Oral Feeding Difficulty in Large for Gestational Age Infants: Defining Interrelationships between Body Composition, Oral Feeding Ability, and Appetite-Regulating Hormones

项目摘要/摘要 新生儿重症监护病房(NICU)婴儿口腔喂养困难的患病率为 越来越多。这不仅导致NICU住院时间延长，而且还会导致医疗成本的上升。一个 主要原因是胎龄(LGA)婴儿出生率的大幅上升 孕期母体肥胖和糖尿病。LGA婴儿被认为是不良的口腔喂养者。意义重大 在理解LGA婴儿口腔所涉及的复杂机制方面存在知识空白 进食困难。LGA婴儿在宫内暴露于过量能量和身体成分研究 表明他们有较高的脂肪质量(FM)和较低的脱脂质量(FFM)比例。口腔喂养能力 可能会受到饥饿和饱腹感的影响，这可能与 身体的能量储存(以FM为代理)和静息代谢率(RMR，FFM为代理)，以及这些影响 可能是通过食欲调节激素(ARH)水平来调节的。我们的初步数据表明 FFM较高和FFM比例较低(身体成分不成比例)的婴儿需要更长的时间 达到独立的口腔喂养，需要更长的住院时间，需要更高的G管放置。FFM FFM与口服(能量)摄入的关系比FM更好，这表明FFM是能量的主要决定因素 婴儿的摄入量和食欲。标准的NICU喂养策略侧重于促进体重增加 无论出生体重或身体成分，这在LGA婴儿中是不合适的，因为LGA婴儿 在婴儿期早期表现出的“追赶式”成长有更好的长期结果。这些婴儿有一种 在捕获期，调频损耗比调频损耗更大。LGA婴儿有口腔症状 NICU的喂养困难依赖于管状喂养，喂养摄入量由护理调节 团队，而不是婴儿驱使。这些婴儿的FFM%较低可能会降低他们满足 标准口服摄入量以总质量为指标(150毫升/公斤/天)。超额的持续拨备 超过代谢需要的卡路里来自管饲，可能会增加他们的身体肥胖，防止自然 追赶生长，加剧了它们的口腔喂养困难。拟议的研究将评估 LGA婴儿的身体成分、口腔喂养能力和ARH水平之间的相互关系。此外，我们 将评估短期以FFM为指标的饲喂效果(以FFM为指标的目标饲喂量) 与口服喂食的标准方法(以总质量为指标的目标喂食量)相比 有口腔喂养困难的LGA婴儿的结局、捕获体重和身体成分。知识 这一提议将为未来旨在评估精确度的研究提供理论基础 LGA婴儿的营养疗法。这最终可能会缩短住院时间并提高 这些婴儿的生活质量。

Project Summary/Abstract Prevalence of oral feeding difficulty in infants admitted to a neonatal intensive care unit (NICU) is increasing. This not only leads to prolonged NICU stay, but an escalation of healthcare costs as well. A major contributor is the increase in large for gestational age (LGA) infant birth rate because of rising maternal obesity and diabetes during pregnancy. LGA infants are considered poor oral feeders. Significant knowledge gaps exist in understanding the complex mechanisms implicated in LGA infants with oral feeding difficulty. LGA infants are exposed to excess energy in utero and body composition studies have shown that they have higher fat mass (FM) and lower fat-free mass (FFM) proportion. Oral feeding ability can be influenced by hunger and satiety, which may have a feedback mechanism with the state of the body's energy stores (FM as proxy) and resting metabolic rate (RMR, FFM as proxy), and these effects may be mediated through the appetite-regulating hormone (ARH) levels. Our preliminary data suggest that infants with a higher FM and lower FFM proportion (disproportionate body composition) took longer to reach independent oral feeds, required longer hospitalization, and required higher g-tube placement. FFM is better associated with oral (energy) intake than FM, suggesting that FFM is major determinant of energy intake and appetite in infants. The standard NICU feeding strategy is focused on promoting weight gain irrespective of birth weight or body composition, which is inappropriate in LGA infants as LGA infants who demonstrated ‘catch-down’ growth in early infancy had better long-term outcomes. These infants had a greater proportion of FM loss compared to FFM during the catch-down period. LGA infants with oral feeding difficulty in the NICU are dependent on tube-feeding and the feeding intake is regulated by the care team rather than being infant-driven. The lower FFM% in these infants may reduce their ability to meet the standard oral intake volumes indexed to total mass (150 ml/kg/day). The continued provision of excess calories above the metabolic needs from tube-feeding may increase their body adiposity, prevent natural catch-down growth, and exacerbate their oral feeding difficulty. The proposed research will evaluate the interrelationship between body composition, oral feeding ability, and ARH levels in LGA infants. Further, we will evaluate the effects of a short-term FFM-indexed feeding (target feeding volume indexed to FFM) versus the standard approach to feeding (target feeding volume indexed to total mass) on oral feeding outcomes, catch-down weight, and body composition in LGA infants with oral feeding difficulty. Knowledge gained from this proposal will provide a rationale for future studies designed to evaluate precision nutritional therapies for LGA infants. This may ultimately shorten the length of hospital stay and enhance the quality of life for these infants.