Maximizing Protein Growth in the Early Neonatal Period

最大限度地提高新生儿早期蛋白质的生长

• 批准号: 7935119
• 负责人: PATTI THUREEN
• 金额: $ 19.48万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7935119
• 关键词: Academy; Address; Affect; Age-Months; American; Amino Acids; Birth; Body Composition; Catabolism; Country; Data; Development; Energy Intake; Energy-Generating Resources; Equilibrium; Essential Amino Acids; Extremely Low Birth Weight Infant; Failure; Fatty acid glycerol esters; Fetus; Gestational Age; Glucose; Growth; Guidelines; Health; Hospitals; Hour; Infant; Intake; Ions; Leucine; Life; Lipids; Literature; Living Wills; Lysine; Malnutrition; Measurement; Metabolic acidosis; Methodology; Methods; Monitor; Neonatal; Nutrient; Nutritional; Nutritional Support; Outcome; Parenteral Nutrition; Pediatrics; Plasma; Premature Infant; Preparation; Prospective Studies; Proteins; Publishing; Recommendation; Research Personnel; Roentgen Rays; Supplementation; Techniques; Threonine; Time; Tracer; Trophamine; Vulnerable Populations; clinical practice; feeding; fetal; improved; neonate; nitrogen balance; nutrition; oxidation; postnatal; programs; stable isotope

DESCRIPTION (provided by applicant): Current nutritional strategies for very preterm infants in this country are resulting in postnatal growth failure from which the neonate does not recover by the time of hospital discharge. Undernutrition, particularly insufficient protein intake during critical development periods adversely affects long-term neurodevelopmental and health outcomes. Efforts to optimize nutritional support, therefore, particularly in the first weeks of life, are critical to reversing nutritionally related adverse outcomes in this vulnerable population. The only national published recommendation for providing comprehensive nutrition to the preterm neonate through the time of discharge is the American Academy of Pediatrics (AAP) recommendation to mimic the growth rate of the normal fetus of the same gestational age as the preterm jnfant. There are no guidelines by the AAP as to how this should be achieved, and no data in the literature to support or refute this recommendation. We believe that it is critical to determine if this is a valid recommendation. The overarching hypothesis to be addressed by this project is that protein accretion rates can be significantly improved in extremely low birth weight (ELBW) preterm infants during the critical nutritionally-sensitive early postnatal period. We believe that the proposed prospective studies of protein quantity, protein quality and energy intake on protein accretion will enhance the ability to optimize protein gain in these infants. Specific hypotheses to be addressed are: 1) that relatively high amino acid and energy intake initiated in the immediate neonatal period and sustained at fetal delivery rates through close monitoring of nutrient intake over the first 2 months of life will confer a prolonged anabolic advantage compared to current amino acid initiation and advancement strategies, and will determine whether or not fetal nutrient delivery rates administered to the preterm infant will achieve the AAP recommendation that extrauterine growth should approximate that of the fetus at the same gestational age; 2) that optimal concentrations of essential amino acids in parenteral nutrition can be determined that will improve the quality of amino acid intake in order to maximize protein accretion rates; and 3) that energy intakes can be identified that will optimize protein accretion at any given amino acid intake.

描述(申请人提供)：在这个国家，目前针对早产儿的营养策略正在导致出生后发育障碍，新生儿在出院时无法恢复。营养不良，特别是关键发育期蛋白质摄入不足，对神经发育和健康的长期结果产生不利影响。因此，努力优化营养支持，特别是在生命的头几周，对于扭转这一弱势群体中与营养有关的不良后果至关重要。美国儿科学会(American Academy of Pediatrics，AAP)建议模仿与早产儿相同胎龄的正常胎儿的生长速度，这是唯一在出院时向早产儿提供全面营养的全国性建议。AAP没有关于如何实现这一点的指导方针，也没有文献中的数据来支持或驳斥这一建议。我们认为，确定这是否是一项有效的建议至关重要。该项目要解决的最重要的假设是，极低出生体重(ELBW)早产儿在关键的营养敏感早期出生时，蛋白质积累率可以显著提高。我们相信，拟议的蛋白质数量、蛋白质质量和能量摄入对蛋白质摄取的前瞻性研究将增强这些婴儿优化蛋白质摄取的能力。要解决的具体假设是：1)相对较高的氨基酸和能量摄入量开始于新生儿时期，并通过密切监测出生后头两个月的营养摄入量维持在胎儿分娩率，与当前的氨基酸启动和推进策略相比，将提供持久的合成代谢优势，并将决定给予早产儿的胎儿营养分配率是否将达到AAP建议，即宫外生长应与相同胎龄的胎儿接近；2)肠外营养中必需氨基酸的最佳浓度可以确定，这将改善氨基酸摄入量的质量，以最大限度地提高蛋白质增殖率；3)能量摄入量可以确定，在任何给定的氨基酸摄入量下，能量摄入量都会优化蛋白质的积累。