PRediction Of Maturity, Morbidity, and Mortality in PreTerm Infants: The PROMPT Study


How can we use metabolic patterns in very preterm infants to improve the ability to predict health outcomes of preterm infants and help to identify interventions?


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 The issue: consequences of being born before 32 weeks

Infants born very preterm (less than 32 weeks gestation) are at risk for early death and severe complications that can affect both short- and long-term health.

Complications more common in infants born very preterm include:

  • Retinopathy of prematurity (ROP, which can cause vision problems and blindness);
  • Necrotizing enterocolitis (NEC, which can cause short- and long-term difficulties with digestion and macro-and micro-nutrient deficiencies);
  • Bronchopulmonary pulmonary dysplasia (BPD, which can cause difficulties with breathing).

Historically, our ability to identify infants born at <32 weeks who are more likely to die or develop life-changing complications has been extremely limited. This limitation has hindered the development of new therapeutics that might help prevent death and disability.

Preterm baby in the NICU

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What we are doing about it


The goal: optimizing metabolic prediction tools

Our team has shown that metabolic patterns in infants born at <32 weeks gestation may be a useful predictor of mortality and major neonatal complications. The PROMPT study is working to optimize the use of metabolic prediction tools in very preterm infants being cared for in neonatal intensive care units (NICUs) with the hope of improving prediction and identifying in-roads for intervention. We are proudly working with NICUs at UCSF and at the University of Iowa to bring this work to life.


Very preterm infant on mother's chest

Baby's blood sampled from the heel at birth

Method: collecting blood samples from preemies

PROMPT, which is s NIH funded and UCSF PTBi-CA supported and partnered, will enroll 500 very preterm neonates (300 at the University of Iowa Children's Hospital & 200 at UCSF's Benioff Children's Hospital) over a five year period. The study will collect about 10 drops of blood at critical time points during the first week of life and weekly until discharge from the hospital. The specimens will be collected when an infant is already having specimens collected for laboratory testing (as part of routine care) and as such, the pain of collection will be minimized. These specimens will be tested for the same metabolites we have found to be predictive of adverse outcomes in previous work. This will help us determine if this kind of testing might be used routinely in NICU settings to predict outcomes. If we find this to be true, we can use this data to help identify new therapeutics to help improve infant health.

Collecting other samples to understand preemie microbiome

PROMPT study investigators have also partnered with the UCSF Microbiome Center to collect and analyze breastmilk, stool, and oral and skin samples in infants born before 32 weeks to better understand how an infant's microbiome (the population of microbes that live in and on a person's body) impacts mortality and morbidity. By analyzing the microbiome and metabolism in combination, we hope PROMPT results in an improved ability to diagnose complications and will lead to precision approaches aimed at targeted treatment and prevention.


PROMPT: where are we now?

  • We received a National Institutes of Health RO1 Grant!
  • We are partnering with Benioff Center to create a Microbiome Medicine Center.
  • Enrollment for PROMPT has begun in the NICUs at UCSF Benioff Children's Hospital and at the University of Iowa
  • We are partnering with the University of Alabama to validate the metabolic blood test by enrolling 400 Black women and 400 non-Black women.


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