Aerodigestive Pathophysiology-Driven Mechanisms of Infant Feeding Difficulties

婴儿喂养困难的呼吸消化病理生理学驱动机制

基本信息

批准号：
10430145
负责人：
Sudarshan R Jadcherla
金额：
$ 51.1万
依托单位：
RESEARCH INST NATIONWIDE CHILDREN'S HOSP
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10430145
关键词：
Acute Address Age Algorithmic Analysis Algorithms Apple Behavioral Biofeedback Biological Markers Caring Cessation of life Characteristics Chronic Clinical Coupled Data Data Analyses Decision Making Deglutition Deglutition Disorders Dehydration Development Diagnosis Diagnostic Digestive System Disorders Distal Eating Economic Burden Education Effectiveness Enteral Feeding Esophagus Esophagus motility Feeding Methods Feeds Functional disorder Funding Gastroenterology Goals Growth Health Health Care Costs Healthcare Hospitals Impairment Infant Intervention Juice Knowledge Length of Stay Liquid substance Malnutrition Manometry Mathematics Medical Research Methods Milk Mission Monitor Motor National Institute of Diabetes and Digestive and Kidney Diseases Neonatal Neonatal Intensive Care Units Neurodevelopmental Deficit Nutrition Disorders Oral Outcome Parents Pathologic Perinatal Physiologic Monitoring Physiological Pregnancy Prevalence Process Productivity Protocols documentation Provider Public Health Quality of life Recovery Reflex action Rehabilitation therapy Reproducibility Research Resolution Risk Safety Saline Sensory Side Sterility Stimulus Sucrose Survivors Symptoms System Taste Perception Techniques Testing Time Training Translational Research Translations Tube Upper Esophageal Sphincter Variant Visit Water base behavioral response care burden cell motility clinical care clinical decision-making cost estimate data acquisition design diagnostic algorithm diagnostic biomarker electric impedance expectation feeding improved insight neurodevelopment neuropathology novel novel diagnostics novel therapeutics nutrition personalized diagnostics premature response safety testing socioeconomics

项目摘要

PROJECT SUMMARY: The lack of a clear understanding of Disorders of Deglutition (DD) in infants, i.e., impair- ments in eating, dysfunctional swallowing, and aerodigestive symptoms contributes to the rising prevalence and consequences of dehydration, malnutrition, high tube-feeding rates, neurodevelopmental deficits, and chronic hospital visits. These problems are common in the neonatal intensive care units (NICUs) graduates, particularly among those born prematurely or surviving after perinatal neuropathology. The estimated cost per neuropathol- ogy survivor varies from 350K to 500K US$, and prematurity contributes to a staggering, underestimated health care burden of over ~26 billion US$. This proposal addresses this knowledge deficit and sets the stage for early and safe-feeding intervention protocols in infants with DD by addressing both diagnostic- and rehabilitative-chal- lenges to alleviate infant eating concerns that are vital to improving aerodigestive health and neurodevelopment, which is our long-term goal. The central hypothesis is that characteristics of pharyngeal-, upper esophageal sphincter-, and esophageal-motility reflexes, and their contiguous and cross-systems relationships will differ in control and study infants. Our rationale is that identifying these sensory-motor biomarkers will clarify the specific pathophysiological changes contributing to DD in infants with neuropathology, so that inducible self-regulatory functions and recovery strategies can be developed. To accomplish this, novel, high-fidelity, video-integrated, high-resolution impedance manometry methods will be employed at the crib-side while monitoring physiological safety parameters in infants with DD but without neuropathology (control infants) and infants with DD and neu- ropathology (study infants). Our two specific aims are 1) to identify diagnostic biomarkers related to pharyngo- esophageal motility and airway safety which distinguish baseline and active swallowing mechanisms in control vs. study infants, and 2) to test the safety and effectiveness of targeted lingual nutritive stimulation in restoring pharyngo-esophageal motility and airway safety functions in tube-fed control and study infants during maturation. Applying robust state-of-the-art technological advances using video-integrated, high-resolution impedance ma- nometry at the crib-side, new mechanistic insights will be gained by examining the effects of targeted provocation on full column esophageal motility, and airway-digestive interactions. Completion of the proposed aims will 1) ad- vance data analysis algorithms and feeding protocols to facilitate transdisciplinary training, bio-feedback, and parent education; and 2) design a decision-making process to improve personalized nutritive therapies. This proposal addresses a critical need in neonatal gastroenterology by examining unique mechanisms and defining the basis for preventative and corrective therapies critical to addressing this challenging public health burden, which contributes to significant socio-economic burden, prolonged hospital stays, neurodevelopmental delays, or death. This will be accomplished by improving infant feeding, swallowing, airway, and digestive difficulties and advancing nutrition, growth, and long-term neurodevelopment, all within NIDDK's mission.

项目摘要：对婴儿吞咽障碍 (DD) 缺乏清晰的认识，即吞咽障碍饮食失调、吞咽功能障碍和呼吸消化症状导致患病率上升，脱水、营养不良、高管饲率、神经发育缺陷和慢性病的后果医院就诊。这些问题在新生儿重症监护病房 (NICU) 毕业生中很常见，尤其是那些早产或围产期神经病理学后存活的人。每个神经病理学的估计费用幸存者的收入从 35 万美元到 50 万美元不等，早产会导致令人震惊的、被低估的健康状况护理负担超过约 260 亿美元。该提案解决了这一知识缺陷，并为早期通过解决诊断和康复问题，对患有 DD 的婴儿制定安全喂养干预方案缓解婴儿饮食问题的努力，这对于改善呼吸消化健康和神经发育至关重要，这是我们的长期目标。中心假设是咽部、上食管的特征括约肌和食管运动反射，以及它们的连续和跨系统关系将在以下方面有所不同：控制和研究婴儿。我们的理由是，识别这些感觉运动生物标志物将阐明具体的病理生理变化导致婴儿神经病理学中的 DD，因此诱导性自我调节可以制定功能和恢复策略。为了实现这一目标，新颖的、高保真的、视频集成的、将在婴儿床边采用高分辨率阻抗测压方法，同时监测生理情况患有 DD 但无神经病理学的婴儿（对照婴儿）以及患有 DD 和神经病理学的婴儿的安全参数皮肤病理学（研究婴儿）。我们的两个具体目标是 1) 识别与咽部相关的诊断生物标志物食管运动和气道安全，区分控制中的基线和主动吞咽机制与研究婴儿相比，2) 测试有针对性的舌部营养刺激在恢复中的安全性和有效性咽食管运动和气道安全功能在管饲控制和研究婴儿成熟过程中的作用。应用强大的最先进的技术进步，使用视频集成、高分辨率阻抗矩阵在婴儿床一侧进行测量，通过检查有针对性的挑衅的影响将获得新的机制见解关于全柱食管运动和气道消化相互作用。完成拟议目标将 1) ad- 先进的数据分析算法和喂养方案，以促进跨学科培训、生物反馈和家长教育； 2) 设计决策流程以改进个性化营养疗法。这提案通过检查独特的机制和定义来满足新生儿胃肠病学的迫切需求预防和纠正疗法的基础对于解决这一具有挑战性的公共卫生负担至关重要，这会造成严重的社会经济负担、住院时间延长、神经发育迟缓、或死亡。这将通过改善婴儿喂养、吞咽、气道和消化困难以及促进营养、生长和长期神经发育，所有这些都属于 NIDDK 的使命。