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

项目摘要 在全球范围内，每年有近1500万名婴儿早产，对中低收入人群的影响不成比例。 收入国家。在没有母乳的情况下，世界卫生组织和美国人 儿科学会建议使用捐献者母乳(DHM)，因为它具有预防 坏死性小肠结肠炎，一种危及生命的肠道感染。针对这些建议， 捐献母乳银行的发展和DHM的使用在全球范围内正在增加，许多中低收入者 各国将捐赠母乳银行纳入其公共卫生战略，以降低新生儿死亡率。它是 据估计，全球每年有80万婴儿服用DHM，但人们对其营养状况知之甚少 DHM的组成；母乳储备做法如何影响DHM的组成；以及早产营养是否 当DHM与商业上可获得的增强剂一起使用时，建议是实现的。有证据表明 喂食DHM的早产儿的生长速度比喂食早产儿配方奶粉或 母乳，即使使用了多种营养强化剂，也表明营养支持不够理想 (大量营养素、微量营养素或两者兼而有之)。为越来越多的人开发有效的营养疗法 全球接受DHM的早产儿迫切需要DHM的循证营养标准。 到目前为止，关于DHM成分的研究通常很少(&lt；50个样本)，并且代表来自 高收入环境下的单一母乳银行，这可能不同于低收入环境下的DHM和母乳银行 设置。其他限制包括缺乏对维生素、矿物质和生物活性因子的研究，以及 使用方法可能会夸大蛋白质和乳糖值。这项提案旨在解决这些研究 通过对八种不同地域的牛奶进行多地点研究，全球早产儿营养方面的差距 高收入、中等收入和低收入环境下的银行合作伙伴。我们将检查和比较广泛的 来自世界各地600名经批准的母乳银行捐赠者的母乳中的营养物质， DHM的不同地理营养分布(目标1)。用于汇集捐赠者的母乳银行级别的做法将是 使用模拟进行评估，以确定母乳银行可以使用的有效策略，以创造更多 DHM中一致的营养状况(目标2)。最后，我们将评估目前可用的商业广告 当与DHM一起使用时，强化剂符合营养建议，并将确定在 开发一种DHM专用强化剂(目标3)。这项研究的长期目标，旨在回应 RFA-HD-21-006，旨在改善全球范围内越来越多的婴儿接受早产营养护理 捐献的人类乳汁。

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.