Neuroendocrine Mechanisms of Developmental Massage Therapy in Preterm Infants

描述(申请人提供)：这项研究的目的是确定发育按摩疗法(DMT)对早产儿(妊娠37周)的神经内分泌机制。早产儿由于疾病和/或常规护理而承受压力。压力的直接不利影响包括循环皮质醇、心跳和呼吸频率增加，以及低氧血症，长期影响包括出生后发育不良、免疫系统抑制和学习障碍。因此，生理稳定性对早产儿的健康至关重要。生理稳定性取决于自主神经系统(ANS)的交感神经(SNS)和副交感神经(PNS)分支以及内分泌系统的下丘脑-垂体-肾上腺(HPA)轴。PNS在妊娠后期(~37-38周)发育，较小的婴儿(&lt；36周)往往有压倒一切的SNS，这会导致生理不稳定和持续的应激反应。“触摸”或按摩疗法与早产儿皮质醇水平降低和体重增加有关。需要设计良好的随机对照临床试验来评估早产儿推拿疗法的生理和神经内分泌机制：1)加深我们对出生后生长发育的了解；2)最终促进推拿疗法与传统医疗护理的结合。我们计划研究早产儿ANS和HPA轴的相互关系，以评估发育按摩疗法(DMT)如何调节生理稳定性和促进出生后生长。这一建议的中心假设是，DMT与皮质醇产生减少和PNS张力和胰岛素样生长因子1(IGF-1)表达增加有关，从而改善早产儿的出生后生长。在验证这一假说的过程中，我们希望确定发育按摩疗法改善三叉神经痛和IGF-1表达的机制。我们的假设将通过以下具体目标得到验证：#1)我们将在DMT前、中和之后通过心率变异性来确定ANS平衡；#2)我们将比较DM前后ANS平衡与HPA反应的关系；#3)我们将评估接受DMT的早产儿的生长激素(生长激素和IGF-1)轴反应。本研究的目的是确定发育推拿疗法(DMT)对早产儿(妊娠37周)的神经内分泌机制。公共卫生相关性：早产儿因疾病和/或常规护理而承受压力。压力的直接不利影响包括循环皮质醇、心跳和呼吸频率增加，以及低氧血症，长期影响包括出生后发育不良、免疫系统抑制和学习障碍。因此，生理稳定性对早产儿的健康至关重要。生理稳定性取决于自主神经系统(ANS)的交感神经(SNS)和副交感神经(PNS)分支以及内分泌系统的下丘脑-垂体-肾上腺(HPA)轴。PNS在妊娠后期(~37-38周)发育，较小的婴儿(&lt；36周)往往有压倒一切的SNS，这会导致生理不稳定和持续的应激反应。按摩治疗与早产儿皮质醇水平降低和体重增加有关。需要设计良好的随机对照临床试验来评估早产儿推拿疗法的生理和神经内分泌机制：1)加深我们对出生后生长发育的了解；2)最终促进推拿疗法与传统医疗护理的结合。我们计划研究早产儿ANS和HPA轴的相互关系，以评估发育按摩疗法(DMT)如何调节生理稳定性和促进出生后生长。这一建议的中心假设是，DMT与皮质醇产生减少和PNS张力和胰岛素样生长因子1(IGF-1)表达增加有关，从而改善早产儿的出生后生长。在验证这一假说的过程中，我们希望确定发育按摩疗法改善三叉神经痛、IGF-1活性和出生后生长的机制。我们的假设将通过以下具体目标得到验证：#1)我们将在DMT前、中和之后通过心率变异性来确定ANS平衡；#2)我们将比较DM前后ANS平衡与HPA反应的关系；#3)我们将评估接受DMT的早产儿的生长激素(生长激素和IGF-1)轴反应。这些类型的临床试验将指导按摩疗法神经内分泌机制的基础研究，并导致：1)提高生理稳定性和出生后发育的策略；2)关于早产儿ANS/HPA成熟及其失调的新机制见解。

DESCRIPTION (provided by applicant): The purpose of this study is to identify neuroendocrine mechanisms of developmental massage therapy (DMT) in preterm infants (<37 weeks gestation). Preterm infants experience stress due to illness and/or routine care. Immediate adverse effects of stress include increases in circulating cortisol, heart and respiratory rates, and hypoxemia and long-term effects include poor postnatal growth, suppression of the immune system, and impaired learning. Thus, the physiological stability is crucial to the preterm infant's well-being. Physiologic stability is dependent upon the sympathetic (SNS) and parasympathetic (PNS) branches of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis of the endocrine system. PNS develops later in gestation (~37-38 weeks) and younger infants (<36 weeks) tend to have an overriding SNS which leads to physiological instability and a sustained stress response. `Touch' or massage therapy is associated with decreased cortisol levels and improved weight gain in premature infants. Well-designed, randomized controlled clinical trials to evaluate the physiological and neuroendocrine mechanisms of massage therapy in premature infants are needed to: 1) further our understanding of postnatal growth and development and 2) ultimately promote the integration of a massage therapy with conventional medical care. We plan to study the interrelationship of the ANS and HPA axis in premature infants to assess how developmental massage therapy (DMT) modulates physiologic stability and promote postnatal growth. The central hypothesis of this proposal is that DMT is associated with a state of decreased cortisol production and increased PNS tone and insulin-like growth factor 1 (IGF-1) expression