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

分娩孕周对危重婴儿依赖泵的母亲哺乳结局的影响

• 批准号: 10662962
• 负责人: Marion Marler Bendixen
• 金额: $ 13.72万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-23 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662962
• 关键词: Achievement; Admission activity; Area; Back; Behavior; Biological; Biological Markers; Biological Process; Biological Sciences; Biology; Biometry; Birth; Black race; Brain; Caring; Citrates; Clinical; Clinical Research; Complex; Critical Illness; Data; Data Analyses; Dependence; Diabetes Mellitus; Dose; Early identification; Enrollment; Ensure; Environment; Epithelial Cells; Experimental Designs; Exposure to; Faculty; Florida; Frequencies; Future; Gases; Gestational Age; Goals; Grant; Growth and Development function; Health; Hospitalization; Human; Human Milk; Hypertension; Impairment; Infant; Infant Development; Infant Health; Inflammation; Interruption; Knowledge; Lactation; Lactose; Late pregnancy; Leadership; Legal patent; Lung; Lung diseases; Mammary gland; Measures; Mediating; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Metabolic Pathway; Milk; Morbidity - disease rate; Mothers; National Institute of Nursing Research; Neonatal Intensive Care Units; Normal Range; Nutrient; Nutritional Support; Obesity; Organ; Osmosis; Outcome; Outcome Measure; Oxidative Stress; Pathway interactions; Pediatric Hospitals; Physiology; Population; Postpartum Period; Pregnancy; Pregnant Women; Premature Birth; Process; Production; Productivity; Prospective, cohort study; Proteins; Published Comment; Pump; Race; Research; Research Personnel; Research Priority; Resources; Risk; Risk Reduction; Sampling; Science; Seminal; Senior Scientist; Sepsis; Societies; Sodium; Stress; Techniques; Training; Translating; Translational Research; United States National Institutes of Health; Universities; Up-Regulation; Vulnerable Populations; Writing; autocrine; breast pump; career; cell preparation; clinical application; clinical translation; cost; data acquisition; diaries; economic disparity; evidence base; extreme prematurity; health equity; immunoregulation; improved; maternal serum; member; milk removal; milk volume; nutrition; patient oriented research; personalized intervention; personalized medicine; point of care; point of care testing; premature; racial disparity; rate of change; research faculty; response; skills; standard measure; stressor; success

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.

研究摘要 母乳 (MOM) 为新生儿重症监护病房 (NICU) 婴儿提供个性化的风险降低， 但对于 84% 的 NICU 母亲中出生体重非极低婴儿的 MOM 不足的情况，我们知之甚少， 留下了一个重大的研究空白，对黑人新生儿重症监护病房的母婴二人产生了不成比例的影响。不足的 MOM 体积起源于妊娠晚期和产后 1-14 天。这项研究的目标是 确定 GA 对危重婴儿的依赖泵的母亲哺乳结果的影响 住进新生儿重症监护室。关于乳腺成熟对乳腺发育的影响，目前还缺乏足够的了解。 MOM 体积、分泌激活 (SA) 以及 MOM 去除是否/如何介导（例如，吸奶器的使用） 在从分泌分化（上皮细胞）转变的关键窗口期（产后 1-14 天） 准备）到SA（大量MOM体积的开始）和泌乳的自分泌控制（SA的持久性）到 确保持续生产足够的 MOM 量。为了填补这一空白，本修订版以患者为导向 研究职业发展奖（K23）拟议的研究将遵循 188 个种族和经济多样化的人 产后第 1-14 天入住新生儿重症监护病房 (NICU) 的婴儿母亲，根据情况被分配到 4 组中的一组 婴儿分娩时的 GA。目标 1 将比较产后 GA 组之间 MOM 体积的测量值 第 1-14 天。目标 2 将使用 MOM 生物标志物比较 SA 的发作和持续时间 GA 组。目标 3 是探索性的，旨在获取证据来描述生物标志物与生物标志物之间的关系。 4 个 GA 组的 MOM 卷。了解这些机制和 GA 的影响对于 将研究结果转化为针对这一弱势群体的早期识别和个性化干预措施。对此 最后，我组建了一个由资深科学家组成的跨学科团队，他们在营养方面具有互补的专业知识 对危重婴儿、临床和转化研究、生物统计学和哺乳生物学的支持 提供指导以实现拟议的培训目标并促进我过渡到独立 研究生涯。基本的主要培训目标包括： 1) 加深对哺乳生物学的了解， 母亲和婴儿因素； 2）开发和应用临床和实验应用知识 设计、数据采集、数据分析和结果解释； 3) 培养领导力、研究能力 管理、学术人员和资助写作技能对于富有成效的研究人员至关重要。 佛罗里达大学 (UF)、Shands 儿童医院和 UF Diary Science 是提供医疗服务的理想环境 无与伦比的资源来支持和扩展 PI 的新兴转化临床研究，使其成为 以患者为导向的研究领域富有成效的教职人员和独立研究员。修改后的研究计划 直接回应审稿人的意见和国家护理研究所的优先事项 专注于使用多层次方法进行研究，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 倡议保持一致，优先考虑母乳研究。