ENERGY EXPENDITURE, DIETARY INTAKE AND FEEDING PRACTICES FOR PRETERM INFANTS

早产儿的能量消耗、膳食摄入和喂养方法

• 批准号: 6121663
• 负责人: Karen Amelia Pridham
• 金额: $ 3.35万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-12-01 至 1999-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6121663
• 关键词: bioenergetics; child physical development; clinical research; developmental nutrition; diet route /schedule; human subject; infant nutrition disorder; inflammation; low birth weight infant human; lung disorder; nutrient intake activity; nutrition related tag; pediatric nursing; premature infant human

The question the proposed study addresses is: How is energy expenditure related to dietary intake and somatic growth, considering infant characteristics, infant activity, and food intolerance, and controlling feeding practice (caloric density of the diet and ad libitum or prescribed feeding regimen)? The specific aims of the study are as follows: (1) To determine the energy expenditure in the three groups of preterm infants during levels of activity, ranging from quiet sleep to vigorous activity with crying and including feeding; and (2) To determine the contribution energy expenditure makes to the dietary intake and somatic growth of these infants, taking infant characteristics (birthweight, gender, ethnicity, severity of lung disease, and postconceptional age at the time of energy expenditure assessment), infant activity, and food intolerance into account and controlling the caloric density of the diet and the feeding regimen. A 2 x 2 experimental design with random assignment of infants to either ad libitum or prescribed feeding, and, within the feeding practice, to 20- or 24-calorie/ounce feeding substance will be used. Twelve infants will be randomly assigned to each of the four feeding practices. All Infants admitted to the Neonatal Intensive Care Unit (NICU) born at less than 35 weeks gestation with weight that is appropriate for gestational age and who are exclusively formula fed or fed at least 80 percent breast milk will be eligible for this study. Study infants must not have congenital or medical problems interfering with nutritional status. Infants may have recovered from Respiratory Distress Syndrome (RDS) or have mild Bronchopulmonary Dysplasia (BPD). The four study arms will be balanced with respect to the following possible covariates: (a) birthweight, (b) gender, (c) ethnicity, (d) respiratory status (RDS, BPD, or none), and (e) post-conceptional age at the time of energy expenditure assessment. Energy expenditure will be observed with indirect respiratory calorimetry on the first and second day the infant is completely nipple fed at ninety minutes post-prandial for a ninety-minute period each day and with mean heart rate during feeding. The infant's six-hourly dietary intake and daily weight will be the basis for the following measures over the 72-hour study period: (1) mean volume in cc/kg/day of intake; (2) mean kcalories/kg/six-hours of intake; and (3) mean g protein/kg/six-hours of intake. Mean grams weight gain/six-hour period (rate of weight gain) divided by the weight that day will be the measure of somatic growth. Dietary intake outcomes will be analyzed using iterative generalized least-squares regression against the following covariates: (a) NICU location, (b) food intolerance, (c) energy expenditure, (d) severity of lung disease, and (e) feeding practice. The weighted rate of weight gain will be regressed against dietary intake and the other previously listed covariates. The interaction of the two feeding practice factors (feeding regimen and caloric density) will be examined.

拟议研究解决的问题是：考虑到婴儿的特征、婴儿的活动和食物不耐受，以及控制喂养实践（饮食的热量密度和随意或规定的喂养方案），能量消耗与饮食摄入和身体生长是如何相关的？ 本研究的具体目的如下：（1）测定三组早产儿在不同活动水平下的能量消耗，包括安静睡眠和剧烈活动（包括哭闹和喂养）;（2）根据婴儿的特点，确定能量消耗对婴儿膳食摄入和生长发育的贡献（出生体重、性别、种族、肺部疾病的严重程度和能量消耗评估时的受孕后年龄）、婴儿活动和食物不耐受，并控制饮食的热量密度和喂养方案。将采用2 x 2实验设计，将婴儿随机分配至自由采食或处方喂养，并在喂养实践中使用20或24卡路里/盎司的喂养物质。 12名婴儿将被随机分配到四种喂养方式中的每一种。 所有在新生儿重症监护室（NICU）出生的婴儿，出生时孕龄小于35周，体重适合胎龄，并且仅用配方奶粉喂养或至少80%母乳喂养，都有资格参加本研究。 研究婴儿不得有干扰营养状态的先天性或医学问题。 婴儿可能已从呼吸窘迫综合征（RDS）中恢复或患有轻度支气管肺发育不良（BPD）。 四个研究组将在以下可能的协变量方面保持平衡：（a）出生体重，（B）性别，（c）种族，（d）呼吸状态（RDS、BPD或无）和（e）能量消耗评估时的受孕后年龄。在第一天和第二天，使用间接呼吸量热法观察能量消耗，婴儿在餐后90分钟完全用乳头喂养，每天持续90分钟，并在喂养期间观察平均心率。 婴儿的6小时饮食摄入量和每日体重将是72小时研究期间以下测量的基础：（1）平均体积（cc/kg/天摄入量）;（2）平均卡路里/kg/6小时摄入量;和（3）平均蛋白质g/kg/6小时摄入量。 平均体重增加克数/6小时（体重增加率）除以当天的体重将作为躯体生长的指标。 将使用迭代广义最小二乘回归分析以下协变量的饮食摄入结局：（a）NICU位置，（B）食物不耐受，（c）能量消耗，（d）肺部疾病的严重程度，和（e）喂养实践。 体重增加的加权速率将根据饮食摄入量和其他先前列出的协变量进行回归。将检查两个喂养实践因素（喂养方案和热量密度）的相互作用。