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

为极早产儿开发大脑特异性营养状况指标

• 批准号: 10597868
• 负责人: Mandy Brown Belfort
• 金额: $ 75.63万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-26 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597868
• 关键词: Address; Affect; Age; Air; Auditory; Biolectric Impedance; Biometry; Birth; Body Composition; Body measure procedure; Brain; Brain Injuries; Clinical; Cohort Studies; Collaborations; Data; Development; Diet; Dietary Intervention; Dietary intake; Electroencephalography; Epidemiology; Equation; Equilibrium; Equipment; Event-Related Potentials; Fatty acid glycerol esters; Foundations; Gestational Age; Goals; Gold; Growth; Health; Hospitalization; Impairment; Individual; Infant; Intervention; Knowledge; Length; Malnutrition; Measurement; Measures; Micronutrients; Monitor; Morbidity - disease rate; Neonatal Intensive Care; Neonatal Intensive Care Units; Neonatology; Neurodevelopmental Impairment; Neurosciences; Nutrient; Nutrition Assessment; Nutritional; Nutritional Study; Nutritional Support; Nutritional status; Organ; Outcome; Participant; Performance; Plethysmography; Population; Pregnancy; Premature Infant; Proteins; Publishing; Recovery; Research Infrastructure; Research Personnel; Resources; Rest; Sampling; Site; Specificity; Structure; Techniques; Time; Tissues; Translating; Vulnerable Populations; Weight Gain; Work; base; behavior measurement; brain health; brain magnetic resonance imaging; brain size; clinical application; clinical care; clinical practice; cohort; critical period; early detection biomarkers; evidence base; fetal; improved; improved outcome; innovation; magnetic resonance imaging/electroencephalography; neurodevelopment; nutrition; public health relevance; randomized trial; recruit; respiratory; response; virtual

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.

项目概要/摘要 每年，超过 63,000 名美国婴儿在妊娠 32 周以下即早产，目前比例超过 90%。 存活到从新生儿重症监护病房 (NICU) 出院，减少了短期和长期的 发病率已成为重中之重。神经发育障碍是一种长期负担。 影响 NICU 出院后 50-60% 的极早产儿的发病率 营养是临床的基石。 新生儿重症监护病房（NICU）的护理代表了一种高度可修改的策略，以支持婴儿期间的健康大脑发育 关键时期，从而减少长期损害。以前的研究强调了营养积累。 进入组织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。 差距在于评估和监测一段时间内养分积累的准确、具体和可行的策略。 本研究的总体目标是研究无脂肪质量增加作为营养状况的动态生物指标 具体目标包括建立一个新的胎儿无脂肪质量参考，涵盖 整个范围的早产胎龄，从 23 周到 35 周，并使用此参考来定义目标 这项研究应用了基于神经发育结果的无脂肪质量增加。 新生儿重症监护室营养研究的“生长质量”概念创新方法包括应用 在 NICU 环境中测量身体成分的生物阻抗分析，以及定量脑的使用 磁共振成像（MRI）和脑电图（EEG）作为早期生物标志物 除了标准行为测量之外，我们的首要目标是该人群的神经发育。 通过务实、循证的方法改善极早产儿的长期健康和发育结果 基于 NICU 住院期间营养评估和护理的创新。 将为 NICU 环境中的无脂肪大众饮食干预奠定基础。 有潜力为营养评估和监测方法带来有效的范式转变 状况，并最终在发育的关键时期利用营养策略来改善 这些弱势群体的成果。