Development, Infant Clinical Trial
— PRISMOfficial title:
Sildenafil Citrate to Improve Maternal and Neonatal Outcomes in Low-Resource Settings: A Randomized Pilot Feasibility Trial: Pilot Randomized Intrapartum Sildenafil in Mothers
The goal of this feasibility pilot clinical trial is to learn if sildenafil citrate 50mg orally, up to three times during labor, can be appropriately administered, with limited clinical side effects, to laboring mothers to determine feasibility across a spectrum of available healthcare resources. The main questions it aims to answer are: - What are the fetal heart rate monitoring practices in a low-resource setting? - What are the indications for operative delivery in a low-resource? - What is the rate of relevant primary and secondary outcomes to possibly target in a large RCT of intrapartum sildenafil? - What is the limited effect size of sildenafil citrate on maternal and neonatal outcomes in a low-resource setting? Researchers will compare the administration of sildenafil citrate 50 mg orally to a placebo (a look-alike substance that contains no drug) to see if procedures are feasible, the drug is tolerated, the target outcomes are achievable, and effect size is as expected. Participants will: - Take Sildenafil 50 mg/placebo every eight hours or a placebo every eight hours for up to 24 hours during labor - Have the (mothers & babies) medical charts reviewed for outcomes, including fetal distress, operative delivery, maternal side effects, neonatal bag & mask ventilation, Apgar scores, and seizures. - Have a neonatal neurological assessment prior to discharge - Have phone call assessments for re-hospitalization or mortality 7 days post-delivery - Receive child development assessments at 1 year, 2 years and 3 years of age by the Ages and Stages Questionnaire administered via a telephone call The results of this feasibility pilot trial will be used to inform the design and conduct of a large pragmatic randomized controlled trial to determine if sildenafil citrate, compared to placebo, will decrease fetal distress and perinatal asphyxia.
Status | Not yet recruiting |
Enrollment | 1000 |
Est. completion date | January 31, 2028 |
Est. primary completion date | December 31, 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 0 Days to 40 Years |
Eligibility | Inclusion Criteria: 1. Pregnant women presenting in early labor with a term pregnancy (= 37 weeks gestation) - Early labor will be defined as cervical dilation less than or equal to 6 cm - Gestational age will be calculated from the most reliable variable using the following hierarchy of reliability: 2) gestational dating ultrasound completed at any time during the pregnancy (with preference to the earliest exam); 2) date of last menstrual period if menses are regular. 2. Planned vaginal delivery and admission to health facility with clear plan for spontaneous or induced vaginal delivery 3. Maternal age = 18yrs or minors 14-17yrs eligible in countries where married or pregnant minors or their authorized representatives are legally permitted to give consent 4. A single, live fetus in cephalic presentation confirmed prior to randomization Exclusion Criteria: 1. Unknown gestational age 2. Maternal history of cesarean delivery 3. Advanced stage of labor (>6 cm or 10 cm cervical dilation per local standards) and pushing, or too distressed to understand, confirm, or give informed consent regardless of cervical dilation 4. Not capable of giving consent due to other health problems, such as obstetric emergencies (i.e. antepartum hemorrhage) or mental disorder 5. Maternal contraindication to sildenafil therapy, such as hypersensitivity to nitrates or nitrites 6. Any medical condition considered a contraindication per the judgement of site investigators 7. Recognized fetal anomaly 8. Any maternal medical condition or status that precludes informed consent 9. Non-emancipated minors (as per local regulations 10. Plan for cesarean delivery prior to enrollment 11. Previous randomization in the trial |
Country | Name | City | State |
---|---|---|---|
Cameroon | Cameroon Baptist Convention Health Services | Douala | |
Kenya | Egerton University/Nakuru County Referral Hospital | Nakuru | |
Zambia | University Teaching Hospital | Lusaka |
Lead Sponsor | Collaborator |
---|---|
University of Alabama at Birmingham | Cameroon Baptist Convention Health, Egerton University, University Teaching Hospital, Lusaka, Zambia |
Cameroon, Kenya, Zambia,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Percentage of perinatal mortality | Documentation of stillbirth or neonatal death | 96 hours after enrollment | |
Primary | Percentage of operative delivery | Documentation of type of delivery | 96 hours after enrollment | |
Primary | Indication for operative delivery | Documentation of type of delivery | 96 hours after enrollment | |
Secondary | Percentage of mothers who received fetal heart rate monitoring | Documentation of rate of heart rate monitoring | 96 hours after enrollment | |
