[Nutrition in the neonatal period].

My approach to my subject must seem a doubly provincial one to this audience. First, I necessarily look at nutritional science as a paediatrician interested in newborn infants and am incapable of inspecting neonatal life with the eyes of a nutritionist. A more serious handicap must be the limitation of my experience to that minor part of the world with a problem of food surplus rather than scarcity. If I were allowed to define ‘newborn’ or ‘neonatal’, the words would apply only to the first 14 days after birth, in which time the decisive adjustments to extra-uterine circumstances are made. I would want another term to designate the time between birth and the establishment of some positive balances at 3-5 days. May I, then, here use ‘newborn’ or ‘neonatal’ for the first 2 weeks and ‘early postnatal’ for those first few days? Even in that brief early postnatal period, certain characteristics emerge to differentiate newborn human beings as individuals, and one such characteristic is the general degree of their nutrition. Some infants are obviously undernourished at birth. They weigh much less than most others of their gestational ages, and appear thin rather than merely small. Some of the others are, of course, at the opposite end of the distribution curve and appear to be fat; some appear oedematous. By contrast with these, some have the appearance of dehydration; but thin infants and fat infants differ in another way. If attention is devoted to newborn infants for long enough, one must ultimately face the question of why human foetuses vary so widely in nutritional status even though one’s primary concern with them is in their respiration, circulation, or metabolism. Most attempts to relate the growth or weight of the foetus to the nutrition or diet of the mother, if pursued far enough, have shown some degree of association between the two. Among such investigations, the studies of Burke, Beal, Kirkwood & Stuart (1943) have been the best known to me, and these showed several associations between maternal diet and foetal nutrition. But I believe that Dr Thomson and others working under Professor Baird at Aberdeen found little if any evidence of such relationships (Thomson, 1957).