Maximizing Protein Growth in the Early Neonatal Period

最大限度地提高新生儿早期蛋白质的生长

• 批准号: 6987064
• 负责人: PATTI THUREEN
• 金额: $ 31.96万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-15 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6987064
• 关键词: child physical development; clinical research; developmental nutrition; dietary proteins; human subject; low birth weight infant human; newborn human (0-6 weeks); nutrition related tag; protein metabolism

DESCRIPTION (provided by applicant): Current nutritional strategies for very preterm infants in this country are resulting in postnatal growth failure from which the neonate does not recover by the time of hospital discharge. Undernutrition, particularly insufficient protein intake during critical development periods adversely affects long-term neurodevelopmental and health outcomes. Efforts to optimize nutritional support, therefore, particularly in the first weeks of life, are critical to reversing nutritionally related adverse outcomes in this vulnerable population. The only national published recommendation for providing comprehensive nutrition to the preterm neonate through the time of discharge is the American Academy of Pediatrics (AAP) recommendation to mimic the growth rate of the normal fetus of the same gestational age as the preterm jnfant. There are no guidelines by the AAP as to how this should be achieved, and no data in the literature to support or refute this recommendation. We believe that it is critical to determine if this is a valid recommendation. The overarching hypothesis to be addressed by this project is that protein accretion rates can be significantly improved in extremely low birth weight (ELBW) preterm infants during the critical nutritionally-sensitive early postnatal period. We believe that the proposed prospective studies of protein quantity, protein quality and energy intake on protein accretion will enhance the ability to optimize protein gain in these infants. Specific hypotheses to be addressed are: 1) that relatively high amino acid and energy intake initiated in the immediate neonatal period and sustained at fetal delivery rates through close monitoring of nutrient intake over the first 2 months of life will confer a prolonged anabolic advantage compared to current amino acid initiation and advancement strategies, and will determine whether or not fetal nutrient delivery rates administered to the preterm infant will achieve the AAP recommendation that extrauterine growth should approximate that of the fetus at the same gestational age; 2) that optimal concentrations of essential amino acids in parenteral nutrition can be determined that will improve the quality of amino acid intake in order to maximize protein accretion rates; and 3) that energy intakes can be identified that will optimize protein accretion at any given amino acid intake.

描述（由申请方提供）：该国目前针对极早产儿的营养策略导致出生后生长失败，新生儿在出院时无法恢复。营养不良，特别是在关键发育期蛋白质摄入不足，会对长期的神经发育和健康结果产生不利影响。因此，努力优化营养支持，特别是在生命的最初几周，对于扭转这一弱势群体中与营养有关的不良后果至关重要。唯一一个国家公布的关于在早产儿出院时为早产儿提供全面营养的建议是美国儿科学会（AAP）的建议，即模仿与早产儿相同胎龄的正常胎儿的生长速度。AAP没有关于如何实现这一目标的指南，文献中也没有数据支持或反驳这一建议。我们认为，确定这是否是一项有效的建议至关重要。该项目要解决的首要假设是，在关键的营养敏感的出生后早期，极低出生体重（ELBW）早产儿的蛋白质积累率可以显着改善。我们相信，所提出的蛋白质数量、蛋白质质量和能量摄入对蛋白质增加的前瞻性研究将提高这些婴儿优化蛋白质增加的能力。需要解决的具体假设是：1）与目前的氨基酸起始和推进策略相比，在新生儿期开始的相对高的氨基酸和能量摄入，并通过在生命的前2个月内密切监测营养素摄入而维持在胎儿分娩率，将赋予延长的合成代谢优势，并将确定给予早产儿的胎儿营养输送速率是否将达到AAP推荐的子宫外生长应接近相同胎龄胎儿的生长; 2）可以确定胃肠外营养中必需氨基酸的最佳浓度，其将改善氨基酸摄入的质量，以使蛋白质增长率最大化;和3）可以确定能量摄入，其将在任何给定的氨基酸摄入下优化蛋白质增长。