Preface

Maternal and neonatal care technologies have been developing quickly over the last few decades.

The reason for this activity is the vast influence of neonatal care on the future economic stability of society; no other specialties of medicine have that influence on human resources. It is not now just a question of saving lives. It is a question of the possibilities of programming the future quality of life, somatic and mental disease rates, socialization, and life expectancy. New possibilities of respiratory support, instrumental and laboratory monitoring, and new materials are playing a big role in decreasing neonatal and infant mortality. The earliest period of infant life is called the "golden hours" because the sophisticated application of new technologies can save life and reduce negative consequences for the future.

Another trend associated with technological evolution is the humanization of care. Creating a friendly atmosphere in hospitals, parent involvement in neonatal care, and reducing mothers' anxieties are simple but effective methods for improving child health.

The external factors that are interacting with an organism can play a role in programming stimulus if they act in that special critical period of differentiation of tissues and the forming of functions. For humans the perinatal and neonatal periods are the most important in epigenetic programming. Epigenetic mechanisms can regulate gene activity and create stability for all future life. The most important epigenetic mechanisms are methylation, histone modification, and miRNA and tiRNA pathways.

By means of simple environmental factors like nutrition, oxygen support, mothers' behavior, and others metabolic and immune pathways can be programmed for the future. We now understand why throughout life the most important period is infancy, especially the neonatal period.

This book combines different aspects of perinatal care that can be of enormous importance for the health of future generations.

> **Antonina Chubarova** Professor Pirogov Russian National Research Medical University, Russia

**1**

**Chapter 1**

Introductory Chapter:

Intensive Care and

*Antonina Chubarova*

of physicians for every lifesaving?

family to be socialized.

**1. Introduction**

Neonatology - Combining

Family-Friendly Atmosphere

The new millennium is of course the epoch of technologies. New technologies are already everywhere in our life: information technologies, reproductive technologies, new materials, and world globalization. What can this lead to in the inner world of mother and child, in everlasting mystery of childbirth, and in the struggle

This book combines different chapters united by the same idea to improve medi-

Each of them gives an overview of a very important area of perinatology beginning from technologies applied during the first minutes of life till methods that help

It is very important to know that perinatal period is a period of adaptation of fetus and child organism to the environment. "Adaptation" means changes in genes working that will allow a child to have the most advantageous metabolism and behavior in future life. The more we know about genotype, the more it is clear that it is not the only one factor that determines phenotype. The environmental factors such as nutrition, microbiota, mother's behavior, and others can be the strong regulators of gene work. Such factors are called epigenetic factors. During some periods of intensive changes of gene activity, the so-called critical window, these factors can lead to permanent changes in gene activity and form a phenotype. In other words epigenetic factors have a programming role in critical periods. The patterns of reaction to infection, stress, food deprivation, and other environmental factors in later periods of life including aging are formed in gestational period and neonatal period. Perinatal period is the most important critical period in mammal's life. It is a period when the health of future generations can be programmed for all the life period [1]. The mechanisms of programming are already discovered. The process of gene methylation is called "the prima donna" of epigenetic. Methylation inactivates gene transcription [2]. In embryo before implantation, the majority of genes are methylated, and all the next development is a series of demethylation and methylation. Other mechanisms are histone modifications, regulatory miRNA, and tiRNA [3, 4]. Nutrition is a strong external factor of programming. It is a signal of availability

of nutrient resources, their quantity and quality [5]. Nutrition contains methyl (–CH3) group donors: folates, В12, В6, choline, methionine, and betaine. Also nutrition is a platform for macro- and microorganism interaction. And finally it is a

functional molecular donor and direct regulator of gene function.

cal aid to neonate and its parents by the means of modern technologies.

#### **Chapter 1**
