Patterned Experience for Preterm Infants

描述(申请人提供)：这项研究的具体目的是测试模式喂养体验(PFE)从出生到出院的新生儿重症监护病房(NICU)及以后对30周前出生的婴儿的影响。这项研究的主要目的是测试PFE在三个时间点对神经行为组织的影响：过渡到口服喂养、NICU出院和2个月校正年龄(48周PMA)。第二个目标是测试PFE对6个月校正年龄、神经行为发育和临床结果的认知功能的影响。这项研究的探索性目的是描述人口统计因素和生物行为辅助因素对结果变量(神经行为组织、认知功能、神经行为发育和临床结果)的潜在影响。据推测，与那些接受常规喂养护理的婴儿相比，接受PFE的婴儿将有更好的神经行为组织、认知功能、神经行为发育和临床结果。一项纵向随机对照试验包括两组，一组接受从第一次灌胃到完全口腔喂养到出院的模式化喂养体验，另一组接受常规喂养护理体验。该项目计划的干预措施基于神经可塑性和神经保护的原则，旨在利用神经元突触发育以及发育中大脑的经验-期待和经验依赖特征。此外，干预的目的是利用婴儿喂养过程中经常发生的照顾和维持生命的事件。该干预利用了我们在之前的研究中所学到的关于口服喂养的经验，以及我们在理论上假设的与模式喂养的效果有关的情况。因此，为本研究设计的模式喂养体验干预包括与喂养相关的触觉体验的连续性，以训练和建立神经元网络。这种干预提供了神经系统发育的关键时期，并与反复发生的事件(进食)相关，应该会加强神经连接，这对以后的发育可能是重要的，特别是语言和其他认知和神经行为组织技能。这项拟议的研究涉及国家护理研究所关注生物学和行为的相互作用，以努力促进健康和限制疾病。与NINR的目标一致，该干预基于明确的潜在机制，并包括检查与不良神经行为结果有关的遗传辅助因素和其他生物标记物。具体地说，这项拟议的研究将调查如何使用一种独特的干预措施来改善早产的长期后果，这种干预方法很容易适应NICU的护理。

DESCRIPTION (provided by applicant): The specific aim of this study is to test the effect of a patterned feeding experience (PFE) from birth to discharge from the neonatal intensive care unit (NICU) and beyond for infants born before 30 weeks gestation. The primary aim of this study is to test the effect of a PFE on neurobehavioral organization at three time points; the transition to oral feedings, NICU discharge, and 2 months corrected age (48 weeks PMA). The secondary aims are to test the effects of a PFE on cognitive function at 6 months corrected age, neurobehavioral development; and clinical outcomes. The study's exploratory aim is to describe the potential effects of demographic factors and biobehavioral cofactors on the outcome variables (neurobehavioral organization, cognitive function, neurobehavioral development, and clinical outcomes). It is hypothesized that infants who receive the PFE will have improved neurobehavioral organization, cognitive function, neurobehavioral development, and clinical outcomes in comparison to those who receive usual feeding care. A longitudinal, randomized control trial is proposed with two groups, one receiving a patterned feeding experience from the first gavage feeding through full oral feedings to discharge and one receiving usual feeding care experience. The intervention planned for this project is based on principles of neural plasticity and neuroprotection and is designed to take advantage of neuronal synaptic development and both experience-expectant and experience-dependent characteristics of the developing brain. In addition, the intervention is designed to take advantage of a regularly occurring caregiving and life sustaining event in the life of an infant, feeding. The intervention takes advantage of what we have learned about oral feeding experience in our previous studies, as well as what we have theoretically hypothesized is occurring in relation to the effect of patterned feeding. Thus, the patterned feeding experience intervention designed for this study involves a continuity of tactile experiences associated with feeding to train and build neuronal networks. This intervention provided a critical time in neurologic system development and associated with a recurring event (feeding) should enhance neural connections that may be important for later development, particularly language and other cognitive and neurobehavioral organization skills. The proposed study addresses the National Institute of Nursing Research's focus on the interplay of biology and behavior in an effort to promote health and limit disease. Consistent with NINR's goals, the intervention is based on well-defined underlying mechanisms and includes examination of genetic cofactors and other biomarkers implicated in poor neurobehavioral outcomes. Specifically the proposed study will investigate ways to ameliorate the long-term consequences of prematurity using a unique intervention that will easily adapt to caregiving the NICU.