FEEDING INTOLERANCE IN PREMATURE INFANTS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。除了婴儿的发病率和死亡率以及他们的父母和家庭的情感负担外，照顾早产儿的费用代表了近10亿美元的经济负担。早产儿仅占所有活产婴儿的9%，但却占新生儿死亡率的三分之二。她们的保健费用与胎龄成反比。照顾一个存活了26周的妊娠婴儿的费用大约是16.6万美元。早产儿发病率和死亡率的很大一部分以及照顾早产儿所需的巨额费用是由于与喂养有关的问题。与足月儿相比，早产儿的胃肠功能发育不全。因此，早产儿在耐受肠内喂养方面有很大的困难，如喂养后胃残渣和腹胀等症状。这种喂养不耐受与显著的发病率（并发症）有关，在坏死性小肠结肠炎的极端情况下，与死亡率（死亡）有关。这些临床疾病延迟了喂养的进展，从而延迟了完全肠内喂养的时间。这种关系很重要，因为我们已经观察到达到完全肠内喂养所需的时间与住院时间之间的关系。因此，减少喂养不耐受的策略将加速向完全肠内喂养的进展，并最终缩短住院时间。制定减少喂养不耐受战略的关键组成部分之一是能够确定哪些婴儿面临的风险最大。据推测，早产程度越高，风险越大。然而，目前，甚至不可能预测相同胎龄的婴儿中哪些是最危险的。需要进行研究，以确定反映喂养不耐受的临床特征，并制定可以预测喂养不耐受的临床试验。这样的测试将允许早期干预，并有可能预防或改善喂养不耐受的最严重表现，坏死性小肠结肠炎。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The cost of caring for the premature (preterm) infant represents nearly a billion dollar economic burden in addition to the morbidity and mortality experienced by the infants and the emotional burden to their parents and family. Preterm infants represent only 9% of all live births but they account for two-thirds of neonatal mortality . The cost of their health care is inversely related to gestational age . The approximate cost of caring for a 26-week gestation infant who survives is approximately $166,000. A large portion of the morbidity and mortality of the preterm infant and the enormous cost required to care for them is due to feeding related issues. Gastrointestinal (GI) function in the preterm infant is underdeveloped compared with that in the term infant. Consequently, preterm infants experience great difficulty in tolerating enteral feedings as evidenced by symptoms such as gastric residuals after feeding and abdominal distention . This feeding intolerance is associated with significant morbidity (complications) and in the extreme case of necrotizing enterocolitis, mortality (death). These clinical morbidities delay the progression of feedings and consequently, the time to full enteral feedings. This relationship is important, as we have observed a relationship between the time required to reach full enteral feedings and the duration of hospitalization . Hence, strategies that reduce feeding intolerance will hasten the progression to full enteral feedings and ultimately will reduce the duration of hospitalization. One of the key components to developing strategies to reduce feeding intolerance is to be able to identify which infants are most at risk. Presumably the risk is greater with increasing degrees of prematurity. However, at the present time, it is not even possible to predict among infants of the same gestational age which are most at risk. Studies are needed to define the clinical characteristics that reflect feeding intolerance and to develop clinical tests that can predict feeding intolerance. Such tests would allow early intervention and potentially prevent or ameliorate the most severe manifestation of feeding intolerance, necrotizing enterocolitis.