Investigating Donor Human Milk Composition Globally to Develop Effective Strategies for the Nutritional Care of Preterm Infants

项目概要 全球每年有近 1500 万婴儿早产，对中低收入人群影响尤为严重 收入国家。在缺乏母乳（MOM）的情况下，世界卫生组织和美国 儿科学会建议使用捐赠母乳 (DHM)，因为它具有保护作用 坏死性小肠结肠炎，一种危及生命的肠道感染。为了响应这些建议， 全球捐献母乳库的发展和 DHM 的使用正在增加，许多低收入和中等收入国家 各国将捐赠母乳银行纳入其公共卫生战略，以降低新生儿死亡率。它是 据估计，全球每年有 800,000 名婴儿接受 DHM，但人们对其营养知之甚少 DHM的组成；奶库操作如何影响成分；以及是否早产儿营养 当 DHM 与市售强化剂一起使用时，即可达到建议。有证据 与接受早产配方奶粉的婴儿相比，喂养 DHM 的早产儿生长速度较差，或者 母乳，即使使用多营养强化剂，表明营养支持不理想 （常量营养素、微量营养素或两者）。为越来越多的人开发有效的营养疗法 全球范围内接受 DHM 的早产儿，迫切需要基于证据的 DHM 营养标准。 迄今为止，关于 DHM 成分的研究通常规模较小（< 50 个样本），并且代表来自 高收入环境中的单一母乳银行，可能与低收入国家的 DHM 母乳银行不同 设置。其他限制包括缺乏维生素、矿物质和生物活性因子的研究，以及 使用方法可能夸大蛋白质和乳糖值。该提案旨在解决这些研究 通过对八个不同地区的牛奶进行多地点研究，了解全球早产儿营养方面的差距 高、中、低收入环境中的银行合作伙伴。我们将检查和比较广泛的 牛奶中的营养成分来自世界各地 600 个经批准的母乳库捐赠者，以创造全面、 DHM 的地理多样化营养成分（目标 1）。母乳银行层面汇集捐赠者的做法将 使用模拟进行评估，以确定母乳银行可以使用的有效策略来创造更多 DHM 中的营养成分保持一致（目标 2）。最后，我们将评估目前是否可以商用 与 DHM 一起使用时，强化剂符合营养建议，并会识别需要增强的营养 开发 DHM 专用强化剂（目标 3）。本研究的长期目标是为了响应 RFA-HD-21-006 旨在改善全球范围内越来越多接受早产儿营养护理的婴儿 捐赠母乳。

Project Summary Globally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle- income countries. In the absence of mother’s milk (MOM), the World Health Organization and the American Academy of Pediatrics recommend using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal infection. In response to these recommendations, development of donor milk banks and the use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality. It is estimated that 800,000 infants globally receive DHM each year, yet very little is known about the nutritional composition of DHM; how composition is influenced by milk banking practices; and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers. There is evidence that preterm infants fed DHM have inferior growth rates compared to infants receiving preterm formula or mother’s milk, even when multi-nutrient fortifiers are used, suggesting suboptimal nutritional support (macronutrients, micronutrients, or both). To develop effective nutritional therapies for the increasing number of preterm infants globally receiving DHM, evidence-based nutritional standards for DHM are urgently needed. Studies to-date on DHM composition have typically been small (< 50 samples) and represented milk from a single milk bank in a high-income setting, which may be different from DHM from milk banks in low-income settings. Additional limitations include the dearth of studies on vitamins, minerals, and bioactive factors, and the use methods that may overstate protein and lactose values. This proposal seeks to address these research gaps in global preterm infant nutrition by conducting a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings. We will examine and compare a broad range of nutrients in milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM (Aim 1). Milk bank-level practices for pooling donors will be evaluated using simulation to identify effective strategies that can be used by milk banks to create more consistent nutrient profiles in DHM (Aim 2). Finally, we will evaluate whether currently available commercial fortifiers meet nutrient recommendations when used with DHM and will identify nutrients to enhance in the development of a DHM-specific fortifiers (Aim 3). The long-term goal of this study, designed in response to RFA-HD-21-006, is to improve preterm nutritional care globally for the growing number of infants who receive donor human milk.