Using the Fetal Gastrointestinal Tract to Overcome Neonatal Disease
Dr. Buchmiller-Crair is the recipient of the IFFGD 2003 Research Award to Pediatric Investigator, Basic Science. She performs the full spectrum of pediatric surgery with a particular interest in minimal access surgery, management of the short bowel syndrome, and fetal surgical diagnoses and prenatal counseling.
Summary
As a practicing Pediatric Surgeon, I have been struck by the challenges of dealing with severe neonatal growth retardation and gastrointestinal problems after birth. The gestational period before birth provides an intriguing time for possible maternal-fetal interventions, which could hopefully minimize, or eliminate the developing baby's problems. Many human infants born prematurely, or with surgical conditions such as intestinal atresia (where the bowel ends abruptly and is discontinuous) or gastroschisis (where the bowel floats outside the baby's abdomen), and suffer after birth from prolonged gastrointestinal dysfunction with impaired motility and nutrient absorption. Indeed, these children can ultimately need bowel transplantation, as the gut is not able to support the nutritional needs of the child. The understanding of the underlying mechanisms of neonatal gastrointestinal dysmotility and impaired absorption are essential if effective treatments are to be devised. Understanding GI function in-utero will help us differentiate what processes and disease states can be manipulated before birth, from those which are preset, and must be dealt with after birth. We have described above several models of in-utero study, which form the foundation for potential human application. Ameliorating the devastating effects of an immature gastrointestinal system in the preterm and growth-retarded newborn remain our vision, and our laboratory is very thankful for the gracious support of the IFFGD in our endeavors.