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.

尽管医疗的改善节省了可能死亡的许多非常低的出生体重（VLBW）婴儿，但它也导致了更多的病毒患者，包括支气管肺发育不良（BPD）和吞咽功能障碍（吞咽困难）。一旦早产婴儿接近月经年龄的34周，就开始口服喂养，因为延迟起始与许多医疗和发育后果有关。另一方面，在吞咽机制的完全成熟之前，在VLBW婴儿中开始喂食口服喂养可以导致肺部吸收。慢性抽吸会导致持续的炎症状态，疾病发展为慢性肺损伤和BPD，这对于早产儿中已经脆弱且发育不足的肺可能是毁灭性的。据估计，30-70％的VLBW早产儿将患有吞咽困难。尽管存在如此重大的问题，但在口服喂养过程中，VLBW婴儿的吞咽困难的治疗选择有限。在新生儿中，成人的可用干预措施（例如药物治疗和手术干预措施）很少是一种选择。成人中一种替代技术是使用冷食物来刺激更安全的吞咽。冷刺激的使用激活 因此，在Oro-咽中，更多的热受体可为脑干中的吞咽中心提供更大的输入，并改善进食和吞咽运动。在成年人中，使用冷液体的使用与气道穿透和抽吸的显着降低有关。但是，在吞咽困难的早产儿中使用冷牛奶作为治疗选择，尚未评估使临床医生的治疗选择非常有限。在早产婴儿中严重缺乏吞咽困难的研究阻碍了任何基于证据的方法来解决这种常见和实质性问题。该应用的目的是确定冷牛奶喂养对VLBW婴儿吞咽困难的有效性和安全性的初步证据。我们假设在患有吞咽困难的VLBW婴儿中口服冷牛奶将改善吮吸/吞咽/呼吸协调，并减少对气道的穿透力和吸引力。我们进一步假设冷牛奶干预不会产生不利影响。在AIM 1中，我们将评估冷牛奶在患有吞咽困难的VLBW早产儿中的渗透/抽吸的有效性，在AIM 2中，我们将评估早产儿在早产儿中口服冷牛奶的安全性。 据我们所知，目前尚无探讨使用冷牛奶作为VLBW婴儿吞咽困难的潜在治疗干预措施的研究。在我们提出的研究中的成功将为更大的临床试验奠定了基础，该试验可能会改变早产儿的吞咽困难的范例。使用冷牛奶喂养将为临床医生提供一种新的疗法，可影响全国NICUS的临床实践，从而减少吞咽困难的相关负面后果，减少住院时间，降低医疗费用并改善新生儿结果。