Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT06390943 |
Other study ID # |
IRB23-0273 |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
May 15, 2024 |
Est. completion date |
September 30, 2025 |
Study information
Verified date |
May 2024 |
Source |
Harvard School of Public Health (HSPH) |
Contact |
Ilana Dzuba, MHS |
Phone |
(617) 384-6555 |
Email |
idzuba[@]ariadnelabs.org |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Low Birthweight and Preterm Infant Feeding Trial and Supportive Care Package (LIFT-UP) aims
to improve feeding and growth outcomes among low birthweight (LBW; <2.5kg) or preterm (<37
weeks gestational age) infants admitted to neonatal intensive care units (NICU) in India,
Malawi, and Tanzania by (1) supporting the initiation, establishment, and maintenance of
maternal lactation and prioritized provision of human milk, Kangaroo Mother Care (KMC) and
appropriate water, sanitation and hygiene (WASH) practices; and (2) facilitating feeding
counseling at home post-discharge from the facility.
Description:
AIM: To improve feeding and growth outcomes among low birthweight (LBW; <2.5kg) or preterm
(<37 weeks gestational age) infants admitted to NICUs in India, Malawi, and Tanzania by (1)
supporting the initiation, establishment, and maintenance of maternal lactation and
prioritized provision of human milk, Kangaroo Mother Care (KMC) and appropriate water,
sanitation and hygiene (WASH) practices; and (2) facilitating feeding counseling at home
post-discharge from the facility.
OBJECTIVES:
To implement and evaluate a co-designed facility-based lactation support/management and
feeding counseling + KMC + WASH package (FB-FSP+: Facility-Based Feeding Support Package
Plus) for LBW or preterm infants admitted to the neonatal intensive care unit (NICU) and
their families from birth to discharge.
To implement and evaluate a co-designed, scalable transition-to-home lactation
support/management and feeding counseling + KMC + WASH package (TTH-FSP+: Transition to Home
Feeding Support Package Plus) for LBW or preterm infants discharged home from the NICU in
India and their mothers/families.
STUDY DESIGN: This multi-site, mixed-methods adaptive implementation science research study
will collect quantitative and qualitative data to evaluate the training of providers, the
impact of each intervention on key infant feeding, growth, and other health outcomes, the
feasibility and acceptability of each intervention for mothers and providers, and the overall
experience of mother-infant dyads. Investigators will apply the RE-AIM framework to unpack
Reach, Effectiveness, Adoption, Implementation, and Maintenance. Findings will lead to
recommendations for iteration and scale-up of the FB- and TTH-FSP+. Investigators will
evaluate multiple primary and secondary quantitative outcomes to assess effectiveness.
SAMPLE SIZE: Overall, investigators will enroll 695 participants, 50% in India, 50% in Malawi
& Tanzania: up to 520 infants (463 mothers assuming 11% twin rate), 110 mothers (in-depth
interviews), 30 healthcare providers, 15 study staff, and 20 community providers.
Objective 1: A sample of 80 infants and their mothers is sufficient to detect the effect
sizes for each of the primary and secondary outcomes with 80% power, 0.05 alpha. Smaller
improvements in key outcomes for the pre/post analysis can be detected for the implementation
study (n=80 baseline vs 240 implementation) compared to the pilot study (n=80 baseline vs 80
pilot).
Objective 2: Investigators will conduct up to 40 in-depth interviews (IDIs) with providers
and 20 with mothers. A sample of 60 infants and their mothers is sufficient to detect the
effect sizes for each of the primary and secondary outcomes with 80% power, 0.05 alpha.
ENROLLMENT: OBJECTIVE 1 (FB-FSP+) Mother-infant dyads (quantitative): All infants born in a
study facility will receive immediate maternal and newborn care per World Health Organization
recommendations, including breast milk feeding/expression support within 1 hour. Inborn LBW
or preterm infants admitted to the NICU will be screened for eligibility and their mothers
consented.
Mothers (qualitative): Mothers will be recruited and consented before discharge from study
facilities.
Research Nurses (qualitative): Research nurses providing the intervention will be consented
prior to IDIs.
Healthcare providers (quantitative): Appropriate labor ward, NICU, and step-down ward
providers will be identified by facility and NICU leadership/staff to implement the FB-FSP+
and consented.
Healthcare providers (qualitative): NICU providers will be recruited and consented during
study implementation.
ENROLLMENT FOR OBJECTIVE 2 (TTH-FSP+, INDIA ONLY) Mothers (quantitative): Mothers exposed to
Objective 1 will be recruited around the time of discharge and consented.
