Development of a brain-specific nutritional status indicator for very preterm infants

项目摘要/摘要 每年，超过6.3万名美国婴儿早产，怀孕不到32周。现在为90% 从新生儿重症监护病房(NICU)存活到出院，减少短期和长期 疾病已成为最优先考虑的问题。神经发育障碍是一种长期的负担。 NICU出院后影响50%-60%早产儿的发病率。营养是临床的基石 NICU的护理，代表了一种高度可修改的策略，以支持在 关键时期，从而减少长期减损。以前的研究已经强调了营养的积累 作为更健康的大脑发育和更好的神经发育结果的关键驱动力。一股水流 GAP正在制定准确、具体和可行的战略，以评估和监测随时间推移的养分积累。这个 这项研究的总体目标是调查脱脂质量增加量作为营养状态的动态生物指标 在NICU里。具体目标包括为脱脂体重建立一个新的胎儿参考标准，该标准涵盖 整个范围的早产妊娠，从23到35周，并使用这个参考来定义目标 基于神经发育结果的无脂物质堆积。本研究应用了创新的 NICU营养研究中的“生长质量”概念。创新的方法包括应用 生物阻抗分析在NICU环境下测量身体成分，以及定量脑的使用 磁共振成像(MRI)和脑电图(EEG)作为脑血管疾病早期生物标志物 除了标准的行为测量外，这一人群的神经发育。我们的首要目标是 通过务实的证据改善早产儿的长期健康和发育结果- 在NICU住院期间，营养评估和护理方面的创新。这项研究的结果 将为NICU环境中的无脂大众驱动饮食干预奠定基础。这项研究具有很强的 有可能在营养评估和监测的方法上提供有影响力的范式转变 状况，并最终在发展的关键时期利用营养战略来改善 对这一弱势群体的影响。

PROJECT SUMMARY/ABSTRACT Each year, over 63,000 U.S. infants are born very preterm, below 32 weeks of gestation. With >90% now surviving to discharge from the neonatal intensive care unit (NICU), reducing the short- and long-term morbidities has become the highest priority. Neurodevelopmental impairment is a burdensome long-term morbidity that affects 50-60% of very preterm infants after NICU discharge. Nutrition is a cornerstone of clinical care in the NICU and represents a highly modifiable strategy to support healthy brain development during a critical period, thereby reducing long-term impairments. Previous studies have highlighted nutrient accretion into tissues as a key driver of healthier brain development and better neurodevelopmental outcomes. A current gap is in accurate, specific, and feasible strategies to assess and monitor nutrient accretion over time. The overall aim of this study is to investigate fat-free mass accretion as a dynamic bioindicator of nutritional status in the NICU. The specific aims involve establishing a new fetal reference for fat-free mass that covers the entire spectrum of preterm gestational ages, from 23 to 35 weeks, and using this reference to define targets for fat-free mass accretion that are based on neurodevelopmental outcomes. This study applies the innovative concept of “growth quality” to NICU nutrition research. Innovative approaches include the application of bioimpedance analysis to measure body composition in the NICU setting, and the use of quantitative brain magnetic resonance imaging (MRI) and electroencephalography (EEG) as early biomarkers of neurodevelopment in this population, in addition to standard behavioral measures. Our overarching goal is to improve long-term health and developmental outcomes of very preterm infants through pragmatic, evidence- based innovations in nutritional assessment and care during the NICU hospitalization. The results of this study will lay the foundation for fat-free mass-driven dietary interventions in the NICU setting. This study has strong potential to provide an impactful paradigm shift in the approach to the assessment and monitoring of nutritional status and ultimately the leveraging of nutritional strategies during a critical window in development to improve outcomes for this vulnerable population.