Gastrointestinal Risk Factors for Wheezing in Premature Infants

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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.