Improving the survival, growth and developmental of low birth weight newborns through better nutrition

通过更好的营养改善低出生体重新生儿的生存、生长和发育

• 批准号: MC_PC_MR/R019789/1
• 负责人: Stephen Allen
• 金额: $ 25.09万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MC_PC_MR%2FR019789%2F1
• 关键词: Improving; survival; growth; developmental; low

Worldwide, deaths in the first month of life already account for nearly half of all child deaths. This proportion is set to rise as survival in older children is improving faster than in newborns. More than 9 in 10 newborn deaths occur in Africa and Asia and more than 8 in 10 of these deaths are in babies with low birthweight. The greatest risk is in very small babies (birthweight less than 1500g) where as many as 700 of every 1000 die. Small babies who survive often have poor longer-term growth and development posing highly significant consequences for families and societies.Being small at birth is due mainly to being born too early (preterm), not growing well in the womb or a combination of both. Unfortunately, we do not have effective interventions to prevent either of these problems. Therefore, these small babies are a growing challenge especially in poorer countries.We know that nutrition and growth in early life are critically important for the development of the body organs, including the brain, and being able to fight-off the infections that cause many newborn deaths. Improved nutrition and optimal growth may also prevent diseases that are important in later life in poorer countries such as lung disease. However, achieving optimal nutrition in small babies remains a huge challenge especially as high quality, safe feeding through the veins, that bridges the gap between birth and full oral feeding, is rarely available in low-resource countries. In addition, the structure and function of the gut in preterm babies is immature and advancing oral feeds too quickly may cause life-threatening gut damage. The immature gut not only struggles to cope with milk feeds but also allows gut bacteria to cross into the body and cause infection. Small babies often need nursing in neonatal units (NNUs) for 4-6 weeks or more and this is exactly where their gut can be colonized with dangerous bacteria that are resistant to the available antibiotics. There has been little research to tell us how best to feed small babies in NNUs in poorer countries. Even basic principles such as when to introduce feeds and how quickly feeds can be increased safely remain unclear. In addition, there are several promising interventions being developed in richer countries that may well be relevant, feasible and affordable in low-resource settings. These include using nutritional supplements of probiotics (safe, "healthy" bacteria) and components in breast milk ("lactoferrin") to prevent gut infections and boost the baby's immunity.We will establish a core network of 6 NNUs (4 Nigeria/2 Kenya) linking African clinicians and researchers together and with international experts in newborn nutrition, gut health and longer-term lung and brain development. The network will build capacity in those NNUs with limited previous research experience and also engage researchers who are new to working in poorer countries. Workshops in Nigeria and Kenya will allow the team to document current practices, share experience of practical feeding problems and review possible interventions for testing. Standard international criteria for the diagnosis of common problems (such as infection) will be adapted for use across the network and we will set-up a database to share essential clinical information. We will test novel methods to detect genes that make bacteria resistant to antibiotics and to measure key nutrients in small volume blood samples. We will also store samples for later research. We will ensure that we develop processes that are achievable even with low-resources so that they can be rolled-out to other NNUs to expand the network. Our goal is to improve survival, growth and development in low birthweight babies through better nutrition. The network and processes that we will establish will enable us to design and implement the large-scale clinical trials that will be needed to advance care in these most vulnerable infants.

