Enteral Fish Oil is Superior to Ursodeoxycholic Acid (UDCA) and Placebo for the Treatment of Cholestasis in Infants

NCT ID: NCT02420496

Last Updated: 2016-06-21

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

WITHDRAWN

Clinical Phase

PHASE2

Study Classification

INTERVENTIONAL

Study Start Date

2016-06-30

Study Completion Date

2016-06-30

Brief Summary

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To investigate the effect of enteral fish oil and UDCA on the time of cholestasis resolution and other markers of parenteral nutrition-associated liver disease.

Detailed Description

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Conditions

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Cholestasis Liver Disease

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Enteral fish oil

Infants will receive enteral fish oil at a dose of 1mg/kg/day divided in two daily doses given enterally.

Group Type EXPERIMENTAL

Enteral fish oil

Intervention Type DRUG

UDCA (ursodeoxycholic acid)

Infants will receive UDCA at a dose of 10mg/kg/dose in two daily doses given enterally

Group Type ACTIVE_COMPARATOR

Ursodeoxycholic Acid

Intervention Type DRUG

Placebo

Infant will receive placebo in two daily doses given enterally

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Interventions

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Enteral fish oil

Intervention Type DRUG

Ursodeoxycholic Acid

Intervention Type DRUG

Placebo

Intervention Type DRUG

Other Intervention Names

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Nordic Natural Omega 3 Actigall Sterile Water

Eligibility Criteria

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Inclusion Criteria

Neonates admitted to the Neonatal Intensive Care Unit (NICU) at University Hospital (UH) in San Antonio, Texas, who:

1. Are \>14 days old and \<24 months of age
2. Have a serum direct bilirubin of ≥2 mg/dL
3. Are receiving \<3 g/k/day of Intralipid via TPN
4. Are expected to remain hospitalized for at least an additional 21 days

Exclusion Criteria

1. Have a congenitally lethal condition (e.g. Trisomy 13)
2. Have clinically severe bleeding not able to be managed with routine measures
3. Have evidence of a viral hepatitis or primary liver disease as the etiology of their cholestasis
4. Have other health problems such that survival is extremely unlikely even if cholestasis improves
5. Known allergy to eggs or fish products
6. Receiving IV Fish oil
7. Phenobarbital therapy at enrollment
Minimum Eligible Age

14 Days

Maximum Eligible Age

24 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The University of Texas Health Science Center at San Antonio

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Cynthia Blanco, M.D.

Role: PRINCIPAL_INVESTIGATOR

University of Texas

Locations

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University Hospital

San Antonio, Texas, United States

Site Status

Countries

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United States

References

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Kelly DA. Liver complications of pediatric parenteral nutrition--epidemiology. Nutrition. 1998 Jan;14(1):153-7. doi: 10.1016/s0899-9007(97)00232-3.

Reference Type BACKGROUND
PMID: 9437702 (View on PubMed)

Christensen RD, Henry E, Wiedmeier SE, Burnett J, Lambert DK. Identifying patients, on the first day of life, at high-risk of developing parenteral nutrition-associated liver disease. J Perinatol. 2007 May;27(5):284-90. doi: 10.1038/sj.jp.7211686. Epub 2007 Mar 8.

Reference Type BACKGROUND
PMID: 17344923 (View on PubMed)

Nathan JD, Rudolph JA, Kocoshis SA, Alonso MH, Ryckman FC, Tiao GM. Isolated liver and multivisceral transplantation for total parenteral nutrition-related end-stage liver disease. J Pediatr Surg. 2007 Jan;42(1):143-7. doi: 10.1016/j.jpedsurg.2006.09.049.

Reference Type BACKGROUND
PMID: 17208555 (View on PubMed)

Colomb V, Jobert-Giraud A, Lacaille F, Goulet O, Fournet JC, Ricour C. Role of lipid emulsions in cholestasis associated with long-term parenteral nutrition in children. JPEN J Parenter Enteral Nutr. 2000 Nov-Dec;24(6):345-50. doi: 10.1177/0148607100024006345.

