Feeding Behaviors & Energy Cost in Infants with CHD

描述：（由申请人提供）本提案要求继续支持nir资助的研究，该研究的标题为：营养吸吮：生理和行为相关。在目前的建议中，我们(1)通过整合全餐过程中吸吮、吞咽和呼吸的措施来深化我们对喂养组织的分析；(2)表征另一高危人群-先天性心脏病婴儿（CHD）的喂养模式；(3)将喂养表现和能量消耗与CHD婴儿出生后第一年的生长发育问题联系起来。这些婴儿通常很难感觉到，即使他们的手术改善了他们的心脏功能。事实上，手术的成功往往暴露了他们严重的营养综合症，即发育不良（FTT）。为了解决这一重要的临床问题，我们建议测量120名在出生后第一个月内接受手术以纠正或缓解严重心脏异常的婴儿和60名健康新生儿的喂养表现和能量消耗。我们提出的研究的具体目的如下：1)确定哪些方面的喂养表现（如吮吸/吞咽/呼吸协调，进餐时吮吸的时间模式，吮吸压力的产生，对流速变化的适应）最容易受到纠正或姑息性手术后冠心病婴儿的干扰；2)确定婴儿通过人工乳头对流量变化的口咽适应模式，以及流量调节是否代表一种改善餐量结果的可行策略；3)确定喂养组织中断和（可能升高的）能量消耗对不利生长结果的相对贡献，即(i)将喂养中断与生长联系起来，（ii）将能量消耗与生长联系起来，以及（iii）将能量和喂养性能特征整合到冠心病婴儿茁壮成长失败的预测模型中。这项研究解决了我们认为喂养组织在患者营养状况中的核心作用；因此，它代表了一种早期识别的方法，基于喂养表现和精力状况，在一岁前最有可能发生FTT的婴儿。目前的工作可能为有针对性的行为干预提供前景，包括改变流速和有节奏的饲料。

DESCRIPTION: (provided by applicant) This proposal requests continued support for a NINR funded study that had been entitled: Nutritive sucking: Physiological and Behavioral correlates. In the present proposal, we (1) deepen our analysis of feeding organization by integrating measures of sucking, swallowing and breathing over the course of full meals and (2) characterize the feeding patterns of another at-risk population - infants with congenital heart disease (CHD), and (3) relate feeding performance and energy expenditure to problems in growth and development over the first year of life in CHD infants. These infants are often difficult to feel, even when their surgery has improved their cardiac function. Indeed, the success of the surgery often unmasks their severe nutritional syndrome, failure to thrive (FTT). To address this important clinical problem, we propose to measure feeding performance and energy expenditures over the first hear of life in 120 infants who have undergone surgery during the first month of life to correct or palliate sever cardiac abnormalities and 60 healthy newborn controls. The specific aims of our proposed study are as follows: 1) to establish which aspects of feeding performance (e.g. suck/swallow/breathe coordination, temporal patterning of sucking with meals, suck pressure generation, adaptation to variation in flow rate) are most subject to disruption in CHD infant after corrective or palliative surgery; 2) to determine infants' pattern of oropharyngeal adaptation to variations in the flow rate through an artificial nipple, and whether flow rate adjustment represents a viable strategy for improving meal size outcomes; and 3) to determine the relative contributions of disrupted feeding organization and (potentially elevated) energy expenditure to unfavorable growth outcomes, i.e. (i) relate disrupted feeding to growth, (ii) relate energy expenditure to growth, and (iii) integrate energetic and feeding-performance characteristics in a predictive model of failure to thrive in infants with CHD. This study addresses what we believe is the central role of feeding organization in the nutritional status of this patient population; as such, it represents an approach toward early identification, based on feeding performance and energetic profiles, of infants most at risk for developing FTT by the age of one. The present work may offer prospects for targeted behavioral interventions involving modification of flow rates and paced feeds.