Wheezing in Black Preterm Infants: Impact of Vitamin D Supplementation Strategy

黑人早产儿喘息：维生素 D 补充策略的影响

• 批准号: 8502341
• 负责人: Anna Maria Hibbs
• 金额: $ 69.76万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8502341
• 关键词: Accounting; Age; Age-Months; Allergic; Asthma; Atopic Dermatitis; Biological Markers; Birth; Cell Survival; Childhood; Clinical; Data; Development; Diet; Dietary intake; Disease; Dose; Dose-Limiting; Enteral; Face; Gestational Age; Goals; Health; Health Status; Hormones; Hypersensitivity; Immune; Immune system; Infant; Infection; Inflammation; Life; Literature; Lung; Lung Inflammation; Measurement; Measures; Mediating; Morbidity - disease rate; Morphogenesis; Neonatal; Nutritional; Outcome; Pathway interactions; Patients; Phenotype; Play; Population; Premature Birth; Premature Infant; Prevention; Public Health; Publishing; Questionnaires; Randomized Clinical Trials; Recommendation; Recurrence; Regimen; Regulation; Reporting; Rickets; Role; Serum; Shapes; Skin; Smooth Muscle; Structure; Supplementation; Testing; Therapeutic; Very Low Birth Weight Infant; Virus Diseases; Vitamin D; Vitamins; Wheezing; atopy; base; body system; bone health; cell growth; comparative effectiveness; cytokine; experience; health care service utilization; high risk; infancy; meetings; pathogen; premature; prevent; public health relevance; racial difference; respiratory; response; trend; trial comparing

DESCRIPTION (provided by applicant): Black infants face the highest rates of prematurity in the U.S. (18%), have high rates of prematurity-associated wheezing illnesses, and tend to have lower vitamin D levels. The goal of this [comparative effectiveness] study is to identify a vit. D supplementation strategy that minimizes recurrent wheezing in infancy. Long recognized as important for bone health, a growing body of evidence suggests that vit. D may play a role in the regulation and development of many organ systems. The D pathway regulates lung inflammation and impacts morphogenesis, structure, and cell growth and survival in bronchial smooth muscle. Vit. D exposure has the potential to skew cytokine expression from a Th1 (less allergic) to a Th2 (more allergic) phenotype. Due to their developmental immaturity, preterm infants may be particularly vulnerable to any positive or negative effects of vit. D supplementation on the lung, airway, and immune system. Our preliminary data, supported by the literature, suggests that overly aggressive vit. D supplementation may inadvertently increase wheezing in infancy in black, but not white, preterm infants; however, vit. D deficiency could theoretically also increase wheezing via vulnerability to respiratory pathogens. The proposed study is a randomized clinical trial comparing the effect of two different enteral vitamin D supplementation strategies on recurrent wheezing in infancy in 300 black infants born preterm at 300/7-366/7 wks gestational age, a population for whom neither vit. D requirements nor optimal vit. D serum levels have been established. We will test two strategies: (I) sustained supplementation until 6 mo. of age adjusted for prematurity, and (II) cessation of supplementation when a minimum dietary intake of 200 IU/day is reached. The specific aims are to characterize the effect of each strategy on (aim 1) recurrent wheezing and (aim 2) [allergic sensitization] and atopy. We will (aim 3) explore the relationship between vit. D serum levels and recurrent wheezing. We hypothesize that strategy II will be more effective in promoting pulmonary health by minimizing recurrent wheezing, [allergic sensitization], and overall healthcare utilization, and will be sufficient to prevent clinical vit. D deficiency. We also hypothesize that optimal vit. D serum levels will be lower than the norms for other populations. Theoretical Association: Vit. D Status and Health.

描述（由申请人提供）：黑人婴儿面临美国早产率最高的（18％），与早产相关的喘息疾病的发生率很高，并且往往的维生素D水平较低。 [比较有效性]研究的目的是确定VIT。 D补充策略可最大程度地减少婴儿期的喘息。长期以来，人们对骨骼健康很重要，越来越多的证据表明VIT。 D可能在许多器官系统的调节和开发中发挥作用。 D途径调节肺部炎症并影响支气管平滑肌的形态发生，结构以及细胞生长以及生存率。 VIT。 D暴露有可能使细胞因子的表达从Th1（较少过敏）到Th2（更过敏性）表型。由于其发育不良，早产儿可能特别容易受到VIT的任何正面或负面影响的影响。 D补充肺，气道和免疫系统。我们的初步数据得到了文献支持，表明过于侵略性的VIT。 D补充可能会无意中增加婴儿期的喘息，而不是白人早产；但是，vit。理论上，D缺乏症也可以通过易受呼吸道病原体的脆弱性来增加喘息。拟议的研究是一项随机临床试验，比较了两种不同的肠内维生素D补充策略对婴儿期在300/7-366/7 WKS胎龄出生的300名黑人婴儿的婴儿喘息期的效果，他们均不为他们的vit。 d要求也不是最佳的vit。已经建立了血清水平。我们将测试两种策略：（i）持续补充到6个月。适应早产的年龄，以及（ii）当达到最低饮食摄入200 IU/天时，停止补充。具体的目的是表征每种策略对（AIM 1）复发性喘息和（AIM 2）[过敏敏化]和特应特应的影响。我们将（AIM 3）探索VIT之间的关系。 D血清水平和复发性喘息。我们假设II策略II将通过最大程度地减少复发性喘息，[过敏性敏化]和整体医疗保健利用而更有效地促进肺部健康，并且足以防止临床VIT。 D缺乏症。我们还假设该最佳VIT。 D血清水平将低于其他人群的规范。理论关联：VIT。 D状态和健康。