INFECTION IN ELBW INFANTS:PROTECTION WITH MOTHER'S MILK

该一级申请的重点是确定和测试使用母乳（OMM）为极低出生体重（ELBW; <1000 g）婴儿提供感染保护的策略。新生儿重症监护室（NICU）中的免疫缺陷加上病原微生物暴露使ELBW婴儿易发生院内感染，导致短期和长期后遗症，并使NICU住院费用平均增加10，440美元。临床研究证明，OMM喂养的早产儿医院感染的发生率和严重程度低于配方奶粉喂养的早产儿。免疫学研究已经确定了OMM中的特定保护因子，这些保护因子为婴儿提供被动和主动免疫;许多保护因子在早产儿母亲的OMM中的浓度高于足月儿。选定的免疫因子，如分泌型免疫球蛋白A，被吸收和排泄在婴儿的尿液中;乳铁蛋白，具有增强的杀菌性能，已被重新从粪便中捕获。因此，OMM可以为ELBW婴儿提供重要的保护;此外，OMM价格低廉，便于母亲参与婴儿护理。本论文将测试在出生后早期，当ELBW婴儿不能耐受肠内营养时，使用OMM提供感染保护的策略。一个实例是OMM用于常规婴儿口腔护理和/或用于肠道灌注的用途，例如，刺激胃肠道成熟和屏障保护的最小肠内喂养。结果测量可能包括OMM的特定免疫成分是否在婴儿的尿液和粪便中被重新捕获。

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.