Presentation Title: (Jan 27 th
, 2010 – Track A)
D
EVELOPMENTAL
C
ARE OF THE
E
NTERIC
N
ERVOUS
S
YSTEM
(N ILS B ERGMAN , MD MPH P H D)
“ At the conclusion of this activity, the participant should be able to …” (Please list up to 3 learning objectives)
1.
Describe evidence base for newborn stomach capacity.
2.
Predict some of the consequences of overfilling the stomach.
3.
Incorporate feeding frequency research and evidence into developmental care.
Outline with references
Introduction:
Role of smell (1;2), enteromammary cycle (3), premature breastfeeding (4-6), state organization
(7-11), gut hormones (12-16)
Describe evidence base for newborn stomach capacity
Technical review (17), basic anatomy and physiology (18;19), fetal development (20-24), available data on stomach (19;25), Research data (26;27),
Predict some of the consequences of overfilling the stomach
Reflux (28-35), hypoglycemia (33-35), obesity (36-38)
Incorporate feeding frequency research and evidence into developmental care
Growth and stomach assumption (17;27), Milk ejection reflex (39;40),
Conclusion:
Developmental Care of the Enteric Nervous System requires
“Small and frequent feeds, according to the sleep cycle”

Reference List
(1) Schaal B, Hummel T, Soussignan R. Olfaction in the fetal and premature infant: functional status and clinical implications. Clin Perinatol 2004 June;31(2):261-vii.
(2) Doucet S, Soussignan R, Sagot P, Schaal B. The secretion of areolar (Montgomery's) glands from lactating women elicits selective, unconditional responses in neonates. PLoS
One 2009 October 23;4(10):e7579.
(3) Hanson LA. Immunology of Human Milk. Amarilla Texas: Pharmasoft Publishing; 2004.
(4) Nyqvist KH, Farnstrand C, Eeg-Olofsson KE, Ewald U. Early oral behaviour in preterm infants during breastfeeding: an electromyographic study. Acta Paediatrica (Oslo,
Norway: 1992) 2001;90(6):658-63.
(5) Nyqvist KH, Rubertsson C, Ewald U, Sjoden P. Development of the Preterm Infant
Breastfeeding Behavior Scale (PIBBS): a study of nurse-mother agreement. J HUM
LACT 1996 September;12(3):207-19.
(6) Nyqvist KH. Early attainment of breastfeeding competence in very preterm infants. Acta
Paediatrica 2008 June;97(6):776-81.
(7) Curzi-Dascalova L, Figueroa JM, Eiselt M, Christova E, Virassamy A, D'Allest AM.
Sleep state organization in premature infants of less than 35 weeks gestational age.
Pediatr Res 1993;34:624-8.
(8) Feldman R, Eidelman AI. Neonatal state organization, neuromaturation, mother-infant interaction, and cognitive development in small-for-gestational-age premature infants.
Pediatrics 2006 September;118(3):e869-e878.
(9) Karl DJ. Using principles of newborn behavioral state organization to facilitate breastfeeding. MCN: The American Journal of Maternal Child Nursing 2004
September;29(5):292-8.
(10) Ohgi S, Fukuda M, Moriuchi H, Kusumoto T, Akiyama T, Nugent JK et al. Comparison of Kangaroo Care and Standard Care: Behavioral Organization, Development, and
Temperament in Healthy, Low-Birth-Weight Infants Through 1 Year. Journal of
Perinatology 2002 July;22(5):374-9.
(11) Ludington SM. Energy conservation during skin-to-skin contact between preterm infants and their mothers. Heart Lung 1990 September;19(5 Pt 1):445-51.
(12) Uvnas-Moberg K. Oxytocin may mediate the benefits of positive social interactions and emotions. Psychoneuroendocrinology 1998;23(8):819-35.
(13) Uvnas-Moberg K. Effects on mother and infant of oxytocin released in the postpartum period. The Role of Early Experience in Infant development 1999;283-90.