Community providers (quantitative): Community providers within a given cadre(s) who provide
care to LBW or preterm infants within the catchment area will be recruited and consented.
Mothers (qualitative): Mothers receiving the TTH-FSP+ will be recruited and consented during
study visits.
Community providers (qualitative): Community providers will be recruited and consented after
beginning implementation of the TTH-FSP+.
STUDY INTERVENTION: The FB-FSP+ and the TTH-FSP+ will build on an existing Specialized
Lactation Support and Newborn Nutrition for the Small and Sick Newborn Training curriculum to
include support for KMC and WASH. The FSP+ will include a training guide, Standard Operating
Procedures and job aids specific to each hospital's and community's needs identified through
co-design workshops with key stakeholders that utilize human-centered design methods.
DATA COLLECTION FOR OBJECTIVE 1 (FB-FSP+) Data will be collected in 3 phases.
Baseline data collection will occur over 6 weeks among eligible mother-infant dyads prior to
introducing the intervention. Baseline will be the comparison group for the implementation
research study and the pilot study.
A 6-week pilot study conducted by research staff in each country will assess the
acceptability, feasibility, and impact of the ideal delivery of the FB-FSP+. A quick final
iteration of the FSP+ will occur before implementing in phase 3.
The FB-FSP+ will be implemented for 1 year using an adaptive models-based approach. Three
consecutive models will be implemented for 4 months each. Investigators will collect panel
data at 1.5, 5.5, and 10.5 months after the start of implementation for 1.5 months to assess
effectiveness and inform model adaptations. Different mother-infant dyads will be surveyed at
each time point to assess differences in the impact of implementation over time.
Prior to start, healthcare providers will be selected and trained to implement the FSP+ as
part of their regular workload. They will complete a knowledge, attitudes, and practices
(KAP) survey on lactation support/management, feeding, KMC, and WASH (1) prior to training,
(2) immediately post-training, and (3) 6 months post-training.
Data collection with mother-infant dyads will take 1-2 hours at one time point between NICU
admission and day of discharge during panel data collection. Mothers will be asked about
their demographics, pregnancy history, health, and their infants' health. Study staff will
take the mother's weight and height, the infants' weight, length, head circumference and
mid-upper arm circumference (MUAC), and data from mothers' and infants' charts.
A subset of 60 mothers exposed to the FB-FSP+ will be interviewed by study staff, 30 of whom
whose babies received care in the NICU within 1.5 months of implementation and another 30
whose babies received care within 5.5 months. Interviews will explore mothers' experiences
and perceptions of the acceptability and feasibility of the FB-FSP+.
A subset of 15-30 healthcare providers across all sites will be interviewed per time point at
1.5 months and 5.5 months after implementing the FB-FSP+. Investigators aim to interview the
same providers at both times to understand how implementation has affected their practices,
skills and workload over time. Interviews will explore acceptability and feasibility of the
FB-FSP+ and barriers and facilitators to its implementation.
DATA COLLECTION FOR OBJECTIVE 2 (TTH-FSP+, INDIA ONLY) Baseline data collection will occur
before implementing the TTH-FSP+ among mothers exposed to the FB-FSP+ and discharged home.
Data collection points will be on the day of discharge and at 2 and 6 weeks post-discharge.
The TTH-FSP+ will be implemented for 6 months, using an adaptive models-based approach. Three
models will be consecutively implemented for 3 months each. Quantitative and qualitative
analysis will begin after 2 months to inform model adaptations. Data collection points will
be on the day of discharge and at 2 and 6 weeks post-discharge.
Community providers will be trained to deliver the TTH-FSP+ for dyads residing in a defined
catchment area once they are discharged home. Community providers will complete a KAP survey
on feeding counseling, KMC, and WASH at three timepoints: (1) just prior to training, (2)
immediately post-training, and (3) 6 months post-training.
Data collection will begin on the day of discharge prior to leaving the facility, and mothers
will respond to questions about their demographics, pregnancy history, health, and their
infants' health. During 2 home visits, mothers will respond to questions on breastfeeding
self-efficacy and health, as well as their infants' health and feeding practices. Mothers'
weight and height will be measured at one study visit. The infants' weight, length, head
circumference and MUAC will be measured at each study visit.
Interviews with mothers will be done at 6 weeks post-discharge during implementation of Model
1 & 2 and will explore their experiences with the TTH-FSP+ and their perspectives on its
acceptability and feasibility .
Interviews with community providers will be conducted once during implementation of each
Model 1 & 2. Investigators aim to interview the same providers at both time points.
Interviews will explore community providers' experiences delivering the TTH-FSP+ and their
perspectives on its acceptability and feasibility.