VentFirst: A Multicenter RCT of Assisted Ventilation During Delayed Cord Clamping for Extremely Preterm Infants

NCT ID: NCT02742454

Last Updated: 2023-10-30

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

Clinical Phase

NA

Total Enrollment

570 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-06-30

Study Completion Date

2023-12-31

Brief Summary

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The purpose of this study is to determine whether providing ventilatory assistance prior to umbilical cord clamping influences the occurrence of intraventricular hemorrhage (IVH) in extremely preterm (EPT) infants, compared to standard care of providing ventilatory assistance after cord clamping.

Detailed Description

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Newborns with gestational age 23 wks 0 days through 28 wks 6 days are randomized to control (delayed cord clamping for at least 30 seconds, or up to 60 seconds if breathing spontaneously, with ventilatory assistance provided after) or the VentFirst intervention (ventilatory assistance with continuous positive airway pressure or positive pressure ventilation given starting 30 seconds after birth and cord clamping at 120 seconds).

The primary outcome is lack of IVH on 7-10 day head ultrasound or death before day 7.

The study was designed to test the impact of the intervention in each of two cohorts:

1. Infants not breathing well 30 seconds after birth
2. Infants breathing well 30 seconds after birth

Randomization and analysis is stratified by gestational age category:

1. 23 0/6 to 25 6/7 weeks' gestation
2. 26 0/7 to 28 6/7 weeks' gestation

Conditions

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Intraventricular Hemorrhage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors
Board-certified radiologists interpreting head ultrasound findings are blinded to study arm. Consensus on maximum grade of IVH between two radiologists (some combination of site radiologist and one of three external readers blinded to each others' interpretation) is required.

Study Groups

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Standard 30-60 Seconds Cord Clamping

Standard treatment for extremely preterm infants which is delayed cord clamping 30-60 seconds after birth, and assisted ventilation after cord clamping.

Group Type ACTIVE_COMPARATOR

Standard 30-60 Seconds Cord Clamping

Intervention Type PROCEDURE

The infant is stimulated to breathe after birth. If the infant is not breathing well, the cord is clamped at 30 seconds. If the baby is breathing well, the cord is clamped at 60 seconds. Ventilatory assistance is given after cord clamping.

VentFirst 120 Seconds Cord Clamping

Assisted ventilation (face mask continuous positive airway pressure, CPAP, or positive pressure ventilation, PPV) is provided prior to cord clamping at 120 seconds.

Group Type EXPERIMENTAL

VentFirst 120 Seconds Cord Clamping

Intervention Type PROCEDURE

The infant is stimulated to breathe after birth. If the infant is not breathing well, PPV by face mask is given starting at 30 seconds. If the baby is breathing well, CPAP is given starting at 30 seconds. The cord is clamped at 120 seconds.

Interventions

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Standard 30-60 Seconds Cord Clamping

The infant is stimulated to breathe after birth. If the infant is not breathing well, the cord is clamped at 30 seconds. If the baby is breathing well, the cord is clamped at 60 seconds. Ventilatory assistance is given after cord clamping.

Intervention Type PROCEDURE

VentFirst 120 Seconds Cord Clamping

The infant is stimulated to breathe after birth. If the infant is not breathing well, PPV by face mask is given starting at 30 seconds. If the baby is breathing well, CPAP is given starting at 30 seconds. The cord is clamped at 120 seconds.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* 23 0/7 - 28 6/7 weeks' gestation at delivery

Exclusion Criteria

* Life-threatening condition of fetus (e.g. severe hydrops, lethal chromosomal abnormality, severe congenital malformation)
* Suspected severe fetal anemia
* Monochorionic or monoamniotic twins
* Multiple gestation greater than twins
* Decision made for comfort care only
* Medical emergency necessitating emergency delivery (e.g. complete placental abruption)
* Obstetrician or Neonatology concern for inappropriateness of the study intervention based on maternal or fetal factors.
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Brigham and Women's Hospital

OTHER

Sponsor Role collaborator

Mayo Clinic

OTHER

Sponsor Role collaborator

St. Louis University

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role collaborator

Oregon Health and Science University

OTHER

Sponsor Role collaborator

University of Calgary

OTHER

Sponsor Role collaborator

Columbia University

OTHER

Sponsor Role collaborator

Indiana University

OTHER

Sponsor Role collaborator

University of California, Davis

OTHER

Sponsor Role collaborator

University of Alberta

OTHER

Sponsor Role collaborator

University of Alabama at Birmingham

OTHER

Sponsor Role collaborator

University of Virginia

OTHER

Sponsor Role lead

Responsible Party

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Karen Fairchild, MD

Professor of Pediatrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Karen Fairchild, MD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia

Locations

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University of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status

University of California, Davis

Sacramento, California, United States

Site Status

University of Colorado

Denver, Colorado, United States

Site Status

University of Indiana

Indianapolis, Indiana, United States

Site Status

Brigham & Women's Hospital

Boston, Massachusetts, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

St. Louis University

St Louis, Missouri, United States

Site Status

Columbia University Medical Center

New York, New York, United States

Site Status

Oregon Health & Science University

Portland, Oregon, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

University of Calgary

Calgary, Alberta, Canada

Site Status

University of Alberta, Edmonton

Edmonton, Alberta, Canada

Site Status

Countries

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United States Canada

References

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Fairchild KD, Petroni GR, Varhegyi NE, Strand ML, Josephsen JB, Niermeyer S, Barry JS, Warren JB, Rincon M, Fang JL, Thomas SP, Travers CP, Kane AF, Carlo WA, Byrne BJ, Underwood MA, Poulain FR, Law BH, Gorman TE, Leone TA, Bulas DI, Epelman M, Kline-Fath BM, Chisholm CA, Kattwinkel J; VentFirst Consortium. Ventilatory Assistance Before Umbilical Cord Clamping in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Netw Open. 2024 May 1;7(5):e2411140. doi: 10.1001/jamanetworkopen.2024.11140.

Reference Type DERIVED
PMID: 38758557 (View on PubMed)

Other Identifiers

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18783

Identifier Type: -

Identifier Source: org_study_id

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