(Scanned from the applicant's description): A recent NICHD sponsored work shop reported that extremely low birth weight infants experience poor or no growth for the first several days to weeks of life. There is considerable evidence that these early growth deficits have long lasting effects including short stature and poor neurodevelopmental outcomes. The participants concluded that there was urgent need for research to evaluate short and long term metabolic, growth and neurodevelopmental responses of these infants to earlier and more aggressive nutritional management. Results of our recently completed enteral feeding studies highlighted important differences in the growth and nutritional status of VLBW infants. When compared to infants weighing 125 1-1600 g, infants weighing 750-1250 g at birth had significantly lower lengths and head circumference at discharge (weight 2200g). Preservation of weight gain in the face of slower linear growth and head growth is consistent with relative nitrogen deficiency; this interpretation is strengthened by the finding of lower plasma transthyretin concentrations in these infants. Furthermore, it took the smaller infants longer to achieve the desired enteral intakes and to regain birth weight. On the basis of these observations, we hypothesized that an early period of relative nitrogen deficiency underlies the growth failure seen in VLBW infants. To test this hypothesis we propose a randomized, prospective clinical trial to compare an aggressive early nutritional regimen providing 18 percent of energy intake as protein (P:E ratio of 4.5 g:l00 kcal) to a conventional regimen providing 12.5 percent of energy intake as protein (P:E ratio of 3.1 g:100 kcal) in appropriate for gestational age VLBW infants. The outcome of the nutritional intervention will be assessed by measurements of growth, rate and composition of weight gain and nutritional status made at the time parenteral nutrition is discontinued, and at discharge, as well as the neuro-developmental outcome at 18 months corrected age.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD027564-08
Application #
6726888
Study Section
Nutrition Study Section (NTN)
Program Officer
Grave, Gilman D
Project Start
1993-07-01
Project End
2006-04-30
Budget Start
2004-05-01
Budget End
2005-04-30
Support Year
8
Fiscal Year
2004
Total Cost
$294,300
Indirect Cost
Name
Columbia University (N.Y.)
Department
Pediatrics
Type
Schools of Medicine
DUNS #
621889815
City
New York
State
NY
Country
United States
Zip Code
10032
Sahni, R; Schulze, K F; Ohira-Kist, K et al. (2010) Interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infants. Acta Paediatr 99:135-9
Ammari, Amer; Schulze, Karl F; Ohira-Kist, Kiyoko et al. (2009) Effects of body position on thermal, cardiorespiratory and metabolic activity in low birth weight infants. Early Hum Dev 85:497-501
Kashyap, Sudha (2008) Is the early and aggressive administration of protein to very low birth weight infants safe and efficacious? Curr Opin Pediatr 20:132-6
Kashyap, Sudha (2007) Enteral intake for very low birth weight infants: what should the composition be? Semin Perinatol 31:74-82
Fifer, William P; Myers, Michael M; Sahni, Rakesh et al. (2005) Interactions between sleeping position and feeding on cardiorespiratory activity in preterm infants. Dev Psychobiol 47:288-96
Sahni, R; Schulze, K F; Kashyap, S et al. (2005) Sleeping position and electrocortical activity in low birthweight infants. Arch Dis Child Fetal Neonatal Ed 90:F311-5
Sahni, Rakesh; Saluja, Deepak; Schulze, Karl F et al. (2002) Quality of diet, body position, and time after feeding influence behavioral states in low birth weight infants. Pediatr Res 52:399-404
Kashyap, S; Ohira-Kist, K; Abildskov, K et al. (2001) Effects of quality of energy intake on growth and metabolic response of enterally fed low-birth-weight infants. Pediatr Res 50:390-7
Sahni, R; Schulze, K F; Kashyap, S et al. (2000) Maturational changes in heart rate and heart rate variability in low birth weight infants. Dev Psychobiol 37:73-81
Sahni, R; Schulze, K F; Kashyap, S et al. (1999) Body position, sleep states, and cardiorespiratory activity in developing low birth weight infants. Early Hum Dev 54:197-206

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