Inhaled Nitric Oxide for Preventing Chronic Lung Disease in Premature Infants

NCT ID: NCT00006401

Last Updated: 2015-10-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

793 participants

Study Classification

INTERVENTIONAL

Study Start Date

2000-09-30

Study Completion Date

2007-10-31

Brief Summary

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To determine whether or not inhaled nitric oxide (iNO) safely decreases the incidence of chronic lung disease (CLD) in premature infants.

Detailed Description

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BACKGROUND:

Despite advances in medical, nursing, and respiratory care, CLD affects up to 50 percent of premature infants. As a result, nearly 50,000 infants in the United States develop CLD. It is desirable to investigate therapies that decrease the incidence of CLD because it is associated with failure to thrive, developmental delay, increased risk of pulmonary infection, reactive airway disease, pulmonary hypertension, and death.

DESIGN NARRATIVE:

This is a randomized, double-blind, placebo-controlled, multi-center study. Three specific hypotheses will be tested: 1) iNO reduces the incidence of CLD; 2) iNO reduces serum and lung (tracheal aspirate) markers of inflammation; and 3) iNO does not increase the incidence of intraventricular hemorrhage in premature neonates. The primary endpoint is survival without CLD (defined as continued oxygen requirement) at 36 weeks post conceptional age.

A total of 793 premature newborns will be enrolled from 14 centers within 48 hours of birth. They will be randomly assigned to receive either placebo or iNO at 5 ppm until the breathing tube can be safely removed or after 21 days. The iNO will be delivered by an INOvent delivery system in such a way that physicians and nurses will not know which treatment each participant is receiving. Management strategies for aspects of patient care including mechanical ventilation, surfactant administration, fluid administration, and steroid use will be determined by physicians at each center. Serial cranial ultrasounds and methemoglobin levels will be monitored to determine adverse events. The first 200 patients will have serial blood samples and tracheal aspirates obtained for measurements of inflammatory mediators, including interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), endothelin-1, myeloperoxidase, neutrophil counts (tracheal aspirates), and endothelin-1 (blood). Participants will be seen at 12 and 24 months of age to monitor the long-term effects on the cardiopulmonary or neurologic systems. At these visits, a health questionnaire will be administered and Bayley II scales of infant development will be completed.

Conditions

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Lung Diseases Bronchopulmonary Dysplasia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Inhaled Nitric Oxide (iNO)

Nitric Oxide study gas will be initiated at 5 ppm using the INOvent delivery system. The delivery system provides for masked delivery of the treatment gas. This dose will be used for a 21-day period or until extubation.

Group Type EXPERIMENTAL

iNO

Intervention Type DRUG

Inhaled Nitric Oxide for Preventing Chronic Lung Disease in Premature Infants

Placebo

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

Inhaled Nitrogen

Interventions

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iNO

Inhaled Nitric Oxide for Preventing Chronic Lung Disease in Premature Infants

Intervention Type DRUG

Placebo

Inhaled Nitrogen

Intervention Type OTHER

Other Intervention Names

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Inhaled nitric oxide.

Eligibility Criteria

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Inclusion Criteria

* Weighing between 500 to 1250 grams at birth
* Gestational age of less than 34 weeks
* Less than 48 hours old
* Respiratory failure on mechanical ventilation
* Absence of structural heart disease (PDA, ASD less than 1 cm, or VSD less than 2 mm are permitted if known prior to study entry)
* Absence of lethal congenital anomaly

Exclusion Criteria

* Concurrent participation in another experimental study (observational studies will be allowed with prior approval by the Steering Committee and Data and Safety Monitoring Board)
* Active pulmonary hemorrhage
* Unevaluated pneumothorax
* High frequency jet ventilation
* Expected short duration of ventilation (less than 48 hours from birth)
Maximum Eligible Age

1 Year

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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John P. Kinsella, MD

Role: STUDY_CHAIR

Children's Hospital Medical Center, Cincinnati

Locations

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St. Joseph's Hospital

Phoenix, Arizona, United States

Site Status

Loma Linda University Medical Center

Loma Linda, California, United States

Site Status

Univeristy of Southern California/Good Samaritan Hospital

Los Angeles, California, United States

Site Status

Children's Hospital

Denver, Colorado, United States

Site Status

University of Connecticut Health Center

Farmington, Connecticut, United States

Site Status

University of Iowa Hospital & Clinics

Iowa City, Iowa, United States

Site Status

University of North Carolina Chapel Hill

Chapel Hill, North Carolina, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

Children's Hospital of Oklahoma

Oklahoma City, Oklahoma, United States

Site Status

Pennsylvania Hospital

Philadelphia, Pennsylvania, United States

Site Status

Magee-Women's Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status

Utah Valley Regional Medical Center

Provo, Utah, United States

Site Status

Countries

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United States

References

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Kinsella JP, Cutter GR, Walsh WF, Gerstmann DR, Bose CL, Hart C, Sekar KC, Auten RL, Bhutani VK, Gerdes JS, George TN, Southgate WM, Carriedo H, Couser RJ, Mammel MC, Hall DC, Pappagallo M, Sardesai S, Strain JD, Baier M, Abman SH. Early inhaled nitric oxide therapy in premature newborns with respiratory failure. N Engl J Med. 2006 Jul 27;355(4):354-64. doi: 10.1056/NEJMoa060442.

Reference Type RESULT
PMID: 16870914 (View on PubMed)

Mourani PM, Kinsella JP, Clermont G, Kong L, Perkins AM, Weissfeld L, Cutter G, Linde-Zwirble WT, Abman SH, Angus DC, Watson RS; Prolonged Outcomes after Nitric Oxide (PrONOx) Investigators. Intensive care unit readmission during childhood after preterm birth with respiratory failure. J Pediatr. 2014 Apr;164(4):749-755.e3. doi: 10.1016/j.jpeds.2013.11.062. Epub 2013 Dec 31.

Reference Type DERIVED
PMID: 24388320 (View on PubMed)

Watson RS, Clermont G, Kinsella JP, Kong L, Arendt RE, Cutter G, Linde-Zwirble WT, Abman SH, Angus DC; Prolonged Outcomes After Nitric Oxide Investigators. Clinical and economic effects of iNO in premature newborns with respiratory failure at 1 year. Pediatrics. 2009 Nov;124(5):1333-43. doi: 10.1542/peds.2009-0114. Epub 2009 Oct 19.

Reference Type DERIVED
PMID: 19841128 (View on PubMed)

Other Identifiers

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U01HL064857

Identifier Type: NIH

Identifier Source: secondary_id

View Link

99-233

Identifier Type: -

Identifier Source: org_study_id

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