Investigating Donor Human Milk Composition Globally to Develop Effective Strategies for the Nutritional Care of Preterm Infants

调查全球捐赠母乳成分，制定早产儿营养护理的有效策略

• 批准号: 10308198
• 负责人: Maryanne Tigchelaar Perrin
• 金额: $ 52.31万
• 依托单位: UNIVERSITY OF NORTH CAROLINA GREENSBORO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308198
• 关键词: Academy; Address; Affect; American; Canada; Caring; Collaborations; Country; Data; Development; Educational workshop; Fatty acid glycerol esters; Geography; Goals; Growth; Hospitals; Human Milk; Immunoglobulin A; Income; Individual; Infant; Infant Care; Infection; Inferior; Knowledge; Lactoferrin; Lactose; Life; Literature; Low income; Macronutrients Nutrition; Methods; Micronutrients; Milk; Milk Banks; Minerals; Necrotizing Enterocolitis; Neonatal Intensive Care Units; Neonatal Mortality; North America; Nutrient; Nutrition Therapy; Nutritional; Nutritional Requirements; Nutritional Support; Oligosaccharides; Pediatrics; Pregnancy; Premature Birth; Premature Infant; Proteins; Public Health; Recommendation; Reporting; Research; Research Design; Role; Sampling; Site; Sodium; United States; United States National Institutes of Health; Vitamins; World Health Organization; biobank; donor milk; effectiveness evaluation; enteric infection; evidence base; experience; feeding; geographic difference; improved; infant nutrition; low and middle-income countries; nutrition; pasteurization; premature; protective effect; response; simulation

Project Summary Globally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle- income countries. In the absence of mother’s milk (MOM), the World Health Organization and the American Academy of Pediatrics recommend using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal infection. In response to these recommendations, development of donor milk banks and the use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality. It is estimated that 800,000 infants globally receive DHM each year, yet very little is known about the nutritional composition of DHM; how composition is influenced by milk banking practices; and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers. There is evidence that preterm infants fed DHM have inferior growth rates compared to infants receiving preterm formula or mother’s milk, even when multi-nutrient fortifiers are used, suggesting suboptimal nutritional support (macronutrients, micronutrients, or both). To develop effective nutritional therapies for the increasing number of preterm infants globally receiving DHM, evidence-based nutritional standards for DHM are urgently needed. Studies to-date on DHM composition have typically been small (< 50 samples) and represented milk from a single milk bank in a high-income setting, which may be different from DHM from milk banks in low-income settings. Additional limitations include the dearth of studies on vitamins, minerals, and bioactive factors, and the use methods that may overstate protein and lactose values. This proposal seeks to address these research gaps in global preterm infant nutrition by conducting a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings. We will examine and compare a broad range of nutrients in milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM (Aim 1). Milk bank-level practices for pooling donors will be evaluated using simulation to identify effective strategies that can be used by milk banks to create more consistent nutrient profiles in DHM (Aim 2). Finally, we will evaluate whether currently available commercial fortifiers meet nutrient recommendations when used with DHM and will identify nutrients to enhance in the development of a DHM-specific fortifiers (Aim 3). The long-term goal of this study, designed in response to RFA-HD-21-006, is to improve preterm nutritional care globally for the growing number of infants who receive donor human milk.

项目摘要 在全球范围内，近1500万婴儿每年都过早出生，对低和中间的影响不成比例 收入国家。在没有母亲的牛奶（妈妈），世界卫生组织和美国人的情况下 儿科学院建议使用捐赠人牛奶（DHM），因为它的保护作用 坏死性小肠结肠炎，一种威胁生命的肠道感染。为了回应这些建议 捐赠牛奶银行的开发和DHM的使用正在增加全球，许多低收入和中等收入 将捐赠者牛奶银行纳入其公共卫生策略以降低新生儿死亡率的国家。这是 估计全球有80万婴儿每年接受DHM，但对营养知之甚少 DHM的组成；成分如何受牛奶银行业务的影响；以及早产营养素是否 当DHM与市售堡垒一起使用时，将获得建议。有证据 与接受早产配方或 即使使用多营养堡垒，母乳也表明营养支持 （大量营养素，微量营养素或两者）。开发有效的营养疗法，以增加数量的 迫切需要全球接受DHM的早产儿，急需DHM的循证营养标准。 对DHM组成的研究通常很小（<50个样本），并代表了来自A的牛奶 高收入环境中的单牛奶库，这可能与低收入的牛奶银行不同 设置。其他局限性包括对维生素，矿物质和生物活性因素的研究死亡以及 可能夸大蛋白质和乳糖值的使用方法。该建议旨在解决这些研究 通过八个地理上的牛奶进行多站点研究，全球早产婴儿营养的差距 高收入设置的银行合作伙伴。我们将检查和比较一系列 来自全球600名认可的牛奶库捐赠者的牛奶中的营养成分，以创造全面的， DHM的地理营养概况在地理上种植（AIM 1）。牛奶银行级别的合并捐助者的做法将是 使用仿真来评估牛奶库可以使用的有效策略以创建更多 DHM中一致的营养谱（AIM 2）。最后，我们将评估当前是否可用的商业 与DHM一起使用时，FORTIFIER符合营养建议，并将确定营养以增强 开发DHM特异性堡垒（AIM 3）。这项研究的长期目标是根据 RFA-HD-21-006，将针对越来越多的婴儿进行全球早产 捐赠人牛奶。