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Effects of Transitional Circulation in ELBW Infants

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ClinicalTrials.gov Identifier: NCT02016599
Recruitment Status : Recruiting
First Posted : December 20, 2013
Last Update Posted : June 6, 2019
Sponsor:
Collaborators:
Texas Children's Hospital
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
Danielle Rios, Baylor College of Medicine

Brief Summary:

Prematurity is a very important problem in this country. Prematurity can cause problems with organ (such as the brain, heart, kidneys) growth and development. A very important part of keeping premature babies healthy is ensuring good blood flow to all of these organs.

Some premature babies have problems with their hearts and getting enough blood out to the rest of their bodies. This problem is referred to as hypotension (low blood pressure) and is found by looking at blood test values and while examining the baby. These babies will need medications to help their heart deliver blood to all of the important areas in their bodies.

Babies who have hypotension requiring medications tend to have more problems than premature babies that don't need hypotension medication. Some of these problems include a higher risk of bleeding into their brain, kidney problems, liver problems, intestinal (gut) problems causing difficulty tolerating feeds, and a very dangerous infection of their intestines. Some long term effects include hearing loss, developmental delay, and learning problems in the future that are worse than other premature babies who did not have hypotension. Hypotensive premature babies also have a higher risk of death.

The cause of hypotension in the first week of life is still not known. We know that babies have to get used to being in the outside world instead of in the womb. A lot of changes with the heart and lungs have to happen for them to not be affected by that transition. If we could gain a better understanding of those changes, we might be able to prevent some of these issues from happening.

This study will look closely at premature babies with and without hypotension to assess the heart and lung changes in the first week of life. To do this, we will use monitoring machines and tests to get a better idea of all the changes that happen. This information will help all neonatologists who care for premature babies.


Condition or disease Intervention/treatment
Neonatal Prematurity Hypotension Other: Monitoring and biospecimen collection

Detailed Description:

Screening Phase: The subject's parents/guardians/LAR will be approached if the infant's birth weight makes them eligible for this research study.

Study Phase: During this study, we will use the monitoring methods normally used in the Neonatal Intensive Care Unit (NICU) and some new monitoring methods to find out all the changes that the infant's heart and lungs go through during the first week after delivery. During this period the study doctor and staff will:

  1. Collect demographic (age, race, ethnicity) and labor/delivery information.
  2. Perform serial physical exams to evaluate the infant's skin.
  3. Take several blood samples (2-3 drops per sample) to measure the lactate, troponin, and creatinine levels. These blood samples will be taken 1-4 times a day.
  4. Perform Echocardiograms (ultrasound of the heart) on a daily or more or less frequent basis. In between echocardiograms, we will monitor cardiac output with a non-invasive monitor using leads similar to those used for regular heart rate monitoring in the NICU. These tests are being done solely for research purposes and will be paid for by the study.
  5. Measure the amount of blood flow reaching the infant's brain and kidneys using a near-infrared spectroscopy (NIRS) machine. This test is being done solely for research purposes and will be paid for by the study.
  6. Perform Electrocardiograms (ECGs) to monitor how much blood flow is reaching the infant's heart. The sticky pads required for this test will be attached to the infant's chest as part of his/her routine care. For the purposes of this study, we will continuously monitor the machine to record the results.
  7. Measure the amount of blood flowing in one of the arteries in the brain using cerebral Doppler ultrasound
  8. Record results from any other monitoring tools the infant's doctor is using as part of his/her routine care. This will help us identify patterns that might lead to issues in premature babies. We will also be studying the effects of any medications the infant's doctor prescribes; especially those used for low blood pressure.

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Study Type : Observational
Estimated Enrollment : 200 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Delineating the Effects of Transitional Circulation Physiology on Extremely Low Birth Weight (ELBW) Infants
Actual Study Start Date : September 22, 2017
Estimated Primary Completion Date : August 2021
Estimated Study Completion Date : September 2022

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Initial cohort
Initial cohort used to develop a series of multivariate clinical deterioration indices using monitoring modalities and biospecimen collection
Other: Monitoring and biospecimen collection
The study team will use monitoring methods normally used in the NICU (physical exams, echocardiograms, and ECG) and some new monitoring methods (Near-infrared spectroscopy or NIRS) to find out all the changes that a baby's heart and lungs go through during the first week after delivery. In addition, blood samples will be taken to assess lactate, troponin, and creatinine levels.

Validation cohort
Separate cohort of infants used to validate the clinical deterioration indices using monitoring modalities and biospecimen collection
Other: Monitoring and biospecimen collection
The study team will use monitoring methods normally used in the NICU (physical exams, echocardiograms, and ECG) and some new monitoring methods (Near-infrared spectroscopy or NIRS) to find out all the changes that a baby's heart and lungs go through during the first week after delivery. In addition, blood samples will be taken to assess lactate, troponin, and creatinine levels.




Primary Outcome Measures :
  1. Quantify physiologic changes during transitional circulation [ Time Frame: 7 days ]
    Develop a series of multivariate clinical deterioration indices which can be evaluated in real-time to provide continuous and calibrated measurements of likelihood of experiencing an outcome


Secondary Outcome Measures :
  1. Quantify cardiac output [ Time Frame: 7 days ]
    Quantify cardiac output during normal transitional circulation

  2. Quantify the differences in perfusion of end organs [ Time Frame: 7 days ]
    Quantify the differences in perfusion of end organs during transitional cicrculation

  3. Measure cardiopulmonary interaction patterns [ Time Frame: 1 year ]
    Measure cardiopulmonary interaction patterns during the transitional circulation and periods of hemodynamic instability to serve as forewarning of impending crisis

  4. Quantify the change in degree of systemic perfusion [ Time Frame: 7 days ]
    Quantify the change in the degree of systemic perfusion prior to and after vasoactive medication usage.


Biospecimen Retention:   Samples Without DNA
Blood samples will be taken to assess the lactate, troponin, and creatinine levels. These samples will be destroyed once analysis is complete.


Information from the National Library of Medicine

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Ages Eligible for Study:   up to 1 Week   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
All ELBW infants are eligible for enrollment. There will not be a placebo group. Data from the first 100 patients will be used to develop the clinical deterioration indices and data from the next 100 patients will be used to validate the indices.
Criteria

Inclusion Criteria:

  • Infant born at less than or equal to 1000 grams
  • Admitted to NICU

Exclusion Criteria:

  • Infant does not meet inclusion criteria
  • Infant has life-threatening congenital defect
  • Infant has congenital hydrops

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02016599


Contacts
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Contact: Danielle Rios, MD (832) 826-3717 drrios@texaschildrens.org

Locations
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United States, Texas
Texas Children's Hospital Recruiting
Houston, Texas, United States, 77030
Contact: Danielle Rios, MD    832-826-3717    drrios@texaschildrens.org   
Sponsors and Collaborators
Baylor College of Medicine
Texas Children's Hospital
National Institutes of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
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Principal Investigator: Danielle Rios, MD Baylor College of Medicine

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Responsible Party: Danielle Rios, Assistant Professor, Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT02016599     History of Changes
Other Study ID Numbers: H-33536
1K23HL130522-01 ( U.S. NIH Grant/Contract )
First Posted: December 20, 2013    Key Record Dates
Last Update Posted: June 6, 2019
Last Verified: June 2019

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Danielle Rios, Baylor College of Medicine:
Hypotension
Low blood pressure
Neonate
Extremely Low Birth Weight Infant

Additional relevant MeSH terms:
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Hypotension
Vascular Diseases
Cardiovascular Diseases