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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03445689
Other study ID # 20161114
Secondary ID U01HL133689
Status Completed
Phase
First received
Last updated
Start date September 4, 2018
Est. completion date November 1, 2023

Study information

Verified date November 2023
Source University of Miami
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Premature infants present with significant oxygenation instability in the form of frequent spontaneous episodes of hypoxemia during the first weeks after birth. These infants are also exposed to hyperoxemia. The objective of this study is to determine the extent to which exposure to frequent episodes of hypoxemia and hyperoxemia in extreme premature infants during the early stages of their evolving lung disease is associated with altered maturation and function of their respiratory control system. This study is part of the Prematurity-Related Ventilatory Control (Pre-Vent): Role in Respiratory Outcomes Clinical Research Centers (CRC) (U01) cooperative program of the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH).


Description:

Most extreme premature infants present with respiratory failure due to altered lung function compounded by breathing instability due to an immature respiratory control function. Premature infants present with significant oxygenation instability in the form of frequent spontaneous episodes of hypoxemia during the first weeks after birth. As a result, these infants receive oxygen supplementation but this is often excessive and these infants are also exposed to hyperoxemia. The extent to which these episodes of hypoxemia or the exposure to hyperoxemia impact on the maturation and function of the control of breathing system in extreme premature infants during the evolving stages of their respiratory disease is unknown. This is a prospective study that will systematically evaluate such association in extreme premature infants. The main objective of this study is to determine the extent to which exposure to frequent episodes of hypoxemia and hyperoxemia in extreme premature infants during the early stages of their evolving lung disease is associated with altered maturation and function of their respiratory control system. This study is part of the Prematurity-Related Ventilatory Control (Pre-Vent): Role in Respiratory Outcomes Clinical Research Centers (CRC) (U01) cooperative program of the National Heart Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH).


Recruitment information / eligibility

Status Completed
Enrollment 70
Est. completion date November 1, 2023
Est. primary completion date November 1, 2023
Accepts healthy volunteers No
Gender All
Age group N/A and older
Eligibility Inclusion Criteria: - Premature infants born at 23 0/7- 28 6/7 weeks gestational age - Postnatal age up to equivalent to 36 weeks postmenstrual age - Requiring supplemental oxygen and/or receiving mechanical ventilation, CPAP, nasal ventilation or nasal cannula Exclusion Criteria: - Severe congenital anomalies that may affect life expectancy or pulmonary or neurosensory development - Severe CNS pathology that may alter respiratory control function

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Assessment of oxygenation instability
Recordings of SpO2 and heart rate will be analyzed by dedicated software to obtain frequency, duration and severity of episodes of hypoxemia and hyperoxemia.
Determination of mechanisms of hypoxemia episodes
Recordings of SpO2, heart rate, esophageal pressure, tidal volume, minute volume, respiratory rate and transcutaneous PCO2 will be analyzed to determine the prevalence, severity and duration of hypoxemia episodes produced by the different mechanisms.
Assessment of respiratory instability
Recordings of tidal volume, minute volume and respiratory rate will be analyzed to determine frequency of apnea, periodic breathing, distribution of inter-breath intervals.
apneic threshold of CO2
In mechanically ventilated infants the apneic threshold of CO2 will be measured by transcutaneous PCO2 following a step wise increase in ventilator rate until spontaneous breathing ceases transiently. In spontaneously breathing infants the apnea threshold of CO2 will be measured during episodes central apnea.
Assessment of peripheral chemoreceptor function
The Dejours test will be used to assess peripheral chemoreceptor function by measuring the immediate ventilatory response to high-inspired oxygen.
Assessment of central chemo-receptor function
Central chemo-receptor function will be assessed by measuring the ventilatory response to inspired CO2.

Locations

Country Name City State
United States NICU at Holtz Children's Hospital Miami Florida

Sponsors (2)

Lead Sponsor Collaborator
University of Miami National Heart, Lung, and Blood Institute (NHLBI)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Peripheral chemoreceptor control of breathing function Ventilatory response to oxygen (Dejours test) at 32 weeks corrected postmenstrual age
Primary Peripheral chemoreceptor control of breathing function Ventilatory response to oxygen (Dejours test) at 36 weeks corrected postmenstrual age
Primary Central chemoreceptor control of breathing function Ventilatory response to carbon dioxide at 32 weeks corrected postmenstrual age
Primary Central chemoreceptor control of breathing function Ventilatory response to carbon dioxide at 36 weeks corrected postmenstrual age
Primary Change in peripheral chemoreceptor control of breathing function Ventilatory response to oxygen (Dejours test) Change from 32 to 36 weeks postmenstrual age
Primary Change in central chemoreceptor control of breathing function Ventilatory response to carbon dioxide Change from 32 to 36 weeks postmenstrual age
Secondary Ventilatory stability - Apnea frequency Frequency of apnea episodes per hour at 32 and 36 weeks corrected postmenstrual age
Secondary Ventilatory stability - Periodic breathing density Percent of time with periodic breathing at 32 and 36 weeks corrected postmenstrual age
Secondary Ventilatory stability - Time series analysis of inter-breath interval Tail slope of the log-scaled probability density function of the inter-breath time series at 32 and 36 weeks corrected postmenstrual age
Secondary Mechanisms of episodic hypoxemia Classify etiology of episodes of hypoxemia as central, obstructive, or mixed apnea or active exhalation based on measurements of respiratory inductance plethysmography, esophageal pressure at 32 and 36 weeks corrected postmenstrual age
Secondary Apneic CO2 threshold in central apnea Carbon dioxide level change at onset of central apnea at 32 and 36 weeks corrected postmenstrual age
Secondary Apneic CO2 threshold during mechanical ventilation Carbon dioxide level change at onset of central apnea with stepwise increase in ventilator rate at 32 and 36 weeks corrected postmenstrual age
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