OMT to Improve Feeding After Hypothermia

Neonatal Encephalopathy Clinical Trial

Official title:

Pilot Study Assessing the Effect of Osteopathic Manipulative Treatment (OMT) on Length of Stay in Infants With Neonatal Encephalopathy After Therapeutic Hypothermia

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03380013
• Other study ID #: IRB 1134889-1
• Status: Completed
• Phase: N/A
• Start date: October 24, 2017
• Est. completion date: April 30, 2019

Study information

• Verified date: May 2019
• Source: Maine Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this study is to determine if infants with neonatal encephalopathy will achieve full oral feeds faster after therapeutic hypothermia has completed if they are treated with osteopathic manipulative treatment. The treated infants will be compared to matched historical controls.

Description:

Infants affected by neonatal encephalopathy (NE) have been shown to have better survival rates and improved long term neurodevelopment following treatment with therapeutic hypothermia. However, a barrier to hospital discharge for these infants is a successful transition from gavage to either breast or bottle feeding.

Often, the factor delaying hospital discharge is slow transition to full oral feeds. Osteopathic manipulative treatment (OMT) helps to effectively stabilize and regulate the autonomic nervous system as well as the cranial nerves important in the sucking and latching reflexes, which may in turn help to ease the transition to full oral feeding. We hypothesize that infants who receive OMT will accelerate the transition to full oral feeds, thus decreasing their overall length of hospitalization compared to historical matched controls.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. completion date: April 30, 2019
• Est. primary completion date: April 30, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 37 Weeks and older

Eligibility

Inclusion Criteria:

• Neonate > 37 weeks gestational age at birth

• Neonate been diagnosed with neonatal encephalopathy or hypoxic ischemic encephalopathy and treated with therapeutic hypothermia

• Neonate with mild to moderate encephalopathy

• EEG without seizure activity

• Brain MRI without basal ganglia injury

Exclusion Criteria:

• Neonate < 37 weeks gestational age at birth

• Neonate with severe encephalopathy (as defined by Sarnat)

• EEG demonstrated seizure activity or evidence of status epilepticus during therapeutic hypothermia treatment

• Brain MRI demonstrating moderate or severe basal ganglia injury

• Neonate affected by neonatal abstinence syndrome (NAS)

• Neonate affected by intrauterine growth restriction (IUGR)

• Neonate born with major congenital anomalies (i.e., cleft palate)

• Prenatal history of maternal insulin dependent gestational or type 1 diabetes

• Moribund status (i.e., infants unlikely to benefit from or are not responsive to aggressive life support)

Related Conditions & MeSH terms

• Brain Diseases
• Feeding; Difficult, Newborn
• Hypothermia
• Neonatal Encephalopathy

Intervention

Procedure:
• Osteopathic Manipulative Treatment (OMT)
Each neonate will have a structural exam completed assessing each body region (head, cervical, thoracic, lumbar, sacral, pelvic, rib cage, and abdominal regions) for underlying somatic dysfunctions prior to each treatment. The specific OMT techniques used will be left to the discretion of the treating physician and will not be based on a predetermined protocol. Treatment techniques will consist of myofascial release, balanced ligamentous tension, balanced membranous tension, and osteopathy in the cranial field. Total treatment time will be 15 minutes. The features of the osteopathic structural exam which will be recorded on paper by the treating physician at the time of the evaluation. The paper will be marked only with the research identifier.

Locations

Country	Name	City	State
United States	Maine Medical Center	Portland	Maine

Sponsors (1)

Lead Sponsor	Collaborator
Maine Medical Center

Country where clinical trial is conducted

United States, 

References & Publications (5)

Cerritelli F, Pizzolorusso G, Ciardelli F, La Mola E, Cozzolino V, Renzetti C, D'Incecco C, Fusilli P, Sabatino G, Barlafante G. Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial. BMC Pediatr. 2013 Apr 26;13:65. doi: 10.1186/1471-2431-13-65. — View Citation

Frymann V. Relation of disturbances of craniosacral mechanisms to symptomatology of the newborn: study of 1,250 infants. J Am Osteopath Assoc. 1966 Jun;65(10):1059-75. — View Citation

Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. Osteopath Med Prim Care. 2008 Jun 5;2:7. doi: 10.1186/1750-4732-2-7. — View Citation

Inder TE. Pediatrics: predicting outcomes after perinatal brain injury. Nat Rev Neurol. 2011 Sep 13;7(10):544-5. doi: 10.1038/nrneurol.2011.142. — View Citation

Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG. Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev. 2013 Jan 31;(1):CD003311. doi: 10.1002/14651858.CD003311.pub3. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Total hospital length of stay	Assess the effect of OMT on total hospital length of stay. We will compare infants treated with OMT 1:3 with matched historical controls.	4-6 weeks
Secondary	Number of days until full oral feeding is achieved	Assess the effect of OMT on the number of days until full oral feeding is achieved.	4-6 weeks
Secondary	Patterns of somatic dysfunction	We will perform an osteopathic structural exam before and after treatment while recording the specific somatic dysfunctions observed within the medical record. We will then use these notes to perform a qualitative analysis of patterns of somatic dysfunction specific to the craniosacral mechanism before and after OMT.	4-6 weeks