INFECTION IN ELBW INFANTS:PROTECTION WITH MOTHER'S MILK

本一级申请的重点是确定和测试使用自己的母乳（OMM）为极低出生体重（ELBW; <1000g）婴儿提供感染保护的策略。新生儿重症监护病房（NICU）的免疫功能不全加上接触致病性微生物使新生儿易发生院内感染，导致短期和长期的后遗症，并使每次感染平均增加10,440美元的NICU住院费用。临床研究表明，与配方奶喂养的早产儿相比，用omm喂养的早产儿医院感染的发生率和严重程度较低。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；与足月婴儿相比，早产儿母亲的OMM发病率更高。选定的免疫因子，如分泌性免疫球蛋白A，在婴儿尿液中被吸收和排泄；已从粪便中重新获得具有增强杀菌特性的乳铁蛋白。因此，OMM可能对ELBW婴儿提供重要的保护；此外，OMM费用低廉，有助于母亲参与婴儿护理。论文将测试策略，使用OMM提供保护，防止感染在早期出生后时期，当ELBW婴儿不能耐受肠内营养。一个例子是使用OMM进行常规婴儿口腔护理和/或肠道启动，例如，刺激成熟和胃肠道屏障保护的最小肠内喂养。结果测量可能包括是否在婴儿尿液和粪便中重新捕获OMM的特定免疫成分。

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.