Clinical Epidemiologic and Biologic Studies of Donor Human Milk and Breastfeeding

描述(申请人提供)：母乳喂养是一种重要的健康促进行为。母乳是所有婴儿的理想饮食，可以优化智力，预防儿童时期的传染病和特应性疾病，并降低肥胖、高血压和其他慢性病的风险。极低出生体重(VLBW)早产儿是终身残疾风险最高的婴儿，他们的母乳喂养比率在美国是最低的。母乳并不总是可用的，巴氏杀菌的捐赠者母乳是一种需要调查的替代方案。目前尚不清楚捐赠者的母乳是否具有与母亲母乳类似的健康和发育优势。通过确定与早产婴儿配方奶粉相比，捐赠母乳对健康和发育结果的影响，我们寻求优化这一脆弱人群的结果。住进NICU的足月儿和晚早产儿的母乳喂养率低于健康的足月儿。了解这些人群中母乳喂养成功的预测因素对于设计干预措施至关重要。这份申请书描述了一项为期5年的培训计划，以培养成功成为一名独立的新生儿流行病学调查员所需的技能。在此奖项期间，PI保证至少有80%的受保护时间用于研究。拟议研究的内部和外部高级调查人员对候选人给予了广泛支持，并将继续下去。Saftlas博士和Morriss博士将赞助和共同赞助PI的培训，他们各自在围产期流行病学和大型数据库分析方面的专业知识将指导PI的努力。我们的供体母乳研究的假设是，供体母乳在极低出生体重儿中提供与母乳类似的健康和发育优势。国际母乳喂养协会的初步回顾数据显示，捐赠母乳和母乳喂养的婴儿的发育结局相似，因此有以下目的：1)对捐赠母乳和早产儿配方奶进行随机试验，以确定与配方奶相比，捐赠母乳是否能增强中短期健康和发育结果；2)在生长相等的假设下，回顾比较捐赠母乳和母乳喂养的早产儿18-22个月的生长情况；3)确定预测NICU住院人群中母乳喂养成功的因素，以便设计消除障碍的干预措施。

DESCRIPTION (provided by applicant): Breastfeeding is an important health-promoting behavior. Human milk is the ideal diet for all infants, optimizes intellect, and provides protection against infectious and atopic diseases in childhood as well as decreasing risks for obesity, hypertension and other chronic diseases. Infants with the highest risk of life-long disability, very low birthweight (VLBW) preterm infants, are breastfed at some of the lowest rates in the US. Maternal milk is not always available, and pasteurized donor human milk is an alternative that requires investigation. Whether donor milk conveys health and developmental advantages similar to those bestowed by maternal milk is unknown. By determining the effects of donor milk on health and developmental outcomes when compared to preterm infant formula, we seek to optimize outcomes in this fragile population. Term and late-preterm infants admitted to NICUs are breastfed at lower rates than healthy term infants. Understanding factors predictive of breastfeeding success in these populations is essential to designing interventions. This application describes a 5-year training plan to develop skills necessary for success as an independent neonatal epidemiology investigator. The PI is guaranteed at least 80% protected time to devote to research during this award. Extensive support has been given to the candidate by senior investigators both internal and external to the proposed research, and will continue. Drs. Saftlas and Morriss will sponsor and co-sponsor the Pi's training, and their respective expertise in perinatal epidemiology and large-database analysis will guide the Pi's efforts. The hypothesis of our donor milk research is that donor human milk offers health and developmental advantages similar to maternal milk in VLBW infants. The Pi's preliminary retrospective data show similar developmental outcomes in donor milk and maternal milk fed infants, leading to the following aims: 1) To conduct a randomized trial of donor human milk vs. preterm infant formula, to determine if short and medium-term health and developmental outcomes are enhanced by donor milk compared to formula; 2) To retrospectively compare growth through 18-22 months in preterm infants fed donor human milk compared with those fed maternal milk, with the hypothesis that growth is equivalent; 3) To determine factors predictive of breastfeeding success in the term and late-preterm populations admitted to NICUs, in order to design interventions to eradicate barriers.