Phenotypic Driven Growth Trajectories in Very Preterm Infants to Define Nutritionally Mediated Health Outcomes and Modifiable Targets

项目摘要 极早产儿的生长模式与神经发育和健康结果有关，但理想的生长 还没有建立模式轨迹，作为指导对这一群体进行营养干预的手段。 由于大多数极早产儿的生长低于预期的胎儿或婴儿轨迹， 描述极早产儿的生长特征是阐明营养在护理中的作用的重要步骤 和早产儿的发育。首要目标是确定非常早产儿的生长模式 在足月之前和生命的第一年，表型定义（母体、婴儿和 环境因素，包括健康的社会决定因素），并决定表型的影响- 了解极早产儿神经发育和健康结果的生长模式。我们假设 表型衍生的潜在类别增长分析衍生的曲线包括临床和环境 新生儿重症监护室（NICU）和出院后期间的连续暴露将 确定预测结果的增长模式。为了研究这一假设，我们将研究 分类为两个哨兵时期，从出生到36周胎龄（NICU时期）和从出生到12周胎龄（NICU时期）。 月龄（婴儿期）。通过详细收集母婴健康、社会和 健康、营养摄入和身体成分的环境决定因素;极早产儿暴露 将鉴定在这些表型信息的生长模式中差异表现的基因。随后 这些基于表型的生长模式对神经发育和健康结果的影响， 测定最后，一个储存库，储存了在头两年里从动物园收集的生物样本。 将建立一个更深入的探索代谢过程相关的确定 表型。这项检查将是第一个连接NICU和出院后时期的检查， 调查生长轨迹，没有预先确定的期望，并通过广泛的营养，健康， 和社会数据。通过对表型定义的生长模式的调查， 影响生长轨迹及其与极早产儿结局的联系将被揭示， 护理和未来的干预性试验，以优化每个极早产儿的营养和生长。

PROJECT SUMMARY Very preterm infant growth patterns are linked to neurodevelopmental and health outcomes, yet, ideal growth pattern trajectories have not been established as a means to guide nutritional intervention for this population. With the majority of very preterm infants exhibiting growth below the expected fetal or infant trajectory, greater characterization of very preterm infant growth is an essential step to elucidate the role of nutrition in the care and development of preterm infants. The overarching objective is to identify very preterm infant growth patterns prior to term age and across the first year of life that are phenotypically-defined (maternal, infant, and environmental factors including social determinants of health) and determine the impact of the phenotypically- informed growth patterns on very preterm infant neurodevelopmental and health outcomes. We hypothesize that phenotypic-derived latent class growth analysis-derived curves encompassing clinical and environmental exposures across the continuum of the neonatal intensive care unit (NICU) and post-discharge periods will identify growth patterns predictive of outcomes. To investigate this hypothesis, patterns of growth will be classified for two sentinel epochs spanning birth to 36 weeks' gestational age (the NICU period) and birth to 12 months' corrected age (infancy). Through a detailed collection of maternal and infant health, social and environmental determinants of health, nutrient intake, and body composition; the very preterm infant exposures differentially represented in these phenotypically-informed growth patterns will be identified. Subsequently, the impact of these phenotypically-informed growth patterns on neurodevelopmental and health outcomes will be determined. Lastly, a repository of longitudinally-collected biologic samples through the first two years of age will be established to foster a deeper exploration of the metabolic processes related to the identified phenotypes. This examination will be the first to bridge the NICU and post-hospital discharge epochs to investigate growth trajectory without predetermined expectations and informed by extensive nutrition, health, and social data. Through this investigation of phenotypically-defined growth patterns, the modifiable factors influencing growth trajectory and its link to very preterm infant outcomes will be revealed to inform both clinical care and future interventional trials to optimize nutrition and growth for each very preterm infant.