Promotion of Exclusive Breastfeeding in Children with Sickle Cell Disease for Improved Health Outcomes

促进镰状细胞病儿童纯母乳喂养以改善健康状况

• 批准号: 10693377
• 负责人: Brandi Pernell
• 金额: $ 16.98万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693377
• 关键词: 2 year old; 5 year old; Academy; Acceleration; Address; Admission activity; Adolescent; Adult; Affect; African American; African American population; African ancestry; Age; Alabama; American; Anti-Inflammatory Agents; Antioxidants; Asthma; Behavior; Biological; Biological Markers; Blood Circulation; Blood Vessels; Blood specimen; Breast Feeding; Breastfed infant; C-reactive protein; Cardiovascular Diseases; Certification; Cessation of life; Chest Pain; Child; Chocolate; Chronic; Chronic Disease; Clinical Trials Design; Communities; Complement; Critical Care; DNA; Diagnosis; Diet; Disease; Drops; Dyspnea; Education; Erythrocytes; Ethnic Population; Event; Exclusive Breastfeeding; Exposure to; Feasibility Studies; Fever; Fostering; Future; Goals; Health; Healthy People 2020; Hemoglobin; Hemolysis; High Prevalence; Home visitation; Hospitalization; Human; Human Milk; Hypoxia; Immunologics; Individual; Infant; Infiltration; Inflammation; Inflammatory; Inherited; Interleukin-8; Intervention; Intervention Trial; Knowledge; Lactation consultant; Lead; Leadership; Length; Life; Life Style; Longevity; Low income; Medial; Milk; Mothers; Neonatal Screening; Nitric Oxide; Nutritional; Obesity; Observational Study; Organ; Outcome; Oxidative Stress; Pain; Pathogenesis; Pathologic Processes; Pathway interactions; Pediatrics; Persons; Physical activity; Physiological; Population; Prevalence; Prevention strategy; Property; Public Health; Publishing; Randomized, Controlled Trials; Recommendation; Reporting; Research; Risk; Running; Science; Services; Severity of illness; Sickle Cell; Sickle Cell Anemia; Statistical Data Interpretation; Stress; Structure; Supplementation; Support Groups; Testing; Thoracic Radiography; Training; Vascular Endothelium; Woman; World Health Organization; acute care; acute chest syndrome; airway inflammation; breast pump; cell community; community engaged research; community organizations; comorbidity; design; experience; feasibility testing; fighting; health organization; healthspan; high risk population; immunoregulation; improved; improved outcome; indexing; infancy; inflammatory marker; inflammatory modulation; lifestyle factors; lung health; novel marker; peer coaching; peer support; programs; protective effect; racial population; recruit; role model; screening program; standard of care; support network; surveillance data; telomere; trend

ABSTRACT Sickle cell disease (SCD) is an inherited red blood cell disorder that predominantly affects individuals of African descent. The physiologic hallmarks of SCD include chronic red blood cell hemolysis, oxidative stress, inflammation, vascular damage and end-organ damage. These physiologic sequelae lead to unpredictable vaso occlusive complications, such as pain and acute chest syndrome (ACS). Human breastmilk contains antioxidant, anti-inflammatory and immune-modulating properties proven to be protective against chronic inflammatory conditions, such as asthma, obesity and cardiovascular disease. The lasting impacts of human breastmilk have been demonstrated in adolescent and adult studies, wherein individuals that were breastfed as infants had lower levels of biological markers of inflammation in their bloodstream. Interestingly, breastmilk has even been demonstrated to be protective against the erosion of telomeres – which are the protective caps of DNA and established markers of oxidative stress and inflammation. The American Academy of Pediatrics and World Health Organization recommend exclusive breastfeeding (EBF) for the first 6 months of life, followed by 1 to 2 years of breastfeeding with nutritious supplementation. However, despite these recommendations and the well- established protective benefits of EBF, the gap between Healthy People 2020 breastfeeding goals and current rates of EBF is widest amongst African American women compared to all other racial and ethnic groups. Furthermore, the protective effects of EBF have never been explored in SCD. Several studies have noted a lack of breastfeeding role models and support networks as barriers to EBF among African American women. One community-based organization located in Birmingham (Alabama) — the Chocolate Milk Mommies —, specifically addresses these barriers through online and in-person education and support groups, certified lactation consultant services, free breast pump rentals for low-income mothers and a home visitation and peer- mentoring program. Chocolate Milk Mommies specifically targets African American mothers, given the lower rates of breastfeeding in this population. This group achieved a 6-month EBF rate of 83% in 2019, far exceeding state and national trends. Given the pervasive oxidative stress and inflammation in SCD, and the consequent risk for pain and poor lung health, it is essential to test the protective benefits of EBF and establish effective EBF- promoting interventions among this high risk population. The aims for this project are to: 1) test the association between EBF exposure and SCD complications, 2) test the association between EBF exposures and biological markers of oxidative stress and inflammation, and 3) pilot the feasibility to recruit and retain 20 mothers of children with SCD to a community-based EBF program (the Chocolate Milk Mommies) for ≥6 months, which will inform a future larger randomized controlled trial. The long-term goal for this research is to establish the protective benefits of breastfeeding in SCD and improve overall health outcomes through the promotion of EBF.

摘要