INFECTION IN ELBW INFANTS:PROTECTION WITH MOTHER'S MILK

L这一级别应用的重点是确定和测试使用自己的母乳为超低出生体重(ELBW；&lt；1000 g)婴儿提供感染保护的策略。免疫功能低下加上暴露在新生儿重症监护病房(NICU)中的病原微生物使ELBW婴儿容易受到医院感染，从而导致短期和长期后遗症，并使NICU的住院费用平均增加每次感染10,440美元。临床研究已经证明，与配方奶喂养的早产儿相比，OMM喂养的早产儿医院感染的发生率和严重性更低。免疫学研究已经确定了OMM中为婴儿提供被动和主动免疫的特定保护因素；许多OMM中早产儿母亲的OMM比足月婴儿更集中。选定的免疫因子，如分泌型免疫球蛋白A，在婴儿的尿液中被吸收和排泄；具有增强杀菌性能的乳铁蛋白已从粪便中被重新捕获。因此，OMM可以为ELBW婴儿提供显著的保护；此外，OMM价格低廉，有利于母亲参与婴儿护理。这篇论文将测试在ELBW婴儿不能耐受肠内营养的出生后早期，使用OMM提供感染保护的策略。一个例子是使用OMM进行常规的婴儿口腔护理和/或肠道启动，例如，刺激胃肠道成熟和屏障保护的最低限度的肠道喂养。结果指标可能包括OMM的特定免疫成分是否在婴儿的尿液和粪便中重新捕获。

The focus of this Level l application is the identification and testing of strategies for using own mothers' milk (OMM) to provide protection from infection for extremely low-birthweight (ELBW; <1000g) infants. Immunoincompetence plus exposure to pathogenic microorganisms in the neonatal intensive care unit (NICU) predispose ELBW infants to nosocomial infections, which result in short-and long-term sequelae, and increase the cost of the NICU stay by a mean of $ 10,440 per infection. Clinical studies have documented a lower incidence and severity of nosocomial infections in OMM-fed than formula-fed preterm infants. Immunologic research has identified specific protective factors in OMM that provide passive and active immunity for the infant; many are concentrated more highly in OMM from mothers of preterm than term infants. Selected immunologic factors, such as secretory immunoglobulin A, are absorbed and excreted in the infant's urine; lactoferrin, with enhanced bacteriocidal properties, has been recaptured from feces. Thus, OMM may provide significant protection for ELBW infants; additionally, OMM is inexpensive, and facilitates mothers' participation in infant care. The dissertation will test strategies for using OMM to provide protection from infection during the early post-birth period when ELBW infants cannot tolerate enteral nutrition. An example is the use of OMM for routine infant mouth care and/or for gut-priming, e.g., minimal enteral feedings that stimulate maturation and barrier protection of the gastrointestinal tract. Outcome measures might include whether specific immune components of OMM are recaptured in infants' urine and feces.