Oral Feeding Difficulty in Large for Gestational Age Infants: Defining Interrelationships between Body Composition, Oral Feeding Ability, and Appetite-Regulating Hormones

项目总结/摘要 新生儿重症监护病房（NICU）中婴儿经口喂养困难的患病率 增加。这不仅导致NICU住院时间延长，而且还导致医疗费用上升。一 主要原因是胎龄较大婴儿出生率的增加， 孕妇肥胖和糖尿病。LGA婴儿被认为是较差的口服喂养者。显著 在理解LGA婴儿口腔疾病的复杂机制方面存在知识差距， 进食困难LGA婴儿在子宫内暴露于过量的能量，身体成分研究表明， 结果表明，他们有较高的脂肪质量（FM）和较低的脂肪质量（FFM）的比例。经口进食能力 可以受到饥饿和饱腹感的影响，这可能与大脑的状态有反馈机制。 身体的能量储存（FM作为代理）和静息代谢率（RMR，FFM作为代理），以及这些影响 可能通过食欲调节激素（ARH）水平介导。我们的初步数据显示， 具有较高FM和较低FFM比例（不成比例的身体组成）的婴儿需要更长的时间来 达到独立的口服喂养，需要更长的住院时间，并需要更高的G管放置。FFM 与FM相比，FFM与口服（能量）摄入的相关性更好，表明FFM是能量的主要决定因素 婴儿的食欲和食欲。标准的新生儿重症监护室喂养策略的重点是促进体重增加 无论出生体重或身体组成，这是不合适的LGA婴儿，因为LGA婴儿 研究表明，婴儿早期的“追赶式”生长具有更好的长期结果。这些婴儿 在捕获期间，FM损失的比例大于FFM。LGA婴儿口腔 NICU中的喂养困难依赖于管饲，喂养摄入量由护理人员调节 团队而不是由婴儿驱动。这些婴儿中较低的FFM%可能会降低他们满足 以总质量为指数的标准口服摄入量（150 ml/kg/天）。继续提供超额 管饲的热量超过代谢需要可能会增加他们的身体肥胖，阻止自然 抑制生长，并加剧它们的口服进食困难。拟议的研究将评估 LGA婴儿身体组成、经口喂养能力和ARH水平之间的相互关系我们还 将评估短期FFM指数喂养的效果（以FFM为指数的目标喂养量） 与标准喂养方法（以总质量为指数的目标喂养量）相比， 结果，追赶体重，和身体组成的LGA婴儿与口服喂养困难。知识 从这一提议中获得的信息将为未来旨在评价精密度的研究提供依据 LGA婴儿的营养疗法。这可能最终缩短住院时间， 这些婴儿的生活质量。

Project Summary/Abstract Prevalence of oral feeding difficulty in infants admitted to a neonatal intensive care unit (NICU) is increasing. This not only leads to prolonged NICU stay, but an escalation of healthcare costs as well. A major contributor is the increase in large for gestational age (LGA) infant birth rate because of rising maternal obesity and diabetes during pregnancy. LGA infants are considered poor oral feeders. Significant knowledge gaps exist in understanding the complex mechanisms implicated in LGA infants with oral feeding difficulty. LGA infants are exposed to excess energy in utero and body composition studies have shown that they have higher fat mass (FM) and lower fat-free mass (FFM) proportion. Oral feeding ability can be influenced by hunger and satiety, which may have a feedback mechanism with the state of the body's energy stores (FM as proxy) and resting metabolic rate (RMR, FFM as proxy), and these effects may be mediated through the appetite-regulating hormone (ARH) levels. Our preliminary data suggest that infants with a higher FM and lower FFM proportion (disproportionate body composition) took longer to reach independent oral feeds, required longer hospitalization, and required higher g-tube placement. FFM is better associated with oral (energy) intake than FM, suggesting that FFM is major determinant of energy intake and appetite in infants. The standard NICU feeding strategy is focused on promoting weight gain irrespective of birth weight or body composition, which is inappropriate in LGA infants as LGA infants who demonstrated ‘catch-down’ growth in early infancy had better long-term outcomes. These infants had a greater proportion of FM loss compared to FFM during the catch-down period. LGA infants with oral feeding difficulty in the NICU are dependent on tube-feeding and the feeding intake is regulated by the care team rather than being infant-driven. The lower FFM% in these infants may reduce their ability to meet the standard oral intake volumes indexed to total mass (150 ml/kg/day). The continued provision of excess calories above the metabolic needs from tube-feeding may increase their body adiposity, prevent natural catch-down growth, and exacerbate their oral feeding difficulty. The proposed research will evaluate the interrelationship between body composition, oral feeding ability, and ARH levels in LGA infants. Further, we will evaluate the effects of a short-term FFM-indexed feeding (target feeding volume indexed to FFM) versus the standard approach to feeding (target feeding volume indexed to total mass) on oral feeding outcomes, catch-down weight, and body composition in LGA infants with oral feeding difficulty. Knowledge gained from this proposal will provide a rationale for future studies designed to evaluate precision nutritional therapies for LGA infants. This may ultimately shorten the length of hospital stay and enhance the quality of life for these infants.