Very Low Birth Weight Infant Clinical Trial
— CordmilkingOfficial title:
Neurodevelopmental Outcomes of Cord Milking in Preterm Infants: Randomized Controlled Trial
NCT number | NCT02987764 |
Other study ID # | 15-001134 |
Secondary ID | |
Status | Terminated |
Phase | N/A |
First received | |
Last updated | |
Start date | May 2016 |
Est. completion date | May 15, 2018 |
Verified date | October 2018 |
Source | University of California, Los Angeles |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Premature birth is a major risk factor for perinatal brain damage and cerebral palsy (CP)
with 47% of all CP cases occurring in infants with birth weight less than 2500 g. CP has
life-long neurological consequences that affect quality of life for the patient. In the last
2 decades, improvements in neonatal intensive care have improved survival of VLBW infants
significantly. This increased survival of VLBW infants poses new challenges towards
developing novel treatments and interventions to decrease neurodevelopmental impairment and
CP. While it is common for extremely preterm infant to survive at 23 weeks of gestation, the
neurologic consequences range from learning difficulties and cognitive defects to severe
disability and cerebral palsy. Currently prenatal neuroprotective agents such as
corticosteroids are utilized whenever a preterm birth is anticipated. However, there are no
proven postnatal interventions to prevent brain damage and cerebral palsy in VLBW infants.
Many recent studies show that delaying umbilical cord clamping (DCC) may improve hemodynamic
stability and decrease intraventricular hemorrhage (IVH) in preterm infants. A decrease in
incidence of IVH has a conceivable prospective benefit of decreasing brain injury and
improving long-term outcomes. Based on these findings, the American College of Obstetricians
and Gynecologist and American Academy of Pediatrics endorse that DCC may benefit the preterm
infants. However, these recommendations have not been adopted by most obstetricians in USA.
The main concern regarding the practice of DCC is the care delay in initiating resuscitation
and providing the needed care to this vulnerable population.
Therefore, as an alternative to DCC, method of cord milking (CM) has been developed to
provide cord blood transfusion to premature infants. CM offers a more practical alternative
to delayed cord clamping that may provide the same benefits without the need to delay
resuscitation. However, there are very few studies of CM in VLBW infants and there is no
evidence demonstrating long-term neurological outcomes and CP after CM.
The investigators hypothesize that cord milking in VLBW infants will result in improving
cerebral oxygenation, function and result in improved long-term neurodevelopmental outcomes
at 2 years of post-menstrual age. Premature infants born at less than or equal to 32 weeks
gestation age will receive cord milking after cutting versus standard care of immediate cord
clamping.
Status | Terminated |
Enrollment | 5 |
Est. completion date | May 15, 2018 |
Est. primary completion date | May 15, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | N/A to 32 Weeks |
Eligibility |
Inclusion Criteria: - 1. Expected delivery at <32 week GA. Exclusion Criteria: - 1. Prenatal diagnosis of chromosomal or severe congenital malformations such as cyanotic congenital heart disease 2. Cord accidents such as ruptured Vasa Previa results in fetal blood loss, need for urgent delivery, placental abruption and cord prolapse 3. considered non-viable by attending neonatologist or obstetrician 4. Consent not granted |
Country | Name | City | State |
---|---|---|---|
United States | Mattel Children's Hospital UCLA | Los Angeles | California |
Lead Sponsor | Collaborator |
---|---|
University of California, Los Angeles |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Measure Cerebral oxygenation and function | First 24 hours of life | ||
Secondary | Apgar Scores | Basic score to measure the newborn status. From 0 to 10. | 1 and 5 minutes | |
Secondary | Neurological injury assessment | Head ultrasound on day #3-5 | Days 3-5 and at 36 weeks postmenstrual age | |
Secondary | Neurological injury assessment | MRI at 36 wk CGA | weeks postmenstrual age | |
Secondary | Hematological assessment | Hematocrit of admission | First 72 hours of life | |
Secondary | Gastrointestinal protection | Necrotizing enterocolitis till 36 wk PMA | 36 weeks postmenstrual age | |
Secondary | Measure Neurodevelopmental impairment | Outcome assessments will be conducted by physicians or nurse practitioners or occupation therapist specializing in neonatal follow-up examination using Bayley Scales of Infant Development III | 18-24 months postmenstrual age |
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