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

由于早产儿太不成熟，不能口服喂养，他们需要几周的喂养管 以满足他们的营养需求。这些饲养管是病原体和抗生素的储存库。 耐药细菌，并可能增加坏死性小肠结肠炎、迟发性败血症和喂奶的风险 不容忍，因此对新生儿健康构成风险。在新生儿重症监护病房(NICU)，指南 关于喂饲管，停留时间是不存在的，而且喂饲管常常几个星期都不更换 在插入之后。与其他外部设备，如中心静脉导管和导尿管一样，风险 设备放置的时间越长，细菌污染的可能性就越大。被污染的喂食管 早产儿可导致胃肠道(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、迟发性败血症和喂奶 不宽容。降低进料管污染的最佳进料管停留时间及其影响程度 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的风险是 未知。这项为期4年的研究的总体目标是确定喂养管的最大停留时间是否为48 与最长进料管停留时间7天(目前的做法)相比，数小时减少了污染， 从而改善新生儿的健康状况。拟议的研究将遵循以下预期队列(N=120) 种族和经济上不同的早产儿出生后4周。婴儿将会是 随机分为1/2组。喂养管每隔0-48小时(组1)和每7天更换一次 (标准做法)(第2组)。目的1.确定进料管停留时间对进料管轮毂的影响， 早产儿喂养管、腔内液体污染、细菌致病性和生物被膜形成 极低出生体重儿。目的2：饲管放置时间对胃肠道微生物代谢和炎症的影响 将比较第一组和第二组之间的差异。目的3、饲喂管停留时间、饲喂管 将确定污染和生物膜形成对选定的健康结果的影响。预计结果将 填补早产儿喂养管停留时间研究的重要空白 时间增加了胃肠道微生物失调和炎症的风险，以及是否留置喂养管的时间 会影响健康结果。

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.