Maternal Stress, Human Milk Composition, and Neurodevelopmental and Feeding Outcomes

项目摘要/摘要 早产和新生儿重症监护病房(NICU)的婴儿住院都有很好的记录 对母亲来说是一件令人紧张的事情。尽管母乳对于促进最佳健康和 早产儿的神经发育，母体产后应激对母体哺乳的影响 尚未对喂养结果和牛奶成分进行系统检查。这项提议的目标是 独立之路奖是对哺乳和喂养结果的详细检查 NICU中早产儿用生物系统方法了解母乳以检查 假设母亲应激与喂养结果和受损的标志物有关 早产儿的神经发育和以影响早产的方式改变母乳和婴儿肠道特征 神经发育。这项拟议的研究直接与尤尼斯·肯尼迪·施莱弗国家研究所 儿童健康和人类发展的科学优先事项，以减少神经发育的发生率 通过了解营养/喂养和微生物组，优化早产儿的结局 了解母乳成分与母体特征的关系。在K99阶段， 将对NICU中感知的、生物学的和已知的母亲应激源进行测量，并 评估与母亲哺乳和喂养结果(母乳产量、母亲自己的乳汁与捐赠者的乳汁)有关的情况 牛奶与早产配方奶粉(目标1)。婴儿还将接受神经发育测试，通过 NICU出院前和4个月校正年龄时的脑电检查以评估两者的关系 母亲应激与早产神经发育结局之间的关系(目标2)。年的职业发展活动 K99阶段，包括应激生理学和婴儿神经发育方面的培训，发展专门知识 NICU中早产儿的哺乳/喂养结果，以及评估母乳的学习技术 和婴儿肠道成分数据及其解释将在良好的研究环境中进行， 明尼苏达大学公共卫生学院流行病学和社区卫生与遗嘱学部 提供必要的技能，成功地检查母亲压力与以下特征的关系 R00期母乳和早产儿肠道组成。靶向代谢和非靶向代谢 将使用方法和微生物分析来阐明母乳和 早产肠道成分与母体应激和早产神经发育(目标3)。建议数 研究为未来的临床干预奠定了基础，旨在减轻孕产妇的影响 通过心理社会支持和/或营养补充来应对产后压力，还将提供 成功启动专注于促进营养的独立研究事业的基础数据 为早产儿带来最佳神经发育的实践。

PROJECT SUMMARY/ABSTRACT Preterm birth and the hospitalization of infants in the neonatal intensive care unit (NICU) are well-documented as stressful events for mothers. Although maternal milk is critically important to promote optimal health and neurodevelopment for preterm infants, the effects of maternal postnatal stress on maternal lactation and feeding outcomes and milk composition have not been systematically examined. The goal of this proposed Pathway to Independence Award is to pair a detailed examination of lactation and feeding outcomes for preterm infants in the NICU with a biological systems approach to understanding human milk to examine the hypothesis that maternal stress is associated with feeding outcomes and markers of impaired neurodevelopment for preterm infants and alters human milk and infant gut profiles in ways that affect preterm neurodevelopment. The proposed research directly aligns with the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s scientific priorities to reduce the incidence of neurodevelopmental disorders, optimize outcomes for preterm infants by understanding nutrition/feeding and the microbiome, and to understand human milk composition in relationship with maternal characteristics. During the K99 phase, measurement of perceived, biological, and known maternal stressors in the NICU will be conducted and assessed in relation to maternal lactation and feeding outcomes (milk production, mothers’ own milk vs donor milk vs preterm formula) (Aim 1). Infants will also undergo neurodevelopmental testing via electroencephalogram before NICU discharge and at 4 months corrected age to assess the relationship between maternal stress and preterm neurodevelopmental outcomes (Aim 2). Career development activities in the K99 phase, including training in stress physiology and infant neurodevelopment, developing expertise in lactation/feeding outcomes for preterm infants in the NICU, and learning techniques for assessing human milk and infant gut composition data and their interpretation will take place in the excellent research environment at the University of Minnesota School of Public Health Division of Epidemiology and Community Health and will provide the skills needed to successfully examine associations of maternal stress with characteristics of maternal milk and preterm infant gut composition in the R00 phase. Targeted and untargeted metabolic approaches and microbial analyses will be used to elucidate the relationships between human milk and preterm gut composition with maternal stress and preterm neurodevelopmental (Aim 3). The proposed research lays the groundwork for future clinical interventions designed to mitigate the effects of maternal postnatal stress through psychosocial support and/or nutritional supplementation and will also provide foundational data for the successful launch of an independent research career focused on promoting nutritional practices which yield optimal neurodevelopment for preterm infants.