leading to improved postnatal growth in premature infants. In the process of testing this hypothesis, we expect to determine the mechanisms by which developmental massage therapy improves PNS tone and IGF-1 expression. Our hypothesis will be tested by the following specific aims: #1) We will determine ANS balance, measured by heart rate variability, before, during, and after DMT; #2) We will compare the relationships between ANS balance and HPA response before and after DM; and #3) We will evaluate somatotrophic (growth hormone and IGF-1) axis response in premature infants who receive DMT. The purpose of this study is to identify neuroendocrine mechanisms of developmental massage therapy (DMT) in preterm infants (<37 weeks gestation). PUBLIC HEALTH RELEVANCE: Preterm infants experience stress due to illness and/or routine care. Immediate adverse effects of stress include increases in circulating cortisol, heart and respiratory rates, and hypoxemia and long-term effects include poor postnatal growth, suppression of the immune system, and impaired learning. Thus, the physiological stability is crucial to the preterm infant's well-being. Physiologic stability is dependent upon the sympathetic (SNS) and parasympathetic (PNS) branches of the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis of the endocrine system. PNS develops later in gestation (~37-38 weeks) and younger infants (<36 weeks) tend to have an overriding SNS which leads to physiological instability and a sustained stress response. Massage therapy is associated with decreased cortisol levels and improved weight gain in premature infants. Well-designed, randomized controlled clinical trials to evaluate the physiological and neuroendocrine mechanisms of massage therapy in premature infants are needed to: 1) further our understanding of postnatal growth and development and 2) ultimately promote the integration of a massage therapy with conventional medical care. We plan to study the interrelationship of the ANS and HPA axis in premature infants to assess how developmental massage therapy (DMT) modulates physiologic stability and promote postnatal growth. The central hypothesis of this proposal is that DMT is associated with a state of decreased cortisol production and increased PNS tone and insulin-like growth factor 1 (IGF-1) expression leading to improved postnatal growth in premature infants. In the process of testing this hypothesis, we expect to determine the mechanisms by which developmental massage therapy improves PNS tone, IGF-1 activity, and postnatal growth. Our hypothesis will be tested by the following specific aims: #1) We will determine ANS balance, measured by heart rate variability, before, during, and after DMT; #2) We will compare the relationships between ANS balance and HPA response before and after DM; and #3) We will evaluate somatotrophic (growth hormone and IGF-1) axis response in premature infants who receive DMT. These types of clinical trials will then direct basic research studies of neuroendocrine mechanisms of massage therapy and lead to: 1) strategies to enhance physiologic stability and postnatal growth and 2) new mechanistic insights about ANS/HPA maturation and its dysregulation in premature infants.