Reference Type BACKGROUND
PMID: 11071594 (View on PubMed)

Javid PJ, Greene AK, Garza J, Gura K, Alwayn IP, Voss S, Nose V, Satchi-Fainaro R, Zausche B, Mulkern RV, Jaksic T, Bistrian B, Folkman J, Puder M. The route of lipid administration affects parenteral nutrition-induced hepatic steatosis in a mouse model. J Pediatr Surg. 2005 Sep;40(9):1446-53. doi: 10.1016/j.jpedsurg.2005.05.045.

Reference Type BACKGROUND
PMID: 16150347 (View on PubMed)

Calder PC. Use of fish oil in parenteral nutrition: Rationale and reality. Proc Nutr Soc. 2006 Aug;65(3):264-77. doi: 10.1079/pns2006500.

Reference Type BACKGROUND
PMID: 16923311 (View on PubMed)

Clayton PT, Whitfield P, Iyer K. The role of phytosterols in the pathogenesis of liver complications of pediatric parenteral nutrition. Nutrition. 1998 Jan;14(1):158-64. doi: 10.1016/s0899-9007(97)00233-5.

Reference Type BACKGROUND
PMID: 9437703 (View on PubMed)

Alwayn IP, Andersson C, Zauscher B, Gura K, Nose V, Puder M. Omega-3 fatty acids improve hepatic steatosis in a murine model: potential implications for the marginal steatotic liver donor. Transplantation. 2005 Mar 15;79(5):606-8. doi: 10.1097/01.tp.0000150023.86487.44.

Reference Type BACKGROUND
PMID: 15753852 (View on PubMed)

Gura KM, Lee S, Valim C, Zhou J, Kim S, Modi BP, Arsenault DA, Strijbosch RA, Lopes S, Duggan C, Puder M. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics. 2008 Mar;121(3):e678-86. doi: 10.1542/peds.2007-2248.

Reference Type BACKGROUND
PMID: 18310188 (View on PubMed)

Premkumar MH, Carter BA, Hawthorne KM, King K, Abrams SA. Fish oil-based lipid emulsions in the treatment of parenteral nutrition-associated liver disease: an ongoing positive experience. Adv Nutr. 2014 Jan 1;5(1):65-70. doi: 10.3945/an.113.004671.

Reference Type BACKGROUND
PMID: 24425724 (View on PubMed)

Chen CY, Tsao PN, Chen HL, Chou HC, Hsieh WS, Chang MH. Ursodeoxycholic acid (UDCA) therapy in very-low-birth-weight infants with parenteral nutrition-associated cholestasis. J Pediatr. 2004 Sep;145(3):317-21. doi: 10.1016/j.jpeds.2004.05.038.

Reference Type BACKGROUND
PMID: 15343182 (View on PubMed)

Thibault M, McMahon J, Faubert G, Charbonneau J, Malo J, Ferreira E, Mohamed I. Parenteral nutrition-associated liver disease: a retrospective study of ursodeoxycholic Acid use in neonates. J Pediatr Pharmacol Ther. 2014 Jan;19(1):42-8. doi: 10.5863/1551-6776-19.1.42.

Reference Type BACKGROUND
PMID: 24782691 (View on PubMed)

Tillman EM, Crill CM, Black DD, Hak EB, Lazar LF, Christensen ML, Huang EY, Helms RA. Enteral fish oil for treatment of parenteral nutrition-associated liver disease in six infants with short-bowel syndrome. Pharmacotherapy. 2011 May;31(5):503-9. doi: 10.1592/phco.31.5.503.

Reference Type BACKGROUND
PMID: 21923431 (View on PubMed)

Yang Q, Ayers K, Welch CD, O'Shea TM. Randomized controlled trial of early enteral fat supplement and fish oil to promote intestinal adaptation in premature infants with an enterostomy. J Pediatr. 2014 Aug;165(2):274-279.e1. doi: 10.1016/j.jpeds.2014.02.002. Epub 2014 Mar 12.

Reference Type BACKGROUND
PMID: 24630347 (View on PubMed)

Other Identifiers

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HSC20150165H

Identifier Type: -

Identifier Source: org_study_id

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