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

大胎龄婴儿的经口喂养困难：定义身体成分、经口喂养能力和食欲调节激素之间的相互关系

• 批准号: 10734263
• 负责人: Kera Michelle McNelis
• 金额: $ 28.4万
• 依托单位: NEMOURS CHILDREN'S HOSPITAL, ORLANDO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-22 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10734263
• 关键词: Admission activity; Age; Basal metabolic rate; Biological; Birth Rate; Birth Weight; Body Composition; Calories; Caring; Clinical; Clinical Trials; Complex; Data; Desire for food; Dose; Economics; Energy Intake; Enteral Feeding; Exposure to; Family; Fatty acid glycerol esters; Feedback; Feeding behaviors; Feeds; Future; Gastrostomy; Gestational Age; Gestational Diabetes; Goals; Growth; Health Care Costs; Hormones; Hospitalization; Hunger; Infant; Intake; Knowledge; Length of Stay; Life; Mediating; Metabolic; Multicenter Trials; Neonatal Intensive Care Units; Nutrient; Nutrition Therapy; Nutritional Support; Obesity; Oral; Outcome; Pilot Projects; Pregnancy; Pregnant Women; Prevalence; Proxy; Quality of life; Randomized, Controlled Trials; Research; Research Design; Risk; Role; Satiation; Severities; Time; Tube; United States; Weight; Weight Gain; cost; feeding; high risk; improved; in utero; indexing; infancy; innovation; maternal diabetes; maternal obesity; novel; precision nutrition; prevent; prospective; response; sex; success; trial comparing

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.

项目概要/摘要 入住新生儿重症监护病房 (NICU) 的婴儿经口喂养困难的患病率 增加。这不仅导致新生儿重症监护室住院时间延长，而且医疗费用也会增加。一个 主要原因是大于胎龄（LGA）婴儿出生率的增加，因为 母亲怀孕期间肥胖和糖尿病。 LGA 婴儿被认为是不良口腔喂养者。重要的 在理解 LGA 婴儿口腔问题所涉及的复杂机制方面存在知识差距 喂养困难。 LGA 婴儿在子宫内暴露于过量能量，身体成分研究表明 研究表明，他们的脂肪质量（FM）较高，无脂肪质量（FFM）比例较低。经口喂养能力 可以受到饥饿和饱腹感的影响，这可能与身体状态有反馈机制 身体的能量储存（FM 作为代表）和静息代谢率（RMR、FFM 作为代表），以及这些影响 可能是通过食欲调节激素（ARH）水平介导的。我们的初步数据表明 FM 较高且 FFM 比例较低（身体成分不成比例）的婴儿需要更长的时间才能 达到独立经口喂养，需要更长的住院时间，并且需要更高的 G 管放置。实况调查团 与 FM 相比，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 婴儿的摄入量和食欲。标准 NICU 喂养策略的重点是促进体重增加 无论出生体重或身体成分如何，这对于 LGA 婴儿来说都是不合适的，因为 LGA 婴儿 研究表明，婴儿早期的“抑制”生长具有更好的长期结果。这些婴儿有一个 在捕获期间，与 FFM 相比，FM 损失的比例更大。 LGA 婴儿口腔 NICU 中的喂养困难取决于管饲，喂养量由护理人员调节 团队而不是婴儿驱动的。这些婴儿的 FFM% 较低可能会降低他们满足需求的能力 标准口服摄入量与总质量相关（150 毫升/公斤/天）。继续超额拨备 高于管饲代谢需要的热量可能会增加他们的身体肥胖，妨碍自然健康 生长缓慢，并加剧了它们的口服喂养困难。拟议的研究将评估 LGA 婴儿的身体成分、经口喂养能力和 ARH 水平之间的相互关系。此外，我们 将评估短期 FFM 指数喂养的效果（目标喂养量以 FFM 为指数） 与经口喂养的标准喂养方法（目标喂养量与总质量挂钩）的比较 经口喂养困难的 LGA 婴儿的结局、捕获体重和身体成分。知识 从该提案中获得的成果将为未来旨在评估精度的研究提供依据 LGA 婴儿的营养疗法。这最终可能会缩短住院时间并增强 这些婴儿的生活质量。