Phenotypic Driven Growth Trajectories in Very Preterm Infants to Define Nutritionally Mediated Health Outcomes and Modifiable Targets

项目总结 早产儿的生长模式与神经发育和健康结局有关，然而，理想的生长 模式轨迹尚未被确定为指导这一人群的营养干预的手段。 由于大多数极早产儿的生长发育低于预期的胎儿或婴儿轨迹， 早产儿生长发育的特征是阐明营养在护理中的作用的关键一步。 和早产儿的发育。首要目标是确定极早产儿的生长模式。 在足月年龄之前和在表型定义的生命的第一年(母亲、婴儿和 环境因素，包括健康的社会决定因素)，并决定表型的影响- 关于早产儿神经发育和健康结果的知情成长模式。我们假设 表型衍生的潜伏期生长分析衍生的曲线涵盖临床和环境 新生儿重症监护病房(NICU)和出院后期间的暴露将 确定预测结果的增长模式。为了研究这一假设，增长模式将是 按出生到胎龄36周(NICU期间)和出生到12周的两个哨兵时期分类 月的校正年龄(婴儿期)。通过详细收集母婴健康、社会和 健康、营养摄入量和身体成分的环境决定因素；早产儿暴露于 将确定在这些表型信息增长模式中不同的表现形式。随后， 这些表型知情的生长模式对神经发育和健康结果的影响将是 下定决心。最后，一个纵向收集的头两年生物样本的储存库 将建立以促进更深入地探索与已识别的 表型。这项检查将是第一次将NICU和出院后的时代联系起来 在没有预定期望的情况下调查增长轨迹，并通过广泛的营养、健康、 和社交数据。通过对表型定义的生长模式的调查，可修改的因素 影响生长轨迹及其与极早产儿结局的联系将被揭示，以告知临床 护理和未来的干预试验，以优化每个早产儿的营养和生长。

PROJECT SUMMARY Very preterm infant growth patterns are linked to neurodevelopmental and health outcomes, yet, ideal growth pattern trajectories have not been established as a means to guide nutritional intervention for this population. With the majority of very preterm infants exhibiting growth below the expected fetal or infant trajectory, greater characterization of very preterm infant growth is an essential step to elucidate the role of nutrition in the care and development of preterm infants. The overarching objective is to identify very preterm infant growth patterns prior to term age and across the first year of life that are phenotypically-defined (maternal, infant, and environmental factors including social determinants of health) and determine the impact of the phenotypically- informed growth patterns on very preterm infant neurodevelopmental and health outcomes. We hypothesize that phenotypic-derived latent class growth analysis-derived curves encompassing clinical and environmental exposures across the continuum of the neonatal intensive care unit (NICU) and post-discharge periods will identify growth patterns predictive of outcomes. To investigate this hypothesis, patterns of growth will be classified for two sentinel epochs spanning birth to 36 weeks' gestational age (the NICU period) and birth to 12 months' corrected age (infancy). Through a detailed collection of maternal and infant health, social and environmental determinants of health, nutrient intake, and body composition; the very preterm infant exposures differentially represented in these phenotypically-informed growth patterns will be identified. Subsequently, the impact of these phenotypically-informed growth patterns on neurodevelopmental and health outcomes will be determined. Lastly, a repository of longitudinally-collected biologic samples through the first two years of age will be established to foster a deeper exploration of the metabolic processes related to the identified phenotypes. This examination will be the first to bridge the NICU and post-hospital discharge epochs to investigate growth trajectory without predetermined expectations and informed by extensive nutrition, health, and social data. Through this investigation of phenotypically-defined growth patterns, the modifiable factors influencing growth trajectory and its link to very preterm infant outcomes will be revealed to inform both clinical care and future interventional trials to optimize nutrition and growth for each very preterm infant.