Gastric ontogeny: clinical implications.

The delivery of a preterm infant offers a unique opportunity to look directly upon the process of ontogeny, while at the same time organ immaturity is the basis of the clinical problems which challenge neonatal medicine. In recent years our knowledge of foregut ontogeny has increased, together with an increased body of clinical experience, yet the nutritional management of the preterm infant remains a contentious area, with wide variations in clinical practice. The compelling evidence of the importance of early nutritional management on neurodevelopmental outcome now focuses the debate sharply. Closer knowledge of the development of functional maturity in the gut may allow more rapid and rational advances to be made. In this paper we discuss the embryology, the development of secretory and digestive function, and the maturation of gastro-oesophageal motor activity as a background to the clinical management of nutrition in the preterm infant.