Secondary | Indication for fetal heart rate monitoring | Documentation of the indication for use of fetal heart rate monitoring | 96 hours after enrollment | |
Secondary | Apgar Score | Documentation of Apgar score at 1 minute and 5 minutes (Value 0-10, with 10 meaning better outcome) | 1 minute and 5 minutes after birth | |
Secondary | Percentage of use of bag and mask ventilation in neonates | Documentation of the use of bag and mask ventilation as resuscitation after delivery | 20 minutes after delivery | |
Secondary | Percentage of neonates with neonatal encephalopathy | Documentation of neonatal neurological exam determined by "modified Sarnat Score (no, mild, moderate, and severe)" ; higher score indicates more severe encephalopathy | 24 hours after birth | |
Secondary | Percentage of neonates with neonatal encephalopathy | Documentation of neonatal neurological exam determined by "Thompson Score (no, mild, moderate and severe)"; higher score indicates more severe encephalopathy | 24 hours after birth | |
Secondary | Percentage of neonates with hypoxemia | Documentation of saturations < 95% measured by noninvasive pre/post pulse oximetry | 48 hours after birth or at discharge, if early discharge | |
Secondary | Percentage of infants with neonatal hypoxic-ischemic encephalopathy | Documentation of neonatal encephalopathy | 96 hours after enrollment | |
Secondary | Percentage of neonatal ICU admissions | Documentation of admission to the Neonatal Intensive Care Unit or comparable level of care | 96 hours after enrollment | |
Secondary | Percentage of maternal rehospitalization | Maternal rehospitalization after initial discharge from the hospital assessed by telephone call to mother | 7 days | |
Secondary | Percentage of neonatal rehospitalization | Neonatal rehospitalization after initial discharge from the hospital assessed by telephone call to mother | 7 days | |
Secondary | Infant/child developmental assessment | Score on "Ages and Stages Questionnaire" obtained by telephone call to parent (developmental assessment tool which scores items (Yes=10, Sometimes=5, Not Yet=0) in areas of Communication, Gross Motor, Fine Motor, Problem Solving, and Personal-Social. Scoring of items are totaled and placed on a graph indicating cutoff score. If score is above cutoff, the child's development appears to be on schedule; near the cutoff, may provide learning activities and monitor; and below cutoff, requiring further assessment. 12-month cutoffs (Communication 15.64; Gross Motor 21.49; Fine Motor 34.50; Problem Solving 27.32 and Personal-Social 21.73); 24-month cutoffs ((Communication 25.17; Gross Motor 38.07; Fine Motor 35.16; Problem Solving 29.78 and Personal-Social 31.54); and 36-month cutoffs (Communication 30.99; Gross Motor 36.99; Fine Motor 18.07; Problem Solving 30.29 and Personal-Social 35.33) | 12 months, 24 months, 36 months |
Status | Clinical Trial | Phase | |
---|---|---|---|
Recruiting |
NCT05412524 -
Impact of Reading on Endogenous Oxytocin System of Preterm Infants
|
N/A | |
Active, not recruiting |
NCT03506971 -
Early Childhood : Action Research in the Lunévillois Area (PERL)
|
N/A | |
Completed |
NCT04301453 -
The Effect of Maternal Scent on Sleep Wake States
|
N/A | |
Terminated |
NCT04436055 -
Intergenerational Effects of Paternal Periconceptional Cannabis and Other Drug Use (EPIC)
|
||
Recruiting |
NCT05527080 -
Development of Motility and Cognition in Infants
|
||
Not yet recruiting |
NCT05901766 -
Effect of Iodine-containing Multiple Micronutrient During Lactation on Infant Neurodevelopment
|
Phase 4 | |
Not yet recruiting |
NCT06396520 -
Neuroimaging of Babies During Natural Sleep to Assess Typical Development and Cerebral Palsy
|
||
Recruiting |
NCT05230199 -
Sensory Optimization of the Hospital Environment
|
N/A | |
Recruiting |
NCT03849248 -
Maternal Scent and Preterm Infant Nutrition
|
N/A | |
Recruiting |
NCT05834907 -
Hands and Hearts Together
|
N/A | |
Not yet recruiting |
NCT05843396 -
Brain Organization, Development, and Response to Intervention in Individual Neonates
|
N/A | |
Completed |
NCT05261503 -
Investigation of the Effectiveness of Environmental Enrichment-Based Intervention in Preterm Infants
|
N/A | |
Completed |
NCT04506541 -
The Effects Of KC On Exclusively Breastfeeding And Baby's Growth And Development According To Attachment Theory
|
N/A | |
Completed |
NCT05778357 -
The Effect of the Covid 19 Pandemic Process on the Neuromotor Developments of 6-24 Month-old Babies
|
||
Active, not recruiting |
NCT05404815 -
Exposure to Plasticisers in the Neonatal Intensive Care Unit
|
||
Completed |
NCT04203589 -
Explorer Babies Early Intervention Program
|
N/A | |
Completed |
NCT03306316 -
Prebiotic in Preterm Infants
|
N/A | |
Completed |
NCT05147480 -
Online Mother-Baby Yoga With Preterm Infants and Their Mothers
|
N/A | |
Recruiting |
NCT04689386 -
Effect of Chest Physiotherapy on the Development of Preterm Infants.
|
N/A | |
Recruiting |
NCT05767242 -
Early Neurophysiological Markers of Language Impairments
|