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: 10200148
• 负责人: Leslie A Parker
• 金额: $ 62.91万
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200148
• 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 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; intestinal barrier; late onset sepsis; metagenomic sequencing; microbial; microbiota; migration; neonatal health; 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.

由于早产极低出生体重婴儿太不成熟，不能口服喂养，他们需要喂养管数周， 以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，并可能增加坏死性小肠结肠炎，迟发性败血症和喂养的风险 不容忍，因此对新生儿健康构成风险。在新生儿重症监护室（NICU），指南 关于饲管停留时间的问题是不存在的，饲管通常数周不更换 插入后。与其他外部器械（如中心静脉管路和导尿管）一样， 细菌污染的风险会增加。受污染的饲管 早产极低出生体重儿可引起胃肠道（GI）微生物生态失调和炎症， 增加并发症的风险，包括坏死性小肠结肠炎、迟发性败血症和进食 不容忍减少饲管污染的最佳饲管停留时间以及 该污染导致GI微生物生态失调和炎症，并随后对新生儿健康造成风险， 未知这项为期4年的研究的总体目标是确定最长饲管留置时间为48 与7天的最大饲管停留时间（当前实践）相比， 从而改善新生儿的健康状况。拟定的研究将遵循前瞻性队列（N = 120）， 种族和经济上不同的早产VLBW婴儿出生后4周。婴儿将 随机分为2组之一。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。将决定饲管停留时间对饲管毂的影响， 早产儿喂养管和管腔内液体污染，细菌致病性和生物膜形成 极低出生体重婴儿。对于目标2，饲管停留时间对GI微生物生态失调和炎症的影响 将比较组1和组2之间的差异。在目标3中，饲管停留时间、饲管 将确定污染和生物膜形成对选定健康结果的影响。结果预计将 填补了关于早产极低出生体重婴儿喂养管留置时间研究的重要空白， 时间增加了胃肠道微生物生态失调和炎症的风险， 影响健康结果。

项目成果

A Computational Quantum-Based Perspective on the Molecular Origins of Life's Building Blocks.

• DOI: 10.3390/e24081012
• 发表时间: 2022-07-22
• 期刊: Entropy (Basel, Switzerland)

Pasteurization of human milk affects the miRNA cargo of EVs decreasing its immunomodulatory activity.

• DOI: 10.1038/s41598-023-37310-x
• 发表时间: 2023-06-21
• 期刊: SCIENTIFIC REPORTS
• 影响因子: 4.6
• 作者: Lamberti, Monica Torrez F.;Parker, Leslie A.;Gonzalez, Claudio F.;Lorca, Graciela L.
• 通讯作者: Lorca, Graciela L.