Cold milk as a novel therapy for dysphagia in preterm infants

冷牛奶作为早产儿吞咽困难的新疗法

• 批准号: 10378455
• 负责人: Nazeeh N Hanna
• 金额: $ 23.1万
• 依托单位: NYU LONG ISLAND SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-28 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10378455
• 关键词: Adolescence; Adult; Adverse effects; Age; Animals; Area; Assessment tool; Axilla; Birth; Blood flow; Bolus Infusion; Brain Stem; Breast Feeding; Breathing; Bronchopulmonary Dysplasia; Caring; Cations; Childhood; Chronic; Clinical Trials; Country; Cranial Nerves; Data; Deglutition; Deglutition Disorders; Development; Diagnosis; Disease; Disease Progression; Doppler Ultrasound; Enteral Feeding; Enzymes; Evaluation; Feeds; Food; Functional disorder; Gestational Age; Grant; Human Milk; Infant; Infant formula; Inflammatory; Intervention; Intestines; Kinetics; Lead; Length of Stay; Link; Liquid substance; Lung; Medical; Medical Care Costs; Milk; Monitor; Morbidity - disease rate; Movement; Neonatal Intensive Care Units; Operative Surgical Procedures; Oral; Oropharyngeal; Penetration; Pharmacotherapy; Pharyngeal structure; Premature Infant; Publications; Publishing; Reflex action; Research; Risk; Safety; Sensory; Sensory Receptors; Severities; Stimulus; Stomach; Stress; System; Techniques; Temperature; Therapeutic; Therapeutic Intervention; Thermoreceptors; Very Low Birth Weight Infant; Visceral Afferents; clinical practice; cold temperature; effectiveness evaluation; effectiveness validation; evidence base; feeding; improved; lung injury; neonatal outcome; neonate; novel therapeutics; oral motor; respiratory; response; success; sucking

Although improvement of medical care has saved many very low birth weight (VLBW) infants who otherwise may have died, it also resulted in more infants with increased morbidities including bronchopulmonary dysplasia (BPD) and swallowing dysfunction (dysphagia). Once preterm infants approach 34 weeks postmenstrual age, oral feeding is initiated, since delayed initiation has been linked to numerous medical and developmental consequences. On the other hand, initiation of oral feeding in VLBW infants before the full maturation of their swallowing mechanisms can lead to aspiration into the lungs. Chronic aspiration results in a persistent inflammatory state, with disease progression to chronic lung injury and BPD that can be devastating for already fragile and developmentally immature lungs in preterm infants. It is estimated that 30-70% of VLBW preterm infants will have dysphagia. In spite of such a significant problem, there are limited therapeutic options for dysphagia management in VLBW infants during oral feeding. Available interventions in adults, such as pharmacotherapy and surgical interventions, are rarely an option in neonates. One alternate technique in adults is to use cold foods to stimulate a safer swallow. The use of cold stimulation activates a greater number of thermo-receptors within the oro-pharynx which consequently provides larger levels of input to the swallowing centers in the brainstem and results in improved feeding and swallowing movements. In adults, the use of cold liquids has been associated with a significant reduction in airway penetration and aspiration. However, the use of cold milk as a therapeutic option in preterm infants with dysphagia has not been evaluated leaving clinicians with very limited therapeutic options. The significant lack of dysphagia research in preterm infants hinders any evidence-based approach to such a common and substantial problem. The objective of this application is to identify preliminary evidence of the efficacy and safety of cold milk feeding for dysphagia management in VLBW infants. We hypothesize that oral feeding of cold milk in VLBW infants with dysphagia will improve suck/swallow/breathe coordination and decrease penetration and aspiration to the airway. We further hypothesize that cold milk intervention will have no adverse effects. In Aim 1 we will evaluate the effectiveness of cold milk to improve penetration/aspiration in VLBW preterm infants with dysphagia and in Aim 2, we will evaluate the safety of oral feeding of cold milk in preterm infants. To the best of our knowledge, there are no current published studies exploring the use of cold milk as a potential therapeutic intervention for dysphagia in VLBW infants. Success in our proposed studies will set the stage for a larger clinical trial that may change the paradigm of dysphagia management in preterm infants. Use of cold milk feeding will provide clinicians with a novel therapy that can impact clinical practice in NICUs throughout the country, thereby reducing the associated negative consequences of dysphagia, decreasing the length of stay, decreasing medical costs, and improving neonatal outcomes.

虽然医疗保健的改善挽救了许多极低出生体重（VLBW）婴儿，否则他们可能会死亡，但它也导致更多婴儿的发病率增加，包括支气管肺发育不良（BPD）和吞咽功能障碍（吞咽困难）。一旦早产儿接近经后34周，就开始口服喂养，因为延迟开始喂养与许多医学和发育后果有关。另一方面，VLBW婴儿在吞咽机制完全成熟之前开始口服喂养可能导致误吸进入肺部。慢性误吸导致持续的炎症状态，疾病进展为慢性肺损伤和BPD，这对早产儿已经脆弱和发育不成熟的肺是毁灭性的。据估计，30-70%的VLBW早产儿会出现吞咽困难。尽管存在这样一个重要的问题，但在口服喂养的VLBW婴儿中，吞咽困难的治疗选择有限。成人可用的干预措施，如药物治疗和手术干预，很少用于新生儿。对成年人来说，另一种方法是用冷的食物刺激更安全的吞咽。使用冷刺激会激活a