(14) Uvnas-Moberg K, Widstrom AM, Marchini G, Winberg J. Release of GI hormones in mother and infant by sensory stimulation. Acta Paediatr Scand 1987
November;76(6):851-60.
(15) Uvnas-Moberg K. Gastrointestinal hormones in mother and infant. Acta Paediatr Scand
Suppl 1989;351:88-93.
(16) Uvnas-Moberg K. Neuroendocrinology of the mother-child interaction. Trends In
Endocrinology And Metabolism: TEM 1996 May;7(4):126-31.
(17) Edmond KT, Bahl R. Optimal feeding of low-birth-weight infants technical review.
WHO 2006;1-131.
(18) Hassan BB, Butler R, Davidson GP, Benninga M, Haslam R, Barnett C et al. Patterns of antropyloric motility in fed healthy preterm infants. Archives Of Disease In Childhood
Fetal And Neonatal Edition 2002 September;87(2):F95-F99.
(19) Naveed M, Manjunath CS, Sreenivas, V. An autopsy Study of Relationship between
Perinatal Stomach Capacity and Birth Weight. Indian J Gastroenterol 1992;11(4):156-8.
(20) Goldstein I, Reece EA, Yarkoni S, Wan M, Green JL, Hobbins JC. Growth of the fetal stomach in normal pregnancies. Obstet Gynecol 1987 October;70(4):641-4.
(21) Sase M, Miwa I, Sumie M, Nakata M, Sugino N, Okada K et al. Gastric emptying cycles in the human fetus. American Journal Of Obstetrics And Gynecology 2005
September;193(3 Pt 2):1000-4.
(22) Sase M, Miwa I, Sumie M, Nakata M, Sugino N, Ross MG. Ontogeny of gastric emptying patterns in the human fetus. The Journal Of Maternal-Fetal & Neonatal
Medicine: The Official Journal Of The European Association Of Perinatal Medicine, The
Federation Of Asia And Oceania Perinatal Societies, The International Society Of
Perinatal Obstetricians 2005 March;17(3):213-7.
(23) Nagata S, Koyanagi T, Fukushima S, Akazawa K, Nakano H. Change in the threedimensional shape of the stomach in the developing human fetus. Early Human
Development 1994 April 30;37(1):27-38.
(24) Xu RJ. Development of the newborn GI tract and its relation to colostrum/milk intake: a review. Reprod Fertil Dev 1996;8(1):35-48.
(25) Scammon RE, Doyle LO. Observations of the capacity of the stomach in the first ten days of post natal life. American Journal of Diseases in Children 1920;516-38.
(26) Widstrom AM, Christensson K, Ransj+¦-Arvidson AB, Matthiesen AS, Winberg J,
Uvn+ñs-Moberg K. Gastric aspirates of newborn infants: pH, volume and levels of gastrin- and somatostatin-like immunoreactivity. Acta Paediatrica Scandinavica 1988
July;77(4):502-8.

(27) Zangen S, Di LC, Zangen T, Mertz H, Schwankovsky L, Hyman PE. Rapid maturation of gastric relaxation in newborn infants. Pediatr Res 2001 November;50(5):629-32.
(28) Ewer AK, Durbin GM, Morgan ME, Booth IW. Gastric emptying and gastro-oesophageal reflux in preterm infants. Archives Of Disease In Childhood Fetal And Neonatal Edition
1996 September;75(2):F117-F121.
(29) Khoshoo V, Edell D, Thompson A, Rubin M. Are we overprescribing antireflux medications for infants with regurgitation? Pediatrics 2007 November;120(5):946-9.
(30) Lopez-Alonso M, Moya MJ, Cabo JA, Ribas J, M, Silny J et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux.
Pediatrics 2006 August;118(2):e299-e308.
(31) Washington N, Spensley PJ, Smith CA, Parker M, Bush D, Jackson SJ et al. Dual pH probe monitoring versus single pH probe monitoring in infants on milk feeds: the impact on diagnosis. Arch Dis Child 1999 October;81(4):309-12.
(32) Baker SS, Roach CM, Leonard MS, Baker RD. Infantile gastroesophageal reflux in a hospital setting. BMC Padiatrics 2008;8(11).
(33) Durand R, Hodges S, LaRock S, Lund L, Schmid S, Swick D et al. The effect of skin-toskin breast-feeding in the immediate recovery period on newborn thermoregulation and blood glucose values. Neonatal Intensive Care 1997 March;10(2):23-9.
(34) Martin-Calama J, Bunuel J, Valero MT, Labay M, Lasarte JJ, Valle F et al. The effect of feeding glucose water to breastfeeding newborns on weight, body temperature, blood glucose, and breastfeeding duration. J Hum Lact 1997 September;13(3):209-13.
(35) Wight NE. Hypoglycemia in breastfed neonates. Breastfeeding Medicine: The Official
Journal Of The Academy Of Breastfeeding Medicine 2006;1(4):253-62.
(36) Barker DJ. In utero programming of chronic disease. Clinical Science (London, England:
1979) 1998 August;95(2):115-28.
(37) Hales CN, Barker DJ. The thrifty phenotype hypothesis. Br Med Bull 2001;60:5-20.
(38) Stettler N, Stallings VA, Troxel AB, Zhao J, Schinnar R, Nelson SE et al. Weight Gain in the First Week of Life and Overweight in Adulthood. Circulation 2005;111:1897-903.
(39) Prime DK, Geddes DT, Hartmann PE. Oxytocin: Milk ejection and maternal-infant wellbeing. Hale & Hartmann's Textbook of Human Lactation 2007;141-55.
(40) Ramsay DT, Kent JC, Owens RA, Hartmann PE. Ultrasound Imaging of Milk Ejection in the Breast of Lactating Women. Pediatrics 2004 February;113(2):361-7.