网红黑料

Researchers report the first premature babies to receive an experimental artificial amniotic fluid patented by University of Florida scientists appear to tolerate the solution, which was given orally in hopes it will help the infants鈥� digestive system develop properly so they can eventually handle regular feedings.

Very-low-birthweight babies, some born nearly four months before their due dates often weighing less than two pounds, are almost universally unable to digest human milk or formula. In their first days or weeks they are fed intravenously, which typically causes their intestines to degenerate from disuse鈥攎aking feeding even more difficult when they later graduate to breast or bottle.

Ultimately, infants can require surgery to remove damaged portions of the digestive tract. Some become candidates for experimental bowel transplantation or even die. Most develop related problems with lifelong consequences, said Martha Sola, M.D., an assistant professor of pediatrics at UF鈥檚 College of Medicine.

鈥淐learly, in utero their intake is not formula,鈥� said Sola, UF鈥檚 liaison for future studies of the artificial amniotic fluid. 鈥淪o even breast milk, which is much better than artificial formula of any sort, is not what their intestines should be seeing at that physiologic age. This work aims to mimic what the intestines at that age are functionally prepared to handle, which would be amniotic fluid.鈥�

Researchers at UF, the University of South Florida, Shands at UF medical center, Shands Jacksonville and the Arnold Palmer Hospital for Women and Children in Orlando tested the artificial amniotic fluid鈥攁 flavorless, colorless, odorless electrolyte-based solution developed at UF known as SAFE START鈥攊n 30 preterm babies whose gestational ages ranged from 25 to 31 weeks. Their findings appeared in the October issue of the Annals of Pharmacotherapy.

While in the womb, a fetus swallows amniotic fluid constantly鈥攁bout 200 to 300 milliliters per kilogram of their weight every day. The growth factors contained in the fluid prompt normal development of the fetal intestine, said Robert D. Christensen, M.D., former chief of neonatology at UF鈥檚 College of Medicine and now chairman of pediatrics at USF鈥檚 College of Medicine.

鈥淭o translate this to somebody our size, it would be like an adult swallowing five gallons of fluid per day,鈥� said Christensen, also physician-in-chief at All Children鈥� s Hospital in St. Petersburg. 鈥淚f you were to drink five gallons of something a day you鈥檇 have to be constantly swallowing it. That鈥檚 what babies do鈥攖hey constantly swallow amniotic fluid, and if they don鈥檛, the bowel doesn鈥檛 develop. It鈥檚 the old adage 鈥榰se it or lose it.鈥� If you don鈥檛 use the intestinal tract, you lose whatever function is present.鈥�

The SAFE START solution has no nutritive or caloric value but contains growth factors essential to normal intestinal development, Christensen said. Animal studies in mice and rats have shown these hormones鈥攇ranulocyte colony-stimulating factor and erythropoietin鈥攕timulate the growth of villi, the intestine鈥檚 fingerlike projections that absorb nutrients from food.

鈥淭his is the first such solution that鈥檚 been developed鈥攖hat鈥檚 the exciting part,鈥� Christensen said. 鈥淥ur hypothesis is that by providing them with simulated amniotic fluid, we prevent the intestinal atrophy that otherwise would occur.鈥�

Each year, an estimated 60,000 low-birthweight babies are born in the United States, said Darlene A. Calhoun, D.O., a former UF faculty member who worked with Christensen and others to develop the solution. Researchers have yet to determine the best way to feed these infants, said Calhoun, now the associate chairman for research at USF鈥檚 Children鈥檚 Research Institute.

鈥淔eeding these babies is a nightmare,鈥� she said. 鈥淲e lose babies from problems with their gut as a result of feeding. It鈥檚 a very complex process; unfortunately, we still don鈥檛 know a lot about it.鈥�

In the study, funded in part by the National Institutes of 网红黑料 and the Children鈥檚 Miracle Network, 30 preterm babies were separated into three groups of 10 each. Babies in each group were given varying amounts of the artificial amniotic fluid at room temperature through a small stomach tube or from a bottle every three hours for a three-day period. The maximum amount babies received each day was equivalent to about four teaspoons. Most tolerated the feedings well; only three did not complete all 24 doses. One had extra fluid in the stomach, one developed abdominal distention and a third became ill with an unrelated heart condition.

Researchers plan to seek federal approval to conduct large-scale multicenter studies to test the safety and effectiveness of the artificial amniotic fluid, which is not yet commercially available, Christensen said.

In addition to degeneration of the intestines, prolonged intravenous feedings also place babies at increased risk of infection, which endangers their lives, lengthens hospitalization and hikes health-care costs, Calhoun said. If neonatal intensive care unit stays could be shortened by just one day per patient, the annual savings to the health-care system would approach $250 million just in the United States, she said. The length of these stays is often determined by how well babies gain weight, which hinges on how soon they begin tolerating full feedings.

鈥淲e hope that by using the solution we might be able to shorten hospitalization by a couple days,鈥� she said. 鈥淭he impact is huge, both financially to the health-care system in addition to the outcomes of these really precious babies.鈥�

Recent research advances have translated into major improvements in the care of premature infants, said Pam Kling, M.D., an assistant professor of pediatrics at the University of Wisconsin-Madison.

鈥淏ut because the mechanisms behind feeding intolerance in premature infants are so difficult to study, we have experienced essentially no advances in treating feeding intolerance,鈥� Kling said. 鈥淭his study may be a first step."