Symptom Trajectories in Infants and Toddlers at Risk for Chronic Feeding Problems

有慢性喂养问题风险的婴儿和幼儿的症状轨迹

• 批准号: 10024081
• 负责人: SUZANNE M THOYRE
• 金额: $ 53.42万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10024081
• 关键词: Acute; Address; Age; Autonomic nervous system; Behavior; Behavioral; Behavioral Symptoms; Biological; Biological Process; Birth; Caring; Characteristics; Child; Child Development; Childhood; Chronic; Constipation; Data; Detection; Development; Disease; Early Diagnosis; Eating; Ensure; Enteral Feeding; Environment; Exposure to; Family; Fatigue; Feeding Patterns; Food; Gestational Age; Growth; Health; Infant; Intervention; Interview; Link; Measurement; Measures; Methods; Modeling; Neonatal; Neonatal Intensive Care; Neonatal Intensive Care Units; Nutritional; Outcome; Parents; Pathway interactions; Physiological; Premature Infant; Prevention; Public Health; Regulation; Rehabilitation therapy; Reporting; Risk; Risk Factors; Sampling; Services; Speed; Standardization; Strategic Planning; Symptoms; System; Time; Toddler; Variant; Visceral pain; base; biobehavior; critical period; demographics; early childhood; feeding; follow-up; gastrointestinal function; high risk; high risk infant; improved; innovation; longitudinal design; medical specialties; neonatal care; neurodevelopment; nutrition; personalized intervention; prevent; prospective; respiratory; sex; skill acquisition; skills; symptom management

Project Summary/Abstract After discharge from neonatal intensive care, a subset of preterm and full-term infants will have elevated risk for compromised development. An estimated 40-70% of these infants will have problematic feeding during the first 24 months. Because problematic feeding may escalate into a chronic feeding disorder, early symptom identification is critical. Linking early physiologic symptoms of problematic feeding with subsequent behavioral symptoms is needed to speed detection, enhance effective symptom management, and disrupt progression from problematic feeding to chronic feeding disorders. A lack of valid assessment that accounts for normal variation in feeding in children’s early development has impeded development of evidence to support a shift to earlier detection and targeted care. To address this problem, our team has developed a set of progressive, valid, reliable measures of symptoms of problematic feeding and eating skill development that can be used from birth through early childhood, with scoring systems that are standardized by age. Two parent-report measures of the child’s feeding environment complete the set. In the proposed study, we will use a concurrent explanatory mixed- methods longitudinal design to prospectively follow 285 infants at risk for feeding problems from discharge from neonatal intensive care through age 24 months. By concentrating assessments in the 1st year with follow-up in the 2nd year, we will study symptoms of problematic feeding across a critical period of development highly sensitive to adequate nutrition and with infants at highest risk for poor outcomes. Aim 1: Characterize children’s symptoms of problematic feeding and trajectories of symptoms from the time of NICU discharge through age 24 months. Aim 2: Determine the relationship of child biological function evident at discharge (neonatal biological risk, feeding skills, cardio-respiratory stability, gastro-intestinal function, autonomic nervous system regulation) and child sex with symptom characteristics and trajectories emerging across the next 24 months. Aim 3: Describe the child’s feeding environment (parent/family demographics; parent strategies to manage problematic feeding symptoms; receipt of feeding specialty services; feeding impact on the parent/family) and its relationship with problematic feeding symptoms from discharge through 24 months. Interviews with a sample subset will allow a more contextual understanding of the child’s feeding environment. Aim 4: Determine the relationship between symptoms of problematic feeding and child outcomes of the development of eating skills, growth, and neurodevelopment. By improving understanding of characteristics of early symptoms of problematic feeding during the period when feeding disorders are emerging, and through better understanding of the family dynamic related to feeding problem development, we can determine common biobehavioral pathways in children’s development of chronic feeding disorders, which will lay the groundwork for development of precision interventions in future research.

项目摘要/摘要 从新生儿重症监护护理中解释后，一部分早产和完整的婴儿的风险较高 损害的发展。这些婴儿中估计有40-70％的婴儿在第一次喂养有问题 24个月。因为有问题的喂养可能会升级为慢性进食障碍，所以早期症状 识别至关重要。将有问题喂养的早期生理症状与随后的行为联系起来 需要症状来加快检测，增强有效的症状管理并破坏从 喂养慢性喂养障碍的问题。缺乏有效评估来解释正常变化 在儿童早期发展中，妨碍了证据的发展，以支持向早期转变 检测和目标护理。为了解决这个问题，我们的团队已经开发了一系列渐进，有效，可靠的 有问题的喂养和饮食技能发展症状的度量，可以从出生到可以使用 幼儿期，评分系统是按年龄标准化的。孩子的两个父母报告措施 喂养环境完成了该集合。在拟议的研究中，我们将使用并发利用混合 方法纵向设计，可前瞻性地关注285名有可能从中出院的婴儿 新生儿重症监护至24个月。通过集中评估在第一年，随访 第二年，我们将在关键的发展中研究有问题的喂养症状 对足够的营养敏感，婴儿的预后风险最高。目标1：描述儿童的 从NICU出院到24岁的NICU出院时期，有问题的喂养症状和症状轨迹 月份。目标2：确定出院时儿童生物学功能证据的关系（新生儿生物学 风险，喂养技能，心脏呼吸稳定性，胃肠道功能，自主神经系统调节） 在接下来的24个月中，儿童性别具有症状特征和轨迹。目标3：描述 孩子的喂养环境（父母/家庭人口统计学；父母管理有问题的喂养的策略 症状;收到喂养专业服务；对父母/家庭的进食影响及其与之的关系 从出院到24个月的有问题的喂养症状。样本子集的采访将允许 对孩子的喂养环境有更多的上下文理解。目标4：确定 饮食技能，增长和儿童成果有问题的喂养和儿童结果的症状 神经发育。通过提高对有问题喂养早期症状的特征的理解 在出现喂养障碍的时期，并通过更好地理解家庭动态 与喂养问题的发展有关，我们可以确定儿童中常见的生物行为途径 慢性喂养障碍的发展，这将为开发精确性奠定基础 未来研究的干预措施。