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

调查全球捐赠母乳成分，制定早产儿营养护理的有效策略

• 批准号: 10693795
• 负责人: Maryanne Tigchelaar Perrin
• 金额: $ 33.52万
• 依托单位: UNIVERSITY OF NORTH CAROLINA GREENSBORO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-03 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10693795
• 关键词: Academy; Address; Affect; American; Canada; Caring; Collaborations; Country; Data; Development; Educational workshop; Fatty acid glycerol esters; Geography; Goals; Growth; Hospitals; Human Milk; Immunoglobulin A; Income; Individual; Infant; Infant Care; Infection; Inferior; Knowledge; Lactoferrin; Lactose; Life; Literature; Low income; Macronutrients Nutrition; Methods; Micronutrients; Milk; Milk Banks; Minerals; Necrotizing Enterocolitis; Neonatal Intensive Care Units; Neonatal Mortality; North America; Nutrient; Nutrition Therapy; Nutritional; Nutritional Requirements; Nutritional Support; Oligosaccharides; Pediatrics; Pregnancy; Premature Birth; Premature Infant; Proteins; Public Health; Recommendation; Reporting; Research; Research Design; Role; Sampling; Site; Sodium; United States; United States National Institutes of Health; Vitamins; World Health Organization; biobank; design; donor milk; effectiveness evaluation; enteric infection; evidence base; experience; extreme prematurity; feeding; geographic difference; improved; infant nutrition; low and middle-income countries; nutrition; pasteurization; premature; protective effect; response; simulation

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.

项目摘要 在全球范围内，每年有近1500万婴儿早产，不成比例地影响到中低收入群体。 收入国家。在缺乏母乳的情况下，世界卫生组织和美国 儿科学会建议使用供体母乳（DHM），因为其对以下疾病具有保护作用： 坏死性小肠结肠炎一种危及生命的肠道感染针对这些建议， 捐赠母乳库的发展和DHM的使用在全球范围内正在增加，许多低收入和中等收入 各国将捐赠母乳库纳入其公共卫生战略，以降低新生儿死亡率。是 据估计，全球每年有80万婴儿接受DHM，但人们对DHM的营养价值知之甚少。 DHM的组成;组成如何受到母乳银行实践的影响;以及早产儿营养素是否 当DHM与市售的增强剂一起使用时，达到了推荐的效果。有证据 喂食DHM的早产儿的生长速度低于喂食早产儿配方奶粉的早产儿， 母乳，即使使用多种营养强化剂，也表明营养支持欠佳 （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， 由于全球范围内接受DHM的早产儿数量不断增加，因此迫切需要制定DHM的循证营养标准。 迄今为止，对DHM成分的研究通常规模较小（< 50个样本），代表来自 高收入环境中的单一母乳银行，这可能不同于低收入环境中的DHM母乳银行 设置.其他限制包括缺乏对维生素、矿物质和生物活性因子的研究， 使用可能夸大蛋白质和乳糖值的方法。这项建议旨在解决这些研究 全球早产儿营养的差距，通过对八个不同地理位置的牛奶进行多点研究， 银行在高、中、低收入环境中的合作伙伴。我们将研究和比较广泛的 来自世界各地600个经批准的母乳银行捐赠者的母乳中的营养成分， DHM的地理多样性营养概况（目标1）。母乳银行一级汇集捐赠者的做法将是 使用模拟进行评估，以确定牛奶银行可以使用的有效策略， DHM中的营养成分一致（目标2）。最后，我们将评估目前可用的商业 当与DHM一起使用时，强化剂符合营养素建议，并将识别营养素以增强 开发DHM特异性强化剂（目标3）。这项研究的长期目标是， 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的营养状况。 捐赠的母乳

项目成果

The Influence of Oligosaccharides when Measuring Lactose and Total Carbohydrates in Human Milk and Comparison of Methods.

低聚糖对测量母乳中乳糖和总碳水化合物的影响及方法比较。

• DOI: 10.1016/j.tjnut.2023.05.004
• 发表时间: 2023
• 期刊: The Journal of nutrition
• 作者: McCune,Sydney;Khwajazada,Sadaf;Yerabandi,Nikhila;Bode,Lars;Belfort,Mandy;Todd,Daniel;Perrin,MaryanneT
• 通讯作者: Perrin,MaryanneT

Investigating donor human milk composition globally to develop effective strategies for the nutritional care of preterm infants: Study protocol.

• DOI: 10.1371/journal.pone.0283846
• 发表时间: 2023
• 期刊: PloS one
• 影响因子: 3.7