Gastrointestinal Risk Factors for Wheezing in Premature Infants

候选人：我渴望成为新生儿流行病学和临床试验的领导者，通过进一步为循证医学提供经验数据来改善新生儿的结果。为了成为一名成功的独立研究者，我努力通过进一步的大规模前瞻性临床研究培训来建立强大的流行病学背景。我对早产儿的肺部结果特别感兴趣，并寻求更好地衡量这些结果并与肺部专家合作。环境：彩虹婴儿和儿童医院和凯斯西储大学为临床研究的多学科合作和培训提供了良好的环境。新生儿科和临床流行病学与生物统计学分别由Richard Martin博士和Susan Redline博士领导，对我的职业发展有很强的承诺。我的家庭部门，新生儿科，在美国国立卫生研究院资助的临床研究方面有着卓越的传统，包括在临床试验和新生儿结局研究方面的丰富经验。它在国际上以临床护理和研究而闻名，包括它在NICHD新生儿研究网络中的作用。研究:这项早产儿前瞻性队列研究的目的是：1)描述出生第一年喘息和胃食管反流（GER）的频率；2)确定患有GER的早产儿是否更容易发生喘息；3)确定某些营养和喂养方式——配方奶喂养、睡前奶瓶喂养和多种维生素的使用——是否与喘息有关。4)评估无创测量喘息和GER的可靠性和有效性。相关性：该研究的重点是较大的，“更健康”的早产儿（28-34周胎龄，没有出生体重限制），他们可能承受着未被认识到的疾病负担。据March of Dimes报道，2003年美国499,008名早产儿中，只有1.4%是极低出生体重（VLBW, <1500g）；研究人群更具有美国早产儿的代表性，而不仅仅是VLBW队列。多学科的方法侧重于潜在的可改变的风险因素喘息，早产最常见的并发症之一。这项研究将通过确定可瞄准的危险因素和适当的非侵入性测量工具，促进未来治疗方法的设计，以防止喘息。

DESCRIPTION (provided by applicant): CANDIDATE: I aspire to become a leader in neonatal epidemiology and clinical trials, improving outcomes of neonates by furthering the empiric data available for evidence-based medicine. To succeed as an independent investigator, I strive to build on a strong epidemiologic background by furthering my training in large-scale prospective clinical research. I have a particular interest in the pulmonary outcomes of premature infants, and seek to be better able to measure these outcomes and collaborate with pulmonary specialists. ENVIRONMENT: Rainbow Babies & Children's Hospital and Case Western Reserve University provide an excellent environment for multidisciplinary collaboration and training in clinical research. The Division of Neonatology and the Division of Clinical Epidemiology and Biostatistics, lead by Dr. Richard Martin and Dr. Susan Redline respectively, have strong commitments to my career development. My home division, Neonatology, has an exceptional tradition of NIH-funded clinical research, including extensive experience with clinical trials and neonatal outcomes research. It is internationally known for clinical care and research, including its role in the NICHD Neonatal Research Network. RESEARCH: The aims of this prospective cohort study of premature infants are to 1) describe the frequency of wheezing and gastroesophageal reflux (GER) in the first year of life 2) determine whether premature infants with GER are more likely to wheeze, 3) determine whether certain nutritional and feeding practices - formula-feeding, bottle-feeding in bed before sleep, and multi-vitamin use ~ are associated with wheezing, and 4) assess the reliability and validity of non-invasive measurements of wheezing and GER. RELEVANCE: The study focuses on larger, "healthier" preterm infants (28-34 wks gestational age, no birth weight restrictions) who may be bearing an under-recognized burden of disease. The March of Dimes reports that of the 499,008 preterm births in the U.S. in 2003, only 1.4% were very low birth weight (VLBW, <1500g); the study population is more representative of premature infants in the U.S. than exclusively VLBW cohorts. A multidisciplinary approach focuses on potentially modifiable risk factors for wheezing, one of the most common complications of prematurity. This study will facilitate the design of future trials of therapies to prevent wheezing by identifying targetable risk factors and appropriate non-invasive measurement tools.