Optimal Feeding Tube Dwell Time in VLBW to Reduce Feeding Tube Contamination

VLBW 中的最佳进料管停留时间可减少进料管污染

• 批准号: 9755511
• 负责人: Leslie A Parker
• 金额: $ 59.48万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-03 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9755511
• 关键词: Address; Area; Bacteria; Bacterial Antibiotic Resistance; Birth; Catheters; Chronic Disease; Culture Techniques; Developmental Delay Disorders; Devices; Enteral Feeding; Evidence based practice; Excision; Goals; Growth; Guidelines; Health; Health Promotion; Hour; Immunity; Impairment; Incidence; Infant; Infant Health; Inflammation; Inflammatory Response; Intensive Care; Intestines; Knowledge; Lead; Left; Length; Length of Stay; Life; Liquid substance; Liver diseases; Medical Device; Microbial Biofilms; Morbidity - disease rate; Necrotizing Enterocolitis; Neonatal; Neonatal Intensive Care Units; Nutritional; Oral; Outcome; Parenteral Nutrition; Pathogenicity; Premature Infant; Prospective cohort; Protocols documentation; Randomized; Research; Ribosomal RNA; Risk; Sampling; Stains; Stomach; Time; Translating; Venous; Very Low Birth Weight Infant; Vulnerable Populations; care costs; cost; disorder prevention; dysbiosis; feeding; gastrointestinal; hospital readmission; improved; indexing; late onset sepsis; metagenomic sequencing; microbial; microbiota; migration; premature; prevent; standard care; urinary

Because premature VLBW infants are too immature to orally feed, they require a feeding tube for weeks to months to meet their nutritional needs. These feeding tubes are a reservoir for pathogenic and antibiotic resistant bacteria and may increase the risk of necrotizing enterocolitis, late onset sepsis and feeding intolerance and are thus a risk to neonatal health. In the neonatal intensive care unit (NICU), guidelines regarding feeding tube dwell time are non-existent and feeding tubes are often not replaced for weeks following insertion. As with other external devices, such as central venous lines and urinary catheters, the risk of bacterial contamination increases the longer the device remains in place. Contaminated feeding tubes in premature VLBW infants can cause gastrointestinal (GI) microbial dysbiosis and inflammation, thereby increasing the risk of complications including necrotizing enterocolitis, late onset sepsis and feeding intolerance. The optimal feeding tube dwell time to decrease feeding tube contamination and the extent to which contamination causes GI microbial dysbiosis and inflammation and subsequent risk to neonatal health is unknown. The overall objective of this 4-year study is to determine if a maximum feeding tube dwell time of 48 hours reduces contamination compared to a maximum feeding tube dwell time of 7 days (current practice), thereby improving neonatal health outcomes. The proposed study will follow a prospective cohort (N = 120) of racially and economically diverse premature VLBW infants for 4 weeks following birth. Infants will be randomized into 1 of 2 groups. Feeding tubes will be changed every 0-48 hours (Group 1) and every 7 days (standard practice) (Group 2). Aim 1. will determine the effect of feeding tube dwell time on feeding tube hub, feeding tube, and intraluminal fluid contamination, bacterial pathogenicity, and biofilm formation in premature VLBW infants. For Aim 2, the effect of feeding tube dwell time on GI microbial dysbiosis and inflammation between Group 1 and Group 2 will be compared. In Aim 3, the effect of feeding tube dwell time, feeding tube contamination and biofilm formation on selected health outcomes will be determined. Results are expected to fill an important gap in research regarding feeding tube dwell time in premature VLBW infants, whether dwell time increases the risk of GI microbial dysbiosis and inflammation and whether feeding tube dwell time influences health outcomes.

由于早产 VLBW 婴儿尚未成熟，无法口服喂养，因此他们需要使用饲管数周才能完成喂养。 几个月来满足他们的营养需求。这些饲管是病原体和抗生素的储存库 耐药细菌，可能会增加坏死性小肠结肠炎、迟发性败血症和喂养的风险 不耐受，因此对新生儿健康构成风险。在新生儿重症监护病房 (NICU) 中，指南 关于饲管停留时间的问题是不存在的，并且饲管通常数周内都没有更换 插入后。与其他外部设备（例如中心静脉管和导尿管）一样，风险 设备保持在原位的时间越长，细菌污染就会增加。受污染的饲管 早产极低出生体重婴儿可导致胃肠道（GI）微生物失调和炎症，从而 增加并发症的风险，包括坏死性小肠结肠炎、迟发性败血症和喂养 不宽容。减少饲管污染的最佳饲管停留时间及其程度 哪种污染会导致胃肠道微生物失调和炎症以及随后对新生儿健康造成的风险 未知。这项为期 4 年的研究的总体目标是确定饲管最大停留时间是否为 48 与最长 7 天的饲管停留时间（当前实践）相比，数小时可减少污染， 从而改善新生儿健康结果。拟议的研究将遵循前瞻性队列（N = 120） 出生后 4 周内种族和经济状况多样化的早产 VLBW 婴儿。婴儿将会 随机分为 2 组中的 1 组。每 0-48 小时（第 1 组）和每 7 天更换一次饲管 （标准做法）（第 2 组）。目标 1. 将确定加料管停留时间对加料管毂的影响， 饲管、管腔内液体污染、细菌致病性和早产儿生物膜形成 极低出生体重婴儿。对于目标 2，饲管停留时间对胃肠道微生物失调和炎症的影响 将比较第 1 组和第 2 组之间的情况。在目标 3 中，加料管停留时间、加料管的影响 将确定污染和生物膜形成对选定健康结果的影响。结果预计 填补了早产 VLBW 婴儿饲管停留时间研究的重要空白，无论是否停留 时间会增加胃肠道微生物失调和炎症的风险以及饲管停留时间是否会增加 影响健康结果。