Safe Excipient Exposure in Neonates and Small ChildreN

NCT ID: NCT02545712

Last Updated: 2017-02-07

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

UNKNOWN

Total Enrollment

630 participants

Study Classification

OBSERVATIONAL

Study Start Date

2016-01-31

Brief Summary

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The purpose of this study is to explore the quantity of excipient exposure in neonatal and young pediatric patients in a Danish Hospital. The focus will be on the preservatives ethanol, propyl glycol, benzyl alcohol, methyl-p-hydroxybenzoate and propanyl-p-hydroxybenzoate and the artificial sweeteners acesulfam potassium, aspartame, glycerol and sorbitol.

Detailed Description

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Studies have previously examined whether or not neonatal nor pediatric patients are exposed to excipients and what excipients they are possibly exposed to. They have shown that practically all neonatal patients receive one or more drug containing an excipient, known to be harmful. This observational study will look at both registered drugs and extemporaneous pharmaceuticals as possible sources of excipients. Based on information provided by the manufacturer (ex. the index-list), the investigator will calculate the amounts of excipients administered to the patient a week after hospitalisation. The investigator will calculate the blood alcohol content when the neonatal patient are exposed to ethanol and/or propylene glycol.

By grouping the patients according to age and subgrouping according to diagnosis/affected organ system and compare the amount of excipient exposure in each group, the study aims at identifying the most vulnerable neonatal and/or pediatric patients in terms of the amount and identity of excipients accumulated in the patient.

The study will use a descriptive, parametric statistic analysis to identify

* an average exposure rate (concentration i mg/l or amount in mg) of each of the listed excipients
* how much the average patient in each age-group is exposed to each excipient
* how much the average patient in each "affected organ system"-subgroup is exposed to each excipient

Conditions

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Excipient Exposure Neonatal Pediatric

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

RETROSPECTIVE

Study Groups

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Neonatal patients

Receiving 2 or more drugs at one day during their hospitalisation. For each drug, it is listed whether it is an extemporaneous, registered, the preparation, dosis, amount, interval, formulation and route of administration. It is noted if the drug contains ethanol, propylene glycol, benzyl alcohol, methyl-p-hydroxybenzoate, propanyl-p-hydroxybenzoate, acesulfam potassium, aspartame, glycerin and/or sorbitol.

Exposure to ethanol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to propylene glycol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to benzyl alcohol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to acesulfam potassium

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to aspartame

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to glycerol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to sorbitol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to methyl-p-hydroxybenzoate

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to propanyl-p-hydroxybenzoate

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to polysorbate-80

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Pediatric patients (28 days ≤ 5 years)

Receiving 3 or more drugs at one day during their hospitalisation. For each drug, it is listed whether it is an extemporaneous, registered, the preparation, dosis, amount, interval, formulation and route of administration. It is noted if the drug contains ethanol, propylene glycol, benzyl alcohol, methyl-p-hydroxybenzoate, propanyl-p-hydroxybenzoate, acesulfam potassium, aspartame, glycerin and/or sorbitol.

Exposure to ethanol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to propylene glycol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to benzyl alcohol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to acesulfam potassium

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to aspartame

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to glycerol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to sorbitol

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to methyl-p-hydroxybenzoate

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to propanyl-p-hydroxybenzoate

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Exposure to polysorbate-80

Intervention Type OTHER

The drug source(s) and amount administered daily are noted.

Interventions

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Exposure to ethanol

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to propylene glycol

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to benzyl alcohol

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to acesulfam potassium

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to aspartame

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to glycerol

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to sorbitol

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to methyl-p-hydroxybenzoate

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to propanyl-p-hydroxybenzoate

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Exposure to polysorbate-80

The drug source(s) and amount administered daily are noted.

Intervention Type OTHER

Other Intervention Names

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Ethyl achohol Acesulfame-K Glycerol including sodium-methyl-p-hydroxybenzoate including sodium-propanyl-p-hydroxybenzoate

Eligibility Criteria

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Inclusion Criteria

* if \< 28 days: must receive 2 or more prescriptions a day
* if 28 days ≤ 5 years: must receive 3 or more prescriptions a day
* must have been/be submitted and treated at the neonatal department (units 5021, 5023, 5024) or pediatric department (units 5061, 5062, 5054, 4144) of Rigshospitalet

Exclusion Criteria

* no up-dated weight is listed
* \> 5 years old
Maximum Eligible Age

5 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rigshospitalet, Denmark

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role lead

Responsible Party

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Kristine Svinning Valeur

MS

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Kristine Svinning Valeur, MS

Role: PRINCIPAL_INVESTIGATOR

University Hospital Bispebjerg and Frederiksberg

References

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Nellis G, Metsvaht T, Varendi H, Toompere K, Lass J, Mesek I, Nunn AJ, Turner MA, Lutsar I; ESNEE consortium. Potentially harmful excipients in neonatal medicines: a pan-European observational study. Arch Dis Child. 2015 Jul;100(7):694-9. doi: 10.1136/archdischild-2014-307793. Epub 2015 Apr 8.

Reference Type BACKGROUND
PMID: 25854872 (View on PubMed)

Souza A Jr, Santos D, Fonseca S, Medeiros M, Batista L, Turner M, Coelho H. Toxic excipients in medications for neonates in Brazil. Eur J Pediatr. 2014 Jul;173(7):935-45. doi: 10.1007/s00431-014-2272-z. Epub 2014 Feb 6.

