Necrotizing Enterocolitis Clinical Trial
— PreColos-RCTOfficial title:
Bovine Colostrum Versus Preterm Formula as the First Supplemental Nutrition for Very Preterm Infants, a Randomized, Controlled Trial
Verified date | July 2022 |
Source | Rigshospitalet, Denmark |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Feeding intolerance is a common problem in very preterm infants due to their immature digestive system. This intolerance extends the time to full enteral feeding and thereby also prolongs the time on parenteral nutrition (PN). Prolonged time to full enteral feeding may predispose these infants to a higher risk of growth retardation, infections and organ dysfunctions (e.g. liver, brain). Mother's own milk (MM) is considered the optimal nutrition for preterm infants and is superior to infant formula (including preterm formula, PF) in stimulating gut maturation, feeding tolerance, resistance against necrotizing enterocolitis (NEC) and late-onset sepsis (LOS), and long-term neurodevelopmental outcomes. However, MM is often absent, or not available in sufficient amounts, during the first days or weeks after preterm delivery. Human donor milk (DM) is probably a better supplement to MM than PF, but DM is not available for all hospitals. To supplement insufficient MM during the early neonatal period in hospital settings with no access to donor milk, we suggest that bovine colostrum (BC) may be used instead of PF for very preterm infants during early life. BC, the first milk from cows after birth, is a rich source of protein and bioactive components, including lactoferrin, lysozyme, lactoperoxidase, immunoglobulins, and various growth factors, such as IGF-I and -II, EGFs, and TGF-β. BC has repeatedly been shown to improve gut maturation and NEC/LOS resistance in a well-established piglet model of preterm infants. We suggest a randomized, controlled trial to investigate the effects of BC vs. PF, supplemented to MM during the first 2 weeks, on the time to full enteral feeding in very preterm infants.
Status | Completed |
Enrollment | 350 |
Est. completion date | November 18, 2020 |
Est. primary completion date | October 23, 2020 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A to 2 Days |
Eligibility | Inclusion Criteria: - Preterm infants with gestational age between 26+0 and 31+6 weeks - Delivered at participating hospitals or transferred from other hospitals within 24 h of age - Signed parental consent Exclusion Criteria: - Major congenital anomalies or birth defects - Congenital infection defined as suspected TORCHES infections: Toxoplasmosis, Rubella, CMV, Herpes, Hepatitis, Coxcackie, Syphilis, Varicella Zoster, HIV, Parvo B19 - Perinatal asphyxia with blood pH < 7.0 (umbilical or first neonatal) - Extremely small for gestational age (birth weight z-score = - 3) - No realistic hope of immediate survival - Has received any formula feeding prior to randomization |
Country | Name | City | State |
---|---|---|---|
China | Dongguan Women and Children's Hospital | Dongguan | Guangdong |
China | Foshan Maternal and Child Health Hospital | Foshan | Guangdong |
China | The Sixth Affiliated Hospital of Sun Yat-sen University | Guangzhou | Guangdong |
China | Longgang District Central Hospital of Shenzhen | Shenzhen | Guangdong |
China | Shenzhen Luohu Maternal and Child Health Hospital | Shenzhen | Guangdong |
China | Shenzhen Nanshan Maternal and Child Health Hospital | Shenzhen | Guangdong |
China | Shenzhen People's Hospital | Shenzhen | Guangdong |
China | University of Chinese Academy of Sciences-Shenzhen Hospital | Shenzhen | Guangdong |
Lead Sponsor | Collaborator |
---|---|
Per Torp Sangild | Dongguan Women and Children's Hospital, Longgang District Central Hospital of Shenzhen, Maternal and Child Health Hospital of Foshan, Shenzhen Luohu Maternal and Child Health Hospital, Shenzhen Nanshan Maternity and Child Healthcare Hospital, Shenzhen People's Hospital, Sixth Affiliated Hospital, Sun Yat-sen University, University of Chinese Academy of Sciences - Shenzhen Hospital |
China,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Time to full enteral feeding | Full feeding volume is defined as the first day a participant receives 120 ml/kg/d for a consecutive period of 72 hours. | From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Combined incidence of severe neonatal infections (NEC, LOS, Meningitis) and mortality | LOS: defined as one positive bacterial culture in blood occurring > 3 days after birth with clinical signs of infection and with antibiotics treatment for = 5 days.
Clinical sepsis: Negative bacterial culture in blood, but the infants have clinical signs of infection and fulfil more than 2 of the following criteria: (1) Decrease in WBC , or increase in WBC(2) Immature//total neutrophils =0.16; (3) CRP =8 µg/mL; (4) Procalcitonin = 2 ng/mL; (5) Platelets = 100 ×109/ L. Meningitis: Positive bacterial culture from cerebrospinal fluid (CSF) with clinical signs. When negative, if the infants have clinical signs of meningitis and have the following changes in leucocyte counts or biochemistry values in CSF: 1) increase in leucocytes, 2) increase in total protein, and 3) increase in glucose, clinical meningitis should be recorded. NEC: Stage II or III according to modified Bell's criteria |
From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | The presence of feeding intolerance | Presence of feeding intolerance is defined as at any time when feeding is withheld by the neonatologists from day 1-7 and from day 8-14. The number of withheld meals of the prescribed feeding volume, and actually received volume from day 1-7 and from day 8-14, are recorded to indicate the degree of feeding intolerance. | From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Volume and color of gastric residual | The volume and color of gastric residuals withdrawn from the gastric tube are recorded by attending nurses, prior to a feeding | From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Days on PN | Days on PN are the total number of days that a participant receives any i.v. protein and/or lipid. | From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Days to regain birth weight | Days to regain birth weight is the total number of days that an infant used to regain his/her birth weight | From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Days of hospitalization | Total number of days that a participant is hospitalized in the neonatal department for | From the start of intervention until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Body weight, length, and head circumference | The weight, length, and head circumference of participants are measured every week | Weekly until discharge home or reach a postconceptional age of 37 weeks, whichever comes first | |
Secondary | Blood tests on day 7 and 14 (extracted from patient charts) | Blood tests are performed according to the standard practices at each hospital, including blood gas, hematology, CRP, blood biochemistry for liver and kidney functions, bone health (e.g. phosphate and bone-specific alkaline phosphatase), mineral status (including sodium, potassium, calcium, chloride, and phosphate), blood lipid profile, and blood glucose. | Postnatal day 7 and 14 |
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