在世界范围内，出生后第一个月的死亡人数已占所有儿童死亡人数的近一半。由于年龄较大儿童的生存率比新生儿的生存率提高得更快，这一比例将会上升。超过十分之九的新生儿死亡发生在非洲和亚洲，其中超过十分之八的婴儿出生体重较低。最大的风险是非常小的婴儿（出生体重低于 1500 克），每 1000 名婴儿中有多达 700 名死亡。存活下来的小婴儿往往长期生长和发育较差，对家庭和社会造成非常严重的后果。出生时较小的主要原因是出生过早（早产）、在子宫内生长不良或两者兼而有之。不幸的是，我们没有有效的干预措施来预防这些问题。因此，这些小婴儿面临着越来越大的挑战，尤其是在较贫穷的国家。我们知道，生命早期的营养和生长对于包括大脑在内的身体器官的发育至关重要，并且能够抵抗导致许多新生儿死亡的感染。改善营养和最佳生长还可以预防较贫穷国家晚年重要的疾病，例如肺病。然而，为小婴儿实现最佳营养仍然是一个巨大的挑战，特别是在资源匮乏的国家，很少能够通过静脉进行高质量、安全的喂养，从而弥补出生和完全口服喂养之间的差距。此外，早产儿肠道的结构和功能尚未成熟，过快地进行经口喂养可能会导致危及生命的肠道损伤。不成熟的肠道不仅难以应对牛奶喂养，而且还允许肠道细菌进入体内并引起感染。小婴儿通常需要在新生儿病房 (NNU) 中护理 4-6 周或更长时间，而这正是他们的肠道可能被对现有抗生素产生抗药性的危险细菌定植的地方。几乎没有研究告诉我们如何在较贫穷国家的 NNU 中最好地喂养小婴儿。甚至基本原则（例如何时引入饲料以及多快安全地增加饲料）仍不清楚。此外，富裕国家正在制定一些有希望的干预措施，这些干预措施在资源匮乏的地区很可能是相关的、可行的和负担得起的。其中包括使用益生菌（安全、“健康”的细菌）和母乳成分（“乳铁蛋白”）的营养补充剂来预防肠道感染并增强婴儿的免疫力。我们将建立一个由 6 个 NNU（4 个尼日利亚/2 个肯尼亚）组成的核心网络，将非洲临床医生和研究人员以及新生儿营养、肠道健康以及长期肺和大脑发育方面的国际专家联系起来。该网络将为那些以前研究经验有限的神经大学进行能力建设，并吸引刚开始在较贫穷国家工作的研究人员。在尼日利亚和肯尼亚举办的研讨会将使团队能够记录当前的做法，分享实际喂养问题的经验，并审查可能的测试干预措施。诊断常见问题（例如感染）的标准国际标准将进行调整，以便在整个网络中使用，我们将建立一个数据库来共享重要的临床信息。我们将测试新方法来检测使细菌对抗生素产生耐药性的基因，并测量小体积血液样本中的关键营养素。我们还将存储样本以供以后研究。我们将确保我们开发的流程即使在资源匮乏的情况下也可以实现，以便将它们推广到其他神经网络大学以扩展网络。我们的目标是通过更好的营养来改善低出生体重婴儿的生存、生长和发育。我们将建立的网络和流程将使我们能够设计和实施大规模临床试验，以促进对这些最脆弱婴儿的护理。

项目成果

Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya.

• DOI: 10.1136/bmjopen-2022-064575
• 发表时间: 2022-12-06
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Staunton, Aimee P.;Nabwera, Helen M.;Allen, Stephen J.;Tongo, Olukemi O.;Akindolire, Abimbola E.;Abdulkadir, Isa;Ezeaka, Chinyere, V;Ezenwa, Beatrice N.;Fajolu, Iretiola B.;Imam, Zainab O.;Umoru, Dominic D.;Otieno, Walter;Nalwa, Grace M.;Olwala, Macrine;Talbert, Alison W.;Andang'o, Pauline E. A.;Mwangome, Martha K.;Abubakar, Ismaela;Embleton, Nicholas D.;behalf Neonatal Nutr Network NeoNuNet
• 通讯作者: behalf Neonatal Nutr Network NeoNuNet

Molecular surveillance reveals widespread colonisation by carbapenemase and extended spectrum beta-lactamase producing organisms in neonatal units in Kenya and Nigeria.

• DOI: 10.1186/s13756-023-01216-0
• 发表时间: 2023-02-22
• 期刊: ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL
• 影响因子: 5.5
• 作者: Edwards, Thomas;Williams, Christopher T.;Olwala, Macrine;Andang'o, Pauline;Otieno, Walter;Nalwa, Grace N.;Akindolire, Abimbola;Cubas-Atienzar, Ana I.;Ross, Toby;Tongo, Olukemi O.;Adams, Emily R.;Nabwera, Helen;Allen, Stephen
• 通讯作者: Allen, Stephen

Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya.

• DOI: 10.3389/fped.2022.892209
• 发表时间: 2022
• 期刊: FRONTIERS IN PEDIATRICS
• 影响因子: 2.6
• 作者: Tongo, Olukemi O.;Olwala, Macrine A.;Talbert, Alison W.;Nabwera, Helen M.;Akindolire, Abimbola E.;Otieno, Walter;Nalwa, Grace M.;Andang'o, Pauline E. A.;Mwangome, Martha K.;Abdulkadir, Isa;Ezeaka, Chinyere V.;Ezenwa, Beatrice N.;Fajolu, Iretiola B.;Imam, Zainab O.;Umoru, Dominic D.;Abubakar, Ismaela;Embleton, Nicholas D.;Allen, Stephen J.
• 通讯作者: Allen, Stephen J.

Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity?

• DOI: 10.1136/bmjgh-2021-007682
• 发表时间: 2021-12
• 期刊: BMJ global health
• 影响因子: 8.1
• 作者: Nabwera HM;Ekhaguere OA;Kirpalani H;Burgoine K;Ezeaka CV;Otieno W;Allen SJ;Embleton ND;Neonatal Nutrition Network (NeoNuNet)
• 通讯作者: Neonatal Nutrition Network (NeoNuNet)

Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya

尼日利亚和肯尼亚住院早产儿和极低出生体重儿的完全肠内喂养时间

• DOI: 10.1101/2022.11.04.22281964
• 发表时间: 2022
• 作者: Imam Z