Promotion of Exclusive Breastfeeding in Children with Sickle Cell Disease for Improved Health Outcomes

摘要 镰状细胞病(SCD)是一种遗传性红细胞疾病，主要影响非洲人 下降。SCD的生理特征包括慢性红细胞溶血、氧化应激、炎症、血管 损伤和末梢器官损伤。这些生理后遗症会导致不可预测的血管闭塞并发症， 如疼痛和急性胸腔综合征(ACS)。人类母乳中含有抗氧化剂、消炎药和 免疫调节特性被证明对慢性炎症条件具有保护作用，例如 哮喘、肥胖症和心血管疾病。母乳的持久影响一直是 在青少年和成人研究中证明了这一点，在这些研究中，婴儿时期接受母乳喂养的人的死亡率较低 血液中炎症的生物标志物的水平。有趣的是，母乳甚至被 证明可以防止端粒的侵蚀-端粒是DNA和DNA的保护帽 已确定的氧化应激和炎症的标志物。美国儿科学会与世界 卫生组织建议在生命的前6个月进行纯母乳喂养(EBF)，然后是1至2个月 多年的母乳喂养和营养补充剂。然而，尽管有这些建议和良好的- EBF的既定保护利益，2020年健康人母乳喂养目标与当前目标之间的差距 与所有其他种族和民族相比，非裔美国女性的EBF比率最高。 此外，EBF在SCD中的保护作用从未被探索过。几项研究已经注意到 缺乏母乳喂养榜样和支持网络是非裔美国妇女开展循证医学的障碍。 一个位于阿拉巴马州伯明翰的社区组织--巧克力奶木乃伊-- 通过在线和面对面的教育和支持小组、认证的 哺乳咨询服务，为低收入母亲免费租用吸奶器，以及家访和同伴- 指导计划。鉴于巧克力奶木乃伊的比例较低，它专门针对非裔美国母亲 在这一人群中母乳喂养的重要性。这一群体在2019年实现了83%的6个月EBF比率，远远超过了国家 和国家趋势。考虑到SCD中普遍存在的氧化应激和炎症，以及由此产生的风险 对于疼痛和肺部健康状况不佳的患者，必须测试EBF的保护作用，并建立有效的EBF- 在这一高危人群中推广干预措施。这个项目的目的是：1)测试这种联系 EBF暴露和SCD并发症之间的关系，2)测试EBF暴露和生物学之间的关联 氧化应激和炎症的标志物，以及3)招募和留住20名母亲的可行性 患有SCD的儿童参加以社区为基础的循证医学计划(巧克力奶妈妈)，为期6个月，≥，这是 将为未来更大规模的随机对照试验提供信息。这项研究的长期目标是建立 在小儿麻痹症中母乳喂养的保护益处，并通过促进循证健康基金改善整体健康结果。

ABSTRACT Sickle cell disease (SCD) is an inherited red blood cell disorder that predominantly affects individuals of African descent. The physiologic hallmarks of SCD include chronic red blood cell hemolysis, oxidative stress, inflammation, vascular damage and end-organ damage. These physiologic sequelae lead to unpredictable vaso occlusive complications, such as pain and acute chest syndrome (ACS). Human breastmilk contains antioxidant, anti-inflammatory and immune-modulating properties proven to be protective against chronic inflammatory conditions, such as asthma, obesity and cardiovascular disease. The lasting impacts of human breastmilk have been demonstrated in adolescent and adult studies, wherein individuals that were breastfed as infants had lower levels of biological markers of inflammation in their bloodstream. Interestingly, breastmilk has even been demonstrated to be protective against the erosion of telomeres – which are the protective caps of DNA and established markers of oxidative stress and inflammation. The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding (EBF) for the first 6 months of life, followed by 1 to 2 years of breastfeeding with nutritious supplementation. However, despite these recommendations and the well- established protective benefits of EBF, the gap between Healthy People 2020 breastfeeding goals and current rates of EBF is widest amongst African American women compared to all other racial and ethnic groups. Furthermore, the protective effects of EBF have never been explored in SCD. Several studies have noted a lack of breastfeeding role models and support networks as barriers to EBF among African American women. One community-based organization located in Birmingham (Alabama) — the Chocolate Milk Mommies —, specifically addresses these barriers through online and in-person education and support groups, certified lactation consultant services, free breast pump rentals for low-income mothers and a home visitation and peer- mentoring program. Chocolate Milk Mommies specifically targets African American mothers, given the lower rates of breastfeeding in this population. This group achieved a 6-month EBF rate of 83% in 2019, far exceeding state and national trends. Given the pervasive oxidative stress and inflammation in SCD, and the consequent risk for pain and poor lung health, it is essential to test the protective benefits of EBF and establish effective EBF- promoting interventions among this high risk population. The aims for this project are to: 1) test the association between EBF exposure and SCD complications, 2) test the association between EBF exposures and biological markers of oxidative stress and inflammation, and 3) pilot the feasibility to recruit and retain 20 mothers of children with SCD to a community-based EBF program (the Chocolate Milk Mommies) for ≥6 months, which will inform a future larger randomized controlled trial. The long-term goal for this research is to establish the protective benefits of breastfeeding in SCD and improve overall health outcomes through the promotion of EBF.