METABOLIC CONSEQUENCES OF GROWTH FAILURE IN EXTREMELY LOW BIRTH WEIGHT INFANTS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Despite continually improving survival rates, growth outcomes for premature extremely low birth weight (ELBW) infants remain exceptionally poor. Growth failure is nearly universal in these infants as they near term gestation. High rates of protein loss and elevated energy expenditures uncompensated by adequate nutritional intake appear to be primary factors in producing this growth failure, perhaps producing metabolic changes that prioritize survival over growth. The goal of the present proposal is to test the overall hypothesis that nutritional inadequacies of the extrauterine environment induce adaptive responses in protein metabolism, energy expenditure, insulin sensitivity, and endothelial function in ELBW infants which persist throughout infancy. Studies will be performed in ELBW and normal control infants at term gestation, 4 and 18 months of age. The following specific aims will be pursued: 1) To assess protein kinetics and protein catabolism during enteral feeding and in response to increased protein intake in ELBW infants throughout infancy. 2) To determine the rate of total energy expenditure, resting energy expenditure, and energy of activity in ELBW infants throughout infancy. 3) To examine insulin sensitivity in ELBW infants throughout infancy. 4) To evaluate endothelial function in ELBW infants throughout infancy. These studies may form the basis for improved clinical and nutritional strategies for these infants, as well as a future opportunity to more thoroughly explore the potential mechanisms underlying these adaptations