Oxygen Toxicity in the Resuscitation in Extremely Premature Infants

NCT ID: NCT00494702

Last Updated: 2008-10-15

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

88 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-04-30

Study Completion Date

2008-09-30

Brief Summary

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The investigators hypothesize that using low oxygen concentrations during resuscitation of extremely premature infants will avoid oxidative stress derived damage and improve outcome.

Detailed Description

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This is a prospective randomized trial enrolling premature infants of less than 28 weeks gestation. Patients are randomly assigned to become resuscitation with an initial oxygen inspiratory fraction (FiO2) of 30% or 90%. Main objective is to reach a target saturation of 85% at 15 min of life.

Immediately after birth pre-and-postductal pulse oximeters are set and oxygen saturation (SpO2) continuously monitored and registered as long as the patient requires oxygen supplementation. FiO2 is stepwise adjusted (increased or decreased 10%) every 90 sec according to heart rate, SpO2 and responsiveness.

Blood samples are drawn from umbilical cord and at day 1, 2 and 7 from peripheral vein to determine oxidative stress markers (GSH, GSSG), angiogenic factors (VEGF, VEGF receptors, Angiopoietin), pro-inflammatory markers (IL8, TNF alfa) and pro-apoptotic markers (Fas Ligand; Cytochrome C).

Urine is collected every day during the first week of life to determine oxidative stress markers (8-oxo-dG; O-tyrosine; F2 isoprostanes; Isofurans).

Babies are followed in the NICU and clinical condition recorded. Serial examinations for ROP and Auditory evoked potentials will be performed. Neurodevelopmental outcome is evaluated at 2 years of postnatal life. Main outcome: Achievement of a target saturation of 85% at 15 min of life. Secondary outcomes: acute complications during delivery; chronic complications (BPD, ROP, IPVH); mortality in the neonatal period.

Conditions

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Birth Asphyxia Premature Birth

Keywords

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Asphyxia Resuscitation Oxidative stress Prematurity Follow up

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators

Study Groups

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LOX

Low saturation group of premature infants that will be kept within preset limits of 85-89%

Group Type EXPERIMENTAL

Resuscitation

Intervention Type PROCEDURE

Use of inspiratory fraction of oxygen needed to achieve oxygen saturation in the preset limits 85-88%

HOX

HOX group of premature infants will be kept within preset saturation limits of 90-93%

Group Type ACTIVE_COMPARATOR

Resuscitation

Intervention Type PROCEDURE

Oxygen inspiratory fraction needed to keep oxygen saturation in the preset limits of 90-93%

Interventions

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Resuscitation

Use of inspiratory fraction of oxygen needed to achieve oxygen saturation in the preset limits 85-88%

Intervention Type PROCEDURE

Resuscitation

Oxygen inspiratory fraction needed to keep oxygen saturation in the preset limits of 90-93%

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Prematurity of less than 28 weeks gestation

Exclusion Criteria

* Severe malformations
* Chromosomopathies
* Informed consent not signed
Minimum Eligible Age

1 Minute

Maximum Eligible Age

3 Minutes

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Fundacion Para La Investigacion Hospital La Fe

OTHER

Sponsor Role lead

Responsible Party

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MAXIMO VENTO

Principal Investigators

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Maximo Vento, Phd, Md

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario La Fe

Locations

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Servicio de Neonatologia

Valencia, Valencia, Spain

Site Status

Countries

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Spain

References

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Vento M, Asensi M, Sastre J, Garcia-Sala F, Pallardo FV, Vina J. Resuscitation with room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated term neonates. Pediatrics. 2001 Apr;107(4):642-7. doi: 10.1542/peds.107.4.642.

Reference Type BACKGROUND
PMID: 11335737 (View on PubMed)

Vento M, Asensi M, Sastre J, Lloret A, Garcia-Sala F, Minana JB, Vina J. Hyperoxemia caused by resuscitation with pure oxygen may alter intracellular redox status by increasing oxidized glutathione in asphyxiated newly born infants. Semin Perinatol. 2002 Dec;26(6):406-10. doi: 10.1053/sper.2002.37312.

Reference Type BACKGROUND
PMID: 12537311 (View on PubMed)

Vento M, Asensi M, Sastre J, Lloret A, Garcia-Sala F, Vina J. Oxidative stress in asphyxiated term infants resuscitated with 100% oxygen. J Pediatr. 2003 Mar;142(3):240-6. doi: 10.1067/mpd.2003.91.

Reference Type BACKGROUND
PMID: 12640369 (View on PubMed)

Saugstad OD, Ramji S, Irani SF, El-Meneza S, Hernandez EA, Vento M, Talvik T, Solberg R, Rootwelt T, Aalen OO. Resuscitation of newborn infants with 21% or 100% oxygen: follow-up at 18 to 24 months. Pediatrics. 2003 Aug;112(2):296-300. doi: 10.1542/peds.112.2.296.

Reference Type BACKGROUND
PMID: 12897277 (View on PubMed)

Saugstad OD, Ramji S, Vento M. Resuscitation of depressed newborn infants with ambient air or pure oxygen: a meta-analysis. Biol Neonate. 2005;87(1):27-34. doi: 10.1159/000080950. Epub 2004 Sep 20.

Reference Type BACKGROUND
PMID: 15452400 (View on PubMed)

Vento M, Sastre J, Asensi MA, Vina J. Room-air resuscitation causes less damage to heart and kidney than 100% oxygen. Am J Respir Crit Care Med. 2005 Dec 1;172(11):1393-8. doi: 10.1164/rccm.200412-1740OC. Epub 2005 Sep 1.

Reference Type BACKGROUND
PMID: 16141440 (View on PubMed)

Saugstad OD, Ramji S, Vento M. Oxygen for newborn resuscitation: how much is enough? Pediatrics. 2006 Aug;118(2):789-92. doi: 10.1542/peds.2006-0832. No abstract available.

Reference Type BACKGROUND
PMID: 16882835 (View on PubMed)

Bookatz GB, Mayer CA, Wilson CG, Vento M, Gelfand SL, Haxhiu MA, Martin RJ. Effect of supplemental oxygen on reinitiation of breathing after neonatal resuscitation in rat pups. Pediatr Res. 2007 Jun;61(6):698-702. doi: 10.1203/pdr.0b013e3180534171.

Reference Type BACKGROUND
PMID: 17426659 (View on PubMed)

Escrig R, Arruza L, Izquierdo I, Villar G, Saenz P, Gimeno A, Moro M, Vento M. Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: a prospective, randomized trial. Pediatrics. 2008 May;121(5):875-81. doi: 10.1542/peds.2007-1984.

Reference Type DERIVED
PMID: 18450889 (View on PubMed)

Other Identifiers

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FISPI05105

Identifier Type: -

Identifier Source: secondary_id

PIO51O5

Identifier Type: -

Identifier Source: org_study_id