The effect of gestational age at delivery on lactation outcomes in pump-dependent mothers of critically ill infants

研究摘要 母乳（母乳）为新生儿重症监护室（NICU）婴儿提供个性化的风险降低， 但是对于84%的NICU母亲的非极低出生体重儿的婴儿出生体重不足知之甚少， 留下了一个主要的研究空白，不成比例地影响了黑人新生儿重症监护室的母婴配对。不足 妊娠晚期和产后1-14天的子宫体积。这项研究的目的是 确定GA对危重婴儿的泵依赖母亲的泌乳结果的影响 住进了新生儿重症监护室对乳腺成熟对乳腺癌的影响， 前列腺体积、分泌激活（SA）以及是否/如何通过前列腺清除介导（例如，吸奶器使用） 在从分泌性分化（上皮细胞）过渡的关键窗口（产后1-14天）期间， 制备）到SA（大量泌乳量的开始）和泌乳的自分泌控制（SA的持久性）， 确保持续生产足够的产量。为了填补这一空白，修订后的指导以病人为导向 研究职业发展奖（K23）的研究将遵循188种族和经济多样化 产后第1-14天入住NICU的婴儿的母亲，并根据婴儿的年龄和性别分为4组， 婴儿分娩时GA。目的1将比较产后GA组之间的乳房体积测量值 第1-14天。目的2将使用两组之间的生物标志物比较SA的发作和持久性的测量。 GA组。目的3是探索性的，以获得证据来表征生物标志物与 4个GA组的体积。理解这些机制和GA的影响对于 将调查结果转化为对这一弱势群体的早期识别和个性化干预。本 最后，我组建了一个由资深科学家组成的跨学科团队，他们在营养学方面具有互补的专业知识， 支持危重婴儿、临床和转化研究、生物统计学和哺乳生物学， 提供指导以实现拟议的培训目标并帮助我过渡到独立人士 研究生涯。基本的主要培训目标包括：1）提高对哺乳生物学的理解， 母亲和婴儿因素; 2）开发和应用临床和实验应用的知识 设计，数据采集，数据分析和结果的解释;和3）发展领导，研究 管理，学术教师，并授予写作技能必不可少的一个富有成效的研究教员。 佛罗里达大学（UF），尚兹儿童医院和UF日记科学是理想的环境，提供 无与伦比的资源，以支持和扩展PI的新兴转化临床研究，成为一个 富有成效的教员和独立研究人员在以病人为导向的研究。修订后的研究计划 直接回应评审员的意见和国家护理研究所的优先事项 专注于研究使用多层次的方法，将生物学与社会联系起来，降低风险，改善健康， 促进健康公平，并与NIH优先考虑母乳研究的倡议保持一致。

Research Abstract Mother own milk (MOM) provides personalized risk reduction for neonatal intensive care unit (NICU) infants, but little is known about insufficient MOM in 84% of NICU mothers with non-very low birthweight infants, leaving a major research gap that disproportionately impacts Black NICU mother-infant dyads. Insufficient MOM volume has its origins in late pregnancy and postpartum days 1-14. The goal of this research is to determine the effect of GA on lactation outcomes among pump-dependent mothers of critically ill infants admitted to the NICU. A major lack of knowledge exists about the effect of mammary gland maturation on MOM volume, secretory activation (SA), and if/how it is mediated by MOM removal (e.g., breast pump use) during the critical window (postpartum days 1-14) of transition from secretory differentiation (epithelial cell preparation) to SA (onset of copious MOM volume) and autocrine control of lactation (permanence of SA) to ensure continued production of adequate MOM volume. To fill this gap, this revised mentored patient-oriented research career development award (K23) proposed study will follow 188 racially and economically diverse mothers of infants admitted to the NICU for postpartum days 1-14 and assigned to 1 of 4 groups based on the infant's GA at delivery. Aim 1 will compare measures of MOM volume between the GA groups over postpartum days 1-14. Aim 2 will compare measures of onset and permanence of SA using MOM biomarkers between the GA groups. Aim 3 is exploratory to gain evidence to characterize the relationship between biomarkers and MOM volume for the 4 GA groups. Understanding of these mechanisms and the impact of GA is critical to translate findings into early identification and personalized interventions for this vulnerable population. To this end, I have assembled an interdisciplinary team of senior scientists with complementary expertise in nutritional support for critically ill infants, clinical and translational research, biostatistics, and lactation biology who will provide mentorship to achieve the proposed training goals and facilitate my transition to an independent research career. Essential primary training goals include: 1) Advance understanding of the biology of lactation, maternal, and infant factors; 2) Develop and apply knowledge of the application of clinical and experimental designs, data acquisition, data analysis, and interpretation of findings; and 3) Develop leadership, research management, academic faculty, and grant writing skills essential for a productive research faculty member. University of Florida (UF), Shands Children's Hospital, and UF Diary Science are ideal environments to provide unparalleled resources to support and extend the PI's emerging translational clinical research to become a productive faculty member and independent researcher in patient-oriented research. The revised research plan is directly responsive to the reviewer comments and to the National Institute of Nursing Research's priorities focused on research using multilevel approaches bridging biology to society reducing risk, improving health, and advancing health equity, as well as aligns with NIH initiatives to prioritize human milk research.