Optimising Newborn Nutrition During Therapeutic Hypothermia.
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|ClinicalTrials.gov Identifier: NCT03278847|
Recruitment Status : Recruiting
First Posted : September 12, 2017
Last Update Posted : August 15, 2019
The overarching aim of this project is to determine the optimum enteral and parenteral nutrition strategy for newborns with Hypoxic Ischaemic Encephalopathy (HIE) during and after therapeutic hypothermia. To do this the investigators will perform two primary comparisons:
- ENTERAL: to determine whether any enteral (milk) feeding, when compared to withholding enteral feeding (no milk), during therapeutic hypothermia, is associated with a difference in the incidence of necrotising enterocolitis.
- PARENTERAL: to determine whether provision of intravenous dextrose, when compared to provision of parenteral nutrition, during therapeutic hypothermia, is associated with a difference in the incidence of blood stream infection.
The investigators will use de-identified data held in an established research database called the National Neonatal Research Database (NNRD) and we will use the potential outcomes framework with application of propensity scoring to define matched subgroups for comparison.
|Condition or disease||Intervention/treatment|
|Infant, Newborn Asphyxia Neonatorum Hypothermia, Induced Parenteral Nutrition Infant Nutrition Necrotizing Enterocolitis Neonatal Sepsis||Dietary Supplement: Received enteral (milk) feeds during therapeutic hypothermia Dietary Supplement: Enteral (milk) feeds withheld during therapeutic hypothermia Dietary Supplement: Received parenteral nutrition during therapeutic hypothermia Dietary Supplement: Did not receive parenteral nutrition during therapeutic hypothermia|
Every year about 1200 babies in England, Wales and Scotland suffer from a lack of oxygen around birth which can lead to long-term brain injury or death. This is called Hypoxic Ischaemic Encephalopathy (HIE). Research has shown that cooling babies with HIE by a few degrees for the first 3 days protects the brain; all babies with moderate or severe HIE in the UK are treated with therapeutic hypothermia (cooling).
Doctors do not know how best to care for babies while they are cooled. A key question is "how to provide nutrition to babies during cooling". There are two main parts to this question, milk feeds ("enteral" nutrition) and intravenous nutrition ("parenteral" nutrition). Doctors don't know how best to provide either milk or intravenous nutrition to cooled babies.
- MILK FEEDS: Some neonatal units in the UK carefully feed babies (usually with maternal breast milk) while they are cooled. This avoids intravenous lines and is believed to help them feed and go home earlier. Other neonatal units do not feed cooled babies because they worry about a condition called necrotising enterocolitis (a devastating and often fatal disease) which might be more common with feeding.
- INTRAVENOUS NUTRITION: All cooled babies need intravenous fluid (even when milk feeds are given it takes several days before enough fluid can be given this way). Some neonatal units give babies intravenous nutrition (which contains fat, protein, carbohydrate, vitamins and minerals) as this may improve growth and recovery. Other neonatal units only give intravenous dextrose with simple salts because of concerns that intravenous nutrition leads to more infections. This study will compare these different ways of providing nutrition. It will use a research database called the National Neonatal Research Database (NNRD). In England, Scotland and Wales doctors and nurses looking after babies in neonatal care (including all cooled babies) use an Electronic Health Record system. Data from this system are anonymised (no baby can be identified) and form the NNRD, so the NNRD holds data from all babies who have been looked after on NHS neonatal units.
The investigators have worked closely with parents and charities in developing the NNRD. The investigators will use the NNRD to study all term babies who received cooling in England, Scotland and Wales since 2008. The investigators will compare the milk feeding and intravenous nutrition they receive.
- MILK FEEDING: The investigators will compare babies who are fed milk while cooled with those that are not fed any milk. The investigator's main goal is to establish whether there is any difference in rates of necrotising enterocolitis.
- INTRAVENOUS NUTRITION: The investigators will compare babies who get intravenous nutrition with those that only get intravenous dextrose. The main difference we are looking for is in the rate of infection. The investigators will also study how many babies die, how long they stay in neonatal care, how soon breastfeeding starts and many are breastfed when they go home.
The investigators will apply a statistical approach called "potential outcomes framework" in which babies are matched in each group (e.g. babies who are fed and those who are not fed) as closely as possible. This will ensure that any difference in outcomes is due to the different nutritional treatments and not due to background differences or other confounders (like how sick a baby is).
The results from this study will help to ensure that babies who need to be cooled for HIE receive the best and safest nutrition in the future.
|Study Type :||Observational|
|Estimated Enrollment :||7200 participants|
|Official Title:||Optimising Newborn Nutrition During Therapeutic Hypothermia: an Observational Study Using Routinely Collected Data|
|Actual Study Start Date :||August 7, 2017|
|Estimated Primary Completion Date :||October 2019|
|Estimated Study Completion Date :||October 2019|
Enteral nutrition comparison
This comparison refers to differences in enteral nutrition during therapeutic hypothermia
Dietary Supplement: Received enteral (milk) feeds during therapeutic hypothermia
In the enteral component of nutrition, the health technology to be assessed is the gradual introduction of enteral (milk) feeds during therapeutic hypothermia:
Dietary Supplement: Enteral (milk) feeds withheld during therapeutic hypothermia
Withholding enteral feeds (keeping a baby nil per os) for the duration of hypothermia.
Parenteral nutrition comparison
This comparison refers to differences in parenteral nutrition during therapeutic hypothermia
Dietary Supplement: Received parenteral nutrition during therapeutic hypothermia
In the parenteral component, the health technology being assessed is administration of parenteral nutrition during therapeutic hypothermia:
Dietary Supplement: Did not receive parenteral nutrition during therapeutic hypothermia
Received standard intravenous fluids (10% dextrose with additional electrolytes added where required) for the duration of hypothermia.
- Necrotising enterocolitis - for the enteral nutrition comparison [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]Defined according to the case definition of Battersby et al., 2017, JAMA Pediatrics
- Blood stream infection - for the parenteral nutrition comparison [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]defined according to the Healthcare Quality Improvement Partnership (HQIP) National Neonatal Audit Programme (NNAP) case definition: pure growth of a recognised pathogen from a normally sterile site
- Survival [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]
- Length of stay [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]Number of days between first neonatal unit admission and final neonatal unit discharge for surviving infants
- Breastfeeding [ Time Frame: At the point of final discharge from neonatal care, assessed up to 1 year ]Any breastfeeding (suckling at the breast) at discharge
- Hypoglycaemia [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]Any diagnosis of hypoglycaemia recorded after therapeutic hypothermia is commenced and before the final neonatal unit discharge
- Time to full feeds [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]The number of days until an infant is recorded as not requiring any parenteral nutrition or fluid
- Growth [ Time Frame: From date of birth until date of final neonatal unit discharge, assessed up to 1 year ]Weight and head circumference for post-menstrual age standard deviation score at final neonatal unit discharge
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03278847
|Contact: Richard Colquhoun||44(0)20 3315 firstname.lastname@example.org|
|Chelsea and Westminster Hospital and NHS Foundation Trust||Recruiting|
|London, United Kingdom, SW10 9NH|
|Contact: Chris Gale, PhD 0203 315 3519 Christopher.email@example.com|
|Principal Investigator: Chris Gale, Phd|
|Imperial College London, Chelsea and Westminster Hospital campus||Active, not recruiting|
|London, United Kingdom, SW10 9NH|
|Principal Investigator:||Chris Gale, MBBS, PhD||Imperial College London|