This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The cost of caring for the premature (preterm) infant represents nearly a billion dollar economic burden in addition to the morbidity and mortality experienced by the infants and the emotional burden to their parents and family. Preterm infants represent only 9% of all live births but they account for two-thirds of neonatal mortality . The cost of their health care is inversely related to gestational age . The approximate cost of caring for a 26-week gestation infant who survives is approximately $166,000. A large portion of the morbidity and mortality of the preterm infant and the enormous cost required to care for them is due to feeding related issues. Gastrointestinal (GI) function in the preterm infant is underdeveloped compared with that in the term infant. Consequently, preterm infants experience great difficulty in tolerating enteral feedings as evidenced by symptoms such as gastric residuals after feeding and abdominal distention . This feeding intolerance is associated with significant morbidity (complications) and in the extreme case of necrotizing enterocolitis, mortality (death). These clinical morbidities delay the progression of feedings and consequently, the time to full enteral feedings. This relationship is important, as we have observed a relationship between the time required to reach full enteral feedings and the duration of hospitalization . Hence, strategies that reduce feeding intolerance will hasten the progression to full enteral feedings and ultimately will reduce the duration of hospitalization. One of the key components to developing strategies to reduce feeding intolerance is to be able to identify which infants are most at risk. Presumably the risk is greater with increasing degrees of prematurity. However, at the present time, it is not even possible to predict among infants of the same gestational age which are most at risk. Studies are needed to define the clinical characteristics that reflect feeding intolerance and to develop clinical tests that can predict feeding intolerance. Such tests would allow early intervention and potentially prevent or ameliorate the most severe manifestation of feeding intolerance, necrotizing enterocolitis.
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