Clinical Epidemiologic and Biologic Studies of Donor Human Milk and Breastfeeding

描述（由申请人提供）：母乳喂养是一种重要的健康促进行为。人乳是所有婴儿的理想饮食，优化智力，保护儿童免受传染病和特应性疾病的侵害，并降低肥胖、高血压和其他慢性疾病的风险。极低出生体重（VLBW）早产儿是终身残疾风险最高的婴儿，其母乳喂养率在美国是最低的。母乳并不总是可用的，巴氏消毒的捐赠母乳是一种替代品，需要调查。捐赠的母乳是否具有与母乳相似的健康和发育优势尚不清楚。通过确定与早产儿配方奶粉相比，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。新生儿重症监护病房收治的足月儿和晚期早产儿的母乳喂养率低于健康足月儿。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。本申请描述了一个为期5年的培训计划，以发展必要的技能，成功作为一个独立的新生儿流行病学调查。PI保证至少80%的受保护时间用于研究。候选人得到了拟议研究内部和外部高级研究人员的广泛支持，并将继续下去。Saftlas和Morriss博士将赞助并共同赞助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的工作。我们的供体母乳研究的假设是，供体母乳为VLBW婴儿提供了与母乳相似的健康和发育优势。Pi的初步回顾性数据显示，捐赠母乳和母乳喂养的婴儿的发育结果相似，从而实现以下目标：1）对捐赠母乳与早产儿配方奶粉进行随机试验，以确定捐赠母乳与配方奶粉相比是否能增强短期和中期健康和发育结果; 2）回顾性比较喂养供体人乳的早产儿与喂养母乳的早产儿在18-22个月内的生长情况，假设生长情况相当; 3）确定在新生儿重症监护病房（NICU）收治的足月和晚期早产儿中母乳喂养成功的预测因素，以设计干预措施消除障碍。

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.