In this edition of NeoReviews, Pamela Thomas and Joseph Neu present two topics that are important examples of early neonatal adaptation to the unique metabolic conditions of postnatal life. These articles continue our efforts to address new discoveries in basic and clinical research that affect important and current problems in clinical practice.

Dr. Thomas discusses mechanisms involved in persistent hyperinsulinemia of infancy. Normally, insulin secretion increases postnatally. The mechanisms for this action are uncertain, but might include increased plasma glucose concentration, increased delivery to the pancreas via the portal vein of food-derived nutrients such as fatty acids and amino acids that augment glucose-induced insulin secretion, and feeding-related production of gut peptides known as incretins that augment insulin secretion. Rat data also indicate a postnatal increase in fetal-type beta-cell apoptosis, with expansion of beta cells and islets that are of the adult type and have a greater capacity to secrete...

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