Prenatal Steroids for Treatment of Congenital Cystic Adenomatoid Malformations (CCAM)

NCT ID: NCT00670956

Last Updated: 2015-03-30

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

1 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-04-30

Study Completion Date

2011-09-30

Brief Summary

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Congenital cystic adenomatoid malformations (CCAMs) are theorized to be growing immature lung tissue. Administration of maternal steroids in the mid-trimester may stop the growth or decrease the size of the CCAM, thus increasing normal lung tissue and improving survival in fetuses with large CCAMs. This is a prospective, blinded, randomized trial comparing administration of a single course of antenatal steroids (Betamethasone) to control (i.e., placebo). The primary outcome variable will be incidence of hydrops. One month postnatal survival and relative size of the CCAM as determined by CCAM volume:head circumference ratio (CVR) between treatment/no treatment groups will be secondary outcome variables. Change in size of CCAM will be serially followed for both groups with individual growth curves being plotted prenatally and these will be compared with pathology weigh and volume to evaluate treatment effect. Other prenatal data collected will include: incidence of polyhydramnios, incidence of premature rupture of membranes, incidence of material complications. We will also compare mode of delivery, postnatal respiratory compromise, need for resection in the first week of life, and occurrence of complications during newborn administration

Detailed Description

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Conditions

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Congenital Cystic Adenomatoid Malformation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Active Study Group

STEROID: Betamethasone; 12 mg intramuscularly x 2 doses 24 hours apart

Group Type ACTIVE_COMPARATOR

Betamethasone

Intervention Type DRUG

12 mg intramuscularly x 2 doses 24 hours apart

Placebo Group

PLACEBO: IM x 2 doses 24 hours apart

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

PLACEBO: IM x 2 doses 24 hours apart

Interventions

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Betamethasone

12 mg intramuscularly x 2 doses 24 hours apart

Intervention Type DRUG

Placebo

PLACEBO: IM x 2 doses 24 hours apart

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* GA \< 26 weeks
* Maternal age \> 18 years of age
* Singleton pregnancy
* Normal chromosomes
* CCAM volume to head circumference ratio (CVR) \> 1.4
* No maternal medical/surgical contraindications
* No evidence of hydrops
* Not previously randomization

Exclusion Criteria

* Maternal diabetes or use of insulin
* Preterm labor
* Multiple congenital anomalies with CCAM
* Chromosomal anomaly with CCAM
* Multiple gestation pregnancy with CCAM
* Not willing to be randomized
* Unable or unwilling to return to UCSF for second dose of drug or placebo
* CVR \< 1.4
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Children's Hospital Medical Center, Cincinnati

OTHER

Sponsor Role collaborator

Children's Hospital of Philadelphia

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Timothy M Crombleholme, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Cincinnati

Douglas Wilson, MD

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Philadelphia

Hanmin Lee, MD

Role: PRINCIPAL_INVESTIGATOR

University of California, San Francisco

Locations

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University of California, San Francisco Fetal Treatment Center

San Francisco, California, United States

Site Status

Cincinnati Children's Hospital

Cincinnati, Ohio, United States

Site Status

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Vu L, Tsao K, Lee H, Nobuhara K, Farmer D, Harrison M, Goldstein RB. Characteristics of congenital cystic adenomatoid malformations associated with nonimmune hydrops and outcome. J Pediatr Surg. 2007 Aug;42(8):1351-6. doi: 10.1016/j.jpedsurg.2007.03.039.

Reference Type BACKGROUND
PMID: 17706495 (View on PubMed)

Schumacher A, Sidor J, Buhling KJ. [Continuous glucose monitoring using the glucose sensor CGMS in metabolically normal pregnant women during betamethasone therapy for fetal respiratory distress syndrome]. Z Geburtshilfe Neonatol. 2006 Oct;210(5):184-90. doi: 10.1055/s-2006-951743. German.

Reference Type BACKGROUND
PMID: 17099841 (View on PubMed)

Peltoniemi OM, Kari MA, Tammela O, Lehtonen L, Marttila R, Halmesmaki E, Jouppila P, Hallman M; Repeat Antenatal Betamethasone Study Group. Randomized trial of a single repeat dose of prenatal betamethasone treatment in imminent preterm birth. Pediatrics. 2007 Feb;119(2):290-8. doi: 10.1542/peds.2006-1549.

Reference Type BACKGROUND
PMID: 17272618 (View on PubMed)

Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004454. doi: 10.1002/14651858.CD004454.pub2.

Reference Type BACKGROUND
PMID: 16856047 (View on PubMed)

Neilson JP. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Obstet Gynecol. 2007 Jan;109(1):189-90. doi: 10.1097/01.aog.0000251610.51286.b1. No abstract available.

Reference Type BACKGROUND
PMID: 17233108 (View on PubMed)

Tsao K, Hawgood S, Vu L, Hirose S, Sydorak R, Albanese CT, Farmer DL, Harrison MR, Lee H. Resolution of hydrops fetalis in congenital cystic adenomatoid malformation after prenatal steroid therapy. J Pediatr Surg. 2003 Mar;38(3):508-10. doi: 10.1053/jpsu.2003.50089.

Reference Type BACKGROUND
PMID: 12632377 (View on PubMed)

Arca MJ, Teich S. Current controversies in perinatal care: fetal versus neonatal surgery. Clin Perinatol. 2004 Sep;31(3):629-48. doi: 10.1016/j.clp.2004.03.016.

Reference Type BACKGROUND
PMID: 15325542 (View on PubMed)

Wilson RD, Baxter JK, Johnson MP, King M, Kasperski S, Crombleholme TM, Flake AW, Hedrick HL, Howell LJ, Adzick NS. Thoracoamniotic shunts: fetal treatment of pleural effusions and congenital cystic adenomatoid malformations. Fetal Diagn Ther. 2004 Sep-Oct;19(5):413-20. doi: 10.1159/000078994.

Reference Type BACKGROUND
PMID: 15305098 (View on PubMed)

Knox EM, Kilby MD, Martin WL, Khan KS. In-utero pulmonary drainage in the management of primary hydrothorax and congenital cystic lung lesion: a systematic review. Ultrasound Obstet Gynecol. 2006 Oct;28(5):726-34. doi: 10.1002/uog.3812.

Reference Type BACKGROUND
PMID: 17001747 (View on PubMed)

Davenport M, Warne SA, Cacciaguerra S, Patel S, Greenough A, Nicolaides K. Current outcome of antenally diagnosed cystic lung disease. J Pediatr Surg. 2004 Apr;39(4):549-56. doi: 10.1016/j.jpedsurg.2003.12.021.

Reference Type BACKGROUND
PMID: 15065026 (View on PubMed)

Miller JA, Corteville JE, Langer JC. Congenital cystic adenomatoid malformation in the fetus: natural history and predictors of outcome. J Pediatr Surg. 1996 Jun;31(6):805-8. doi: 10.1016/s0022-3468(96)90138-4.

Reference Type BACKGROUND
PMID: 8783108 (View on PubMed)

Related Links

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http://www.fetalcarecenter.org/

Fetal Care Center of Cincinnati Children's Hospital

http://fetus.ucsfmedicalcenter.org/

Fetal Treatment Center at the University of California, San Francisco

Other Identifiers

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10-03705

Identifier Type: -

Identifier Source: org_study_id

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