AR CAREER DEVELOPMENT COBRE: PREVENTING THE LONG-TERM NEONATAL PAIN

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 新生儿疼痛的影响可能会导致持续到成年期的生理，激素和行为反应，并可能导致传统药物难以治疗的功能障碍。 减少新生儿疼痛影响的治疗方法尚未得到充分研究，现有的治疗方法被随意使用。 因此，需要有效的疼痛管理和具有低副作用特征的先发制人的干预。 这些先发制人的技术包括与新生儿的皮肤接触（袋鼠护理），促进掖和吸吮糖衣奶嘴。 在本申请中，我们建议评估预防性护理的有效性和作用机制，以防止新生儿疼痛的长期后果。 假设是，先发制人的新生儿干预，将减少与痛苦的新生儿程序相关的应激反应，也将减少不良后果以后的生活。 为了验证这一假设，我们首先提出检查是否新生儿拥抱（NC）周围的时间损伤可以防止长期影响新生儿结肠炎症/疼痛的成年大鼠。 其次，我们将表明，新生儿拥抱（袋鼠护理）将积极影响新生儿重症监护室（NICU）婴儿的医疗保健结果。尚未在人类或动物模型中研究这些预防措施减少暴露于疼痛/压力新生儿程序的成人的长期后果的能力。 为了检验中心假设，设计了三个具体目标。 在具体目标1中，将进行行为研究，以表明NC通过减少与新生儿损伤相关的应激，防止患有新生儿结肠刺激的成年大鼠发生长期内脏高敏感性。 在具体目标2中，将在新生儿重症监护病房测试袋鼠式护理等减压技术，以评估其对病情稳定的早产儿的益处。 在许多临床和基础研究中，新生儿创伤的长期后果一再显示对个体有害。 这些研究强调了在临床环境中开发新的先发制人的护理方法以减轻新生儿创伤的影响的迫切需要。 这项建议汇集了一个由基础和临床科学家组成的小组，既有已建立的，也有正在接受培训的，以评估减压技术对新生儿创伤后果的影响。 拟议的研究集中在一个中心假设上，该假设将在实验室和临床中进行测试，并突出了研究人员之间的高水平协同作用。如果成功，这些研究将使我们能够生成足够的额外数据，以扩大本提案的范围，并开发多研究者R 01应用程序。此外，研究结果应该对新生儿护理产生积极影响，并减少暴露于新生儿疼痛和压力的成年人的长期后果。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The effects of neonatal pain may result in physiological, hormonal and behavioral reactions that persist into adulthood and may cause functional disorders that are refractory to conventional medicine. Treatments to decrease the effects of neonatal pain have not been adequately researched and existing ones are used capriciously. Therefore, effective pain management and pre-emptive interventions with low side effect profiles are needed. These pre-emptive techniques include skin-to-skin contact with the neonate (kangaroo care), facilitated tucking and suckling sugar-coated pacifiers. In this application, we propose to evaluate the effectiveness and mechanism of action of pre-emptive care to prevent long-term consequences of neonatal pain. The hypothesis is that pre-emptive neonatal interventions that will decrease stress responses associated with painful neonatal procedures will also decrease adverse consequences later in life. To test this hypothesis, we first propose to examine whether neonatal cuddling (NC) around the time of injury can prevent the long-term effect of neonatal colon inflammation/pain in the adult rat. Second, we will show that neonatal cuddling (kangaroo care) will positively impact the health care outcomes of babies in the neonatal intensive care unit (NICU). The ability of these pre-emptive measures to reduce the long-term consequences in adults who were exposed to painful/stressful neonatal procedures has not been studied in either humans or animal models. To test the central hypothesis, three specific aims were designed. In specific aim 1, behavioral studies will be conducted to show that NC prevents the development of long-term visceral hypersensitivity in the adult rat with neonatal colon irritation, by reducing the stress associated with neonatal injury. In specific aim 2, stress-reduction techniques such as kangaroo care will be tested in the NICU to evaluate their benefits to premature infants who are in stable condition. The long-term consequences of neonatal trauma have been shown repeatedly to be detrimental to the individual in a number of clinical and basic studies. These studies have emphasized the immediate need to develop new preemptive care approaches in the clinical setting to lessen the impact of neonatal trauma. This proposal brings together a team of basic and clinical scientists, both established and in training, to evaluate the impact of stress-reduction techniques on the consequences of neonatal trauma. The studies proposed focus on one central hypothesis that will be tested in the laboratory and the clinic and highlight the high level of synergy among the investigators. If successful, these studies will enable us to generate additional data sufficient to broaden the scope of this proposal and to develop a multi-investigator R01 application. Furthermore, the results should have a positive impact on neonatal care and decrease long-term consequences in adults who were exposed to neonatal pain and stress.