Neonatal Encephalopathy Clinical Trial
— TIMEOfficial title:
The TIME STUDY: A Randomized Controlled Trial of Therapeutic Hypothermia for Infants With Mild Encephalopathy in California
The TIME study is a randomized, controlled trial to evaluate impact on early measures of neurodevelopment and the safety profile of therapeutic hypothermia in term neonates with Mild Hypoxic-Ischemic Encephalopathy who are < 6 hours of age. Neurodevelopmental outcome will be assessed at 12-14 months of age. The study will enroll 68 neonates randomized to therapeutic hypothermia or normothermia across 5 centers in California.
Status | Not yet recruiting |
Enrollment | 68 |
Est. completion date | January 31, 2025 |
Est. primary completion date | January 31, 2023 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A to 6 Hours |
Eligibility |
Inclusion Criteria (must meet all 3): 1. Neonates born at = 36 0/7 weeks 2. Neonatal signs or contributing factors consistent with an acute peri-partum or intra-partum event (must meet a or b): 1. pH = 7.0 or Base deficit = 16 in any umbilical cord or baby specimen at = 1 hr of age OR 2. No umbilical cord or baby blood gas at = 1 hr of age OR pH 7.01-7.15 or Base deficit 10-15.9 in any cord or baby specimen at = 1 hr of age AND at least one of the following - Apgar score at 10 min = 5 - Continued need for resuscitation at 10 min (chest compressions, bag mask ventilation, intubation with positive pressure ventilation) - Acute Perinatal Event: uterine rupture, placental abruption, cord accident (prolapse, rupture, knot or tight nuchal cord), maternal trauma, maternal hemorrhage or cardiorespiratory arrest, fetal exsanguination from either vasa previa or feto-maternal hemorrhage - Fetal heart rate monitor pattern consistent with acute peripartum or intrapartum event (category III trace: no heart rate variability, presence of recurrent late or variable decelerations, bradycardia, or sinusoidal pattern) 3. Evidence of Mild Encephalopathy on Modified Sarnat Exam. - Presence of at least 2 signs of mild, moderate or severe encephalopathy with no more than 2 moderate or severe findings in the 6 tested categories (level of consciousness, spontaneous activity, posture, tone, neonatal reflexes (suck and moro), and autonomic nervous system Exclusion Criteria: - Patients < 36 0/7 weeks birthweight < 1800gm; congenital or chromosomal anomaly associated with abnormal neurodevelopment or death; patients with moderate or severe HIE (by Sarnat exam or presence of clinical or electrographic seizures) identified within 6 hours after birth; core body temperature < 34°C for more than 1 hour prior to randomization. |
Country | Name | City | State |
---|---|---|---|
United States | Loma Linda Children's Hospital | Loma Linda | California |
United States | Benioff Children's Hospital Oakland | Oakland | California |
United States | Children's Hospital Orange County | Orange | California |
United States | Stanford University | Palo Alto | California |
United States | Rady Children's Hospital | San Diego | California |
Lead Sponsor | Collaborator |
---|---|
Stanford University | Thrasher Research Fund |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Age at Randomization | Age in hours and minutes after birth at randomization | First 24 hours of life | |
Other | Age at Initiation of Treatment | Age in hours and minutes after birth at which normothermia or therapeutic hypothermia are initiated | First 24 hours of life | |
Other | Percentage of participants with disability at 2 years of age | Most enrolled neonates will be followed in high-risk infant follow-up clinics. We will track developmental outcome at 2 years of age for all enrolled patients and determine the proportion of treated and control patients who abnormal measures of neurodevelopment | 2 years | |
Primary | Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS) | Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS) will be assessed at 12-14 months of age. The mean score for a 12 month old normally developing infant is 109 with a standard deviation of 16.5. Higher scores are associated with normal development. | Assessment takes up to 15 minutes and will be conducted at 12-14 months of age | |
Primary | Alberta Infant Motors Scale (AIMS) | Alberta Infant Motors Scale (AIMS) will be assessed at 12-14 months of age. The AIMS score is determined by assessment of 4 positions and scoring the least and most mature position identified. The score is converted to a percentile for age with those in the 5th to 25th percentile identified as suspicious motor development and those with a score corresponding to < 5th percentile being identified as abnormal motor development. | Assessment takes up to 15 minutes and will be conducted at 12-14 months of age | |
Secondary | Percentage of participants with sinus bradycardia | Investigators will determine the proportion of treated and control subjects who develop sinus bradycardia (HR < 80) during the intervention period (72 hours). | 72 hours | |
Secondary | Percentage of participants thrombocytopenia | Investigators will determine the proportion of treated and control subjects who develop thrombocytopenia (platelet count of < 150 x 109/L) during the intervention period | 72 hours | |
Secondary | Percentage of patients who require intubation and mechanical ventilation | Investigators will determine the proportion of treated and control subjects who require intubation and mechanical ventilation | 72 hours | |
Secondary | Percentage of patients with need for central line | Investigators will determine the proportion of treated and control subjects who have a central line (umbilical or PICC) | 72 hours | |
Secondary | Percentage of participants with Persistent Pulmonary Hypertension (PPHN) | Investigators will determine the proportion of treated and control subjects who have a clinical diagnosis of PPHN or who receive inhaled nitric oxide | 72 hours | |
Secondary | Percentage of participants exposed to sedating or analgesic medications | Investigators will determine the proportion of treated and control subjects who receive narcotics or benzodiazepines | 72 hours | |
Secondary | Percentage of participants exposed to inotropic agents | Investigators will determine the proportion of treated and control subjects who receive inotropic support | 76 hours | |
Secondary | Percentage of participants diagnosed with seizures | Investigators will determine the proportion of treated and control subjects who develop clinical and or electrographic seizures | During initial hospital stay up to 30 days | |
Secondary | Age at initiation of feeds | Investigators will determine the age at which enteral feeds are initiated in treated and control patients | During initial hospital stay up to 30 days from date of admission | |
Secondary | Age at full enteral feeds | Investigators will determine the age at which full enteral feeds or breastfeeding ad lib is achieved in treated and control patients | During initial hospital stay and up to 30 days from date of admission | |
Secondary | Percentage of participants who require feeding assistance at discharge | Investigators will determine the proportion of treated and control patients who require feeding support at discharge (NG tube or G-Tube feeds) | At time of discharge from hospital, up to 30 days from admission | |
Secondary | Percentage of participants with fat necrosis and hypercalcemia | Investigators will determine the proportion of treated and control patients who have a diagnosis of fat necrosis and hypercalcemia | From study entry to day of hospital discharge, up to 30 days from admission | |
Secondary | Percentage of participants discharged on anti-convulsant medications | Investigators will determine the proportion of treated and control patients who are discharged home on anti-convulsant medications | At time of discharge from hospital, up to 30 days from admission | |
Secondary | Count of participants with brain injury on MRI | Investigators will determine the number of treated and control patients who have brain injury on MRI | At time of discharge from hospital, up to 30 days from admission | |
Secondary | Length of Hospital Stay | Investigators will determine the length of hospital stay for treated and control patients | At time of discharge from hospital, up to 30 days from admission | |
Secondary | Percentage of participants breastfeeding at discharge | Investigators will determine the proportion of treated and control patients who are breastfeeding at discharge | At time of discharge from hospital, up to 30 days from admission | |
Secondary | Percentage of participants with death and/or hospice at discharge | Investigators will determine the proportion of treated and control patients who die or are discharged home on hospice | At time of discharge from hospital, up to 30 days from admission |
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