Reference Type BACKGROUND
PMID: 24500397 (View on PubMed)

Marek E, Kraft WK. Ethanol pharmacokinetics in neonates and infants. Curr Ther Res Clin Exp. 2014 Oct 22;76:90-7. doi: 10.1016/j.curtheres.2014.09.002. eCollection 2014 Dec.

Reference Type BACKGROUND
PMID: 25379066 (View on PubMed)

Nguyen KA, Claris O, Kassai B. Unlicensed and off-label drug use in a neonatal unit in France. Acta Paediatr. 2011 Apr;100(4):615-7. doi: 10.1111/j.1651-2227.2010.02103.x. Epub 2010 Dec 17. No abstract available.

Reference Type BACKGROUND
PMID: 21410525 (View on PubMed)

Jacqz-Aigrain E. Drug policy in Europe Research and funding in neonates: current challenges, future perspectives, new opportunities. Early Hum Dev. 2011 Mar;87 Suppl 1:S27-30. doi: 10.1016/j.earlhumdev.2011.01.007. Epub 2011 Jan 26.

Reference Type BACKGROUND
PMID: 21269785 (View on PubMed)

Allegaert K. Neonates need tailored drug formulations. World J Clin Pediatr. 2013 Feb 8;2(1):1-5. doi: 10.5409/wjcp.v2.i1.1. eCollection 2013 Feb 8.

Reference Type BACKGROUND
PMID: 25254168 (View on PubMed)

Bellis JR, Kirkham JJ, Thiesen S, Conroy EJ, Bracken LE, Mannix HL, Bird KA, Duncan JC, Peak M, Turner MA, Smyth RL, Nunn AJ, Pirmohamed M. Adverse drug reactions and off-label and unlicensed medicines in children: a nested case-control study of inpatients in a pediatric hospital. BMC Med. 2013 Nov 7;11:238. doi: 10.1186/1741-7015-11-238.

Reference Type BACKGROUND
PMID: 24229060 (View on PubMed)

Nahata MC. Safety of "inert" additives or excipients in paediatric medicines. Arch Dis Child Fetal Neonatal Ed. 2009 Nov;94(6):F392-3. doi: 10.1136/adc.2009.160192. No abstract available.

Reference Type BACKGROUND
PMID: 19846397 (View on PubMed)

Whittaker A, Currie AE, Turner MA, Field DJ, Mulla H, Pandya HC. Toxic additives in medication for preterm infants. Arch Dis Child Fetal Neonatal Ed. 2009 Jul;94(4):F236-40. doi: 10.1136/adc.2008.146035. Epub 2009 Jan 21.

Reference Type BACKGROUND
PMID: 19158148 (View on PubMed)

Saiyed MM, Lalwani T, Rana D. Is off-label use a risk factor for adverse drug reactions in pediatric patients? A prospective study in an Indian tertiary care hospital. Int J Risk Saf Med. 2015;27(1):45-53. doi: 10.3233/JRS-150642.

Reference Type BACKGROUND
PMID: 25766066 (View on PubMed)

Collison KS, Makhoul NJ, Zaidi MZ, Al-Rabiah R, Inglis A, Andres BL, Ubungen R, Shoukri M, Al-Mohanna FA. Interactive effects of neonatal exposure to monosodium glutamate and aspartame on glucose homeostasis. Nutr Metab (Lond). 2012 Jun 14;9(1):58. doi: 10.1186/1743-7075-9-58.

Reference Type BACKGROUND
PMID: 22697049 (View on PubMed)

Ornoy A, Ergaz Z. Alcohol abuse in pregnant women: effects on the fetus and newborn, mode of action and maternal treatment. Int J Environ Res Public Health. 2010 Feb;7(2):364-79. doi: 10.3390/ijerph7020364. Epub 2010 Jan 27.

Reference Type BACKGROUND
PMID: 20616979 (View on PubMed)

Lass J, Kaar R, Jogi K, Varendi H, Metsvaht T, Lutsar I. Drug utilisation pattern and off-label use of medicines in Estonian neonatal units. Eur J Clin Pharmacol. 2011 Dec;67(12):1263-71. doi: 10.1007/s00228-011-1072-x. Epub 2011 Jun 11.

Reference Type BACKGROUND
PMID: 21667125 (View on PubMed)

Fister P, Urh S, Karner A, Krzan M, Paro-Panjan D. The prevalence and pattern of pharmaceutical and excipient exposure in a neonatal unit in Slovenia. J Matern Fetal Neonatal Med. 2015;28(17):2053-61. doi: 10.3109/14767058.2014.976549. Epub 2015 Sep 4.

Reference Type BACKGROUND
PMID: 25316561 (View on PubMed)

Valeur KS, Hertel SA, Lundstrom KE, Holst H. Safe excipient exposure in neonates and small children - protocol for the SEEN project. Dan Med J. 2017 Feb;64(2):A5324.

Reference Type DERIVED
PMID: 28157063 (View on PubMed)

Related Links

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http://adc.bmj.com/content/98/6/e1.14.short

Isaac R, Khan I, Langley C. Ethanol intake of paediatric intensive care patients. Arch Dis Child 2013;98:e1 doi:10.1136/archdischild-2013-303935a.21

Other Identifiers

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BBH-KSV-01

Identifier Type: -

Identifier Source: org_study_id

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