSHOP’S INTERNATIONAL FACULTY E. Bertino (Turin, Italy), G. Buonocore (Siena, Italy), L. Cataldi (Rome, Italy), G. Corsello (Palermo, Italy), C. Dani (Florence, Italy), G.C. Di Renzo (Perugia, Italy), G. Faa (Cagliari, Italy), V. Fanos (Cagliari, Italy), F. Ferrari (Modena, Italy), E. Herting (Lübeck, Germany), S. Iacobelli (Saint Pierre, France), P. Paolillo (Rome, Italy), A. Ragusa (Massa Carrara, Italy), F. Velardi (Rome, Italy) OTHER PRESIDENTS Giovanni Ottonello (Cagliari, Italy), Denis Pisano (Cagliari, Italy), Melania Puddu (Cagliari, Italy) 1/77 www.jpnim.com Open Access Journal of Pediatric and Neonatal Individualized Medicine • vol. 7 • n. 2 • 2018 How to cite FETAL ORIGINS OF ADULT DISEASES – PROGRAMMING AND IMPRINTING IN UTERO [Lecture’s authors]. [Lecture’s title]. In: Selected Lectures of the 14th Low birth weight – IUGR (increased risk for lifelong International Workshop on Neonatology; Cagliari (Italy); October cardiovascular diseases and diabetes) 24-27, 2018. J Pediatr Neonat Individual Med. 2018;7(2):e070238. Barker was the first to demonstrate how low doi: 10.7363/070238. birth weight is associated with elevated risk for cardiovascular diseases (CVDs) in adulthood. He LECT 1 postulated that fetal shortage of nutrients and oxygen due to placental insufficiency is associated with PERINATAL PROGRAMMING: FROM THE the fetal development of physiological pathways WOMB TO THE ADULT. THE FIGO LIFE CYCLE for stress adjustment underlying recruitment of APPROACH the same pathways in adulthood leading to the development of higher adulthood susceptibility M. Hod to obesity, diabetes mellitus, hypertension, and CVDs. According to Barker these “programmed Department of Obstetrics and Gynecology, Rabin Medical Center, Tel Aviv, Israel changes” are metabolic adaptations to fetal under- Chairman, FIGO Pregnancy and NCD Committee nutrition expressed in enhanced catabolism, and self-consuming of substrates for energy supplies. A The first nine months of life shapes the offspring’s prolonged fetal adjustment period to under-nutrition adulthood, while simultaneously impacting maternal also reduces the endocrine concentration of fetal life after pregnancy. Such long-term effects on the growth hormones (FGH), via the reduced transfer health of mothers and their children are mediated of amino acids and glucose across the placenta, due through epigenetic, physiological, endocrine, to decreased maternal Insulin-like growth factor and biochemical pathways, and by imprinting of (IGF). These changes are followed by reduced rates responses to stress. They contribute to the increased of fetal growth also creating a process response to post pregnancy risk of developing non-com- stress that is then recruited in adulthood causing municable diseases (NCDs) that are passed on from metabolic disorders and CVDs. Low birth weight one generation to the next through the critical period was shown to be associated with an increased rate of of pregnancy. A need for an all-encompassing ischemic heart diseases in adulthood. Studies with 3 approach for improving maternal and fetal medicine large cohorts (> 16,000 individuals) in the UK have (MFM) is thus required to interrupt the vicious shown that mortality from ischemic heart disease cycle that starts at pregnancy disorder to improve later in life were 2 fold higher in those born < 2.5 maternal life in this generation and fetal life of the kg at birth compared to the ones born > 4.3 kg. Thin future generations. The holistic approach is needed or stunted and small trunk babies who were born to merge the importance of maternal and fetal health due to in utero undernutrition, hypoxia, and other in the MFM sub-specialty. We, at the RMC, present changes, are pre-disposed to significant diseases a new three-floor holistic and multidisciplinary in the long term. Furthermore, increased mortality model for maternal and fetal medicine. The model’s rates from coronary heart diseases (CHDs) are first floor is pre-pregnancy care and involves family found among men born with a low birth-weight, low planning and assessment of the prior risks for NCDs placental weight or narrow head circumference. The and their pre-pregnancy control and prevention. It prevalence of Type 2 diabetes mellitus and impaired continues through the introduction of the inverted glucose tolerance later in life are 3 fold higher in pyramid of antenatal care that shifts the emphasis people who were born with the smallest (< 2.5 kg) from the third to the first trimester of pregnancy, birth weight compared to the largest who weighed offering a multi-disciplinary screening and risk > 4.3 kg at birth. There is evidence that deficiency assessment followed by individually tailored in insulin production and insulin resistance are prevention and management pathways. The third both determined in utero, and that low birth-weight floor is the post pregnancy health management to babies develop in utero the ‘insulin resistance minimize long-term damage. This model of MFM syndrome’ which is prevailed in their adulthood, care is proposed for improving maternal outcome causing an impaired glucose tolerance, hypertension and preventing short and long-term complications and high concentrations of triacylglycerol. The not only to the mothers but also to their children and extreme example of the long-term impact of nutrient the next coming generations. shortage during pregnancy was discovered with the 2/77 Selected Lectures of the 14th International Workshop on Neonatology • Cagliari (Italy) • October 24th-27th, 2018 Journal of Pediatric and Neonatal Individualized Medicine • vol. 7 • n. 2 • 2018 www.jpnim.com Open Access Dutch study of individuals who were in utero during blood and heart diseases), all impact maternal health the Dutch famine of 1944-1945. This study provides in pregnancy. Pre-pregnancy diabetes and gestational evidence linking fetal undernutrition to programmed diabetes can cause macrosomia, obstructed labor, insulin resistance and Type 2 diabetes. Their glucose postpartum hemorrhage as well as neonatal mortality tolerance tests at age 50 years were all higher than due to prematurity, respiratory distress syndrome, in those conceived before or after the famine. This hypoglycemia, etc. Maternal under-nutrition can study has also provided evidence for long-lasting lead to fetal metabolic and hormonal alterations epigenetic effects transferred from the newborn to causing lifelong susceptibility to certain diseases. their progenies not through the mother but the father, At the same time, low birth-weight and accelerated indicating the profound impact of undernutrition on growth during childhood have been demonstrated as the DNA methylation of germ cells associated with risk factors for cardiovascular disease and diabetes facilitated aging-related diseases for the generations mellitus. This vicious cycle starting from pre- to come. Another example is the Chinese famine pregnancy health, influencing the outcome, which during 1954-1964, which was identified to be in turn causes adulthood diseases associated with associated with a higher likelihood to develop pregnancy disorders in the next generation and metabolic syndrome in adulthood. Based on all continuing, is now recognized as the link between these changes tomes magazine published its series the origin of NCD’S in neonatal life and adulthood of articles on the way the first 9 months shape the diseases. It requires implementation of healthcare
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