EFFECTS OF EARLY AGGRESSIVE NUTRITION ON VLBW INFANTS

描述(从申请者的描述中扫描)：最近的NICHD 赞助工作商店报告称，极低出生体重婴儿经历了 在生命的最初几天到几周内，生长不佳或没有生长。的确有 相当多的证据表明，这些早期的增长赤字已经长期存在 影响包括身材矮小和神经发育不良。这个 与会者得出结论认为，迫切需要进行研究来评估 它们的短期和长期代谢、生长和神经发育反应 对婴儿进行更早、更积极的营养管理。我们的结果是 最近完成的肠内喂养研究强调了在 极低出生体重儿的生长发育及营养状况与婴儿相比 体重125 1-1600克的婴儿出生时体重750-1250克 出院时较短的长度和头围(体重2200克)。保存 在线性增长和头部增长放缓的情况下体重增加的可能性是 与相对缺氮相一致；这种解释是 发现较低的血浆转甲状腺素浓度加强了这一点 这些婴儿。此外，较小的婴儿需要更长的时间才能达到 理想的肠道摄入量和恢复出生体重。在此基础上 根据观测结果，我们假设早期的相对氮 在极低出生体重儿中发现的生长缺陷是缺乏的基础。为了测试这一点 假设我们提出了一项随机的前瞻性临床试验，以比较 积极的早期营养方案提供18%的能量摄入 蛋白质(P：E比为4.5克：100千卡)与提供12.5千卡的传统方案相比 以蛋白质形式摄入的能量百分比(P：E比率为3.1克：100千卡) 适合胎龄极低出生体重儿。营养的结果 干预措施将通过测量增长、速度和组成进行评估。 当时的体重增加和营养状况是 停药和出院时的神经发育结果 18个月矫正年龄。

DESCRIPTION (Scanned from the applicant's description): A recent NICHD sponsored work shop reported that extremely low birth weight infants experience poor or no growth for the first several days to weeks of life. There is considerable evidence that these early growth deficits have long lasting effects including short stature and poor neurodevelopmental outcomes. The participants concluded that there was urgent need for research to evaluate short and long term metabolic, growth and neurodevelopmental responses of these infants to earlier and more aggressive nutritional management. Results of our recently completed enteral feeding studies highlighted important differences in the growth and nutritional status of VLBW infants. When compared to infants weighing 125 1-1600 g, infants weighing 750-1250 g at birth had significantly lower lengths and head circumference at discharge (weight 2200g). Preservation of weight gain in the face of slower linear growth and head growth is consistent with relative nitrogen deficiency; this interpretation is strengthened by the finding of lower plasma transthyretin concentrations in these infants. Furthermore, it took the smaller infants longer to achieve the desired enteral intakes and to regain birth weight. On the basis of these observations, we hypothesized that an early period of relative nitrogen deficiency underlies the growth failure seen in VLBW infants. To test this hypothesis we propose a randomized, prospective clinical trial to compare an aggressive early nutritional regimen providing 18 percent of energy intake as protein (P:E ratio of 4.5 g:l00 kcal) to a conventional regimen providing 12.5 percent of energy intake as protein (P:E ratio of 3.1 g:100 kcal) in appropriate for gestational age VLBW infants. The outcome of the nutritional intervention will be assessed by measurements of growth, rate and composition of weight gain and nutritional status made at the time parenteral nutrition is discontinued, and at discharge, as well as the neuro-developmental outcome at 18 months corrected age.