Imaging Modalities in Diagnosing Necrotizing Enterocolitis in Preterm Infants.

NCT ID: NCT03188380

Last Updated: 2020-05-14

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

200 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-01-01

Study Completion Date

2022-12-31

Brief Summary

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Background Necrotizing enterocolitis (NEC) is one of the most serious conditions in newborns, affecting up to 10% of very low birth weight infants (VLBW). In the most premature population mortality rates can rise as high as 60%.

Typical findings on abdominal radiography (AR) include pnuematosis intestinalis (PI), portal vein gas (PVG) and pneumoperitoneum, but are sometimes not present even in severe cases. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases a head of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in expediting diagnosis and management of NEC.

Methods and analysis The hypothesis being tested is that preforming an AUR in patients with clinical symptoms of NEC but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at \<32 weeks.

Discussion The use of AUS together with AR as an add-on test may increase the accuracy of diagnosing NEC, and precipitate treatment. Swift implementation of antibiotics and bowel rest is extremely important. To our best knowledge, our study will be the first to focus only on VLBW, who are most prone to NEC. It will also be the first multi-centre study evaluating the use of AUS as an add-on test, enabling us to recruit a significantly higher number of patients compared to published studies.

Detailed Description

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Conditions

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Necrotising Enterocolitis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Plain abdominal radiograph (AR)

After meeting enrolment criteria each patient will have an AR performed. One image will be obtained with a vertical beam and a horizontal beam, with the patient supine.

Plain abdominal radiography

Intervention Type DIAGNOSTIC_TEST

After meeting enrolment criteria each patient will have an AR performed. One image will be obtained with a vertical beam and a horizontal beam, with the patient supine.

Abdominal ultrasound

Intervention Type DIAGNOSTIC_TEST

If the AR is inconclusive or no abnormalities typical for NEC are recorded, an AUS will be ordered.

Abdominal ultrasound (AUS)

If plain abdominal radiography is inconclusive or no abnormalities typical for NEC are recorded, an AUS will be ordered.

Plain abdominal radiography

Intervention Type DIAGNOSTIC_TEST

After meeting enrolment criteria each patient will have an AR performed. One image will be obtained with a vertical beam and a horizontal beam, with the patient supine.

Abdominal ultrasound

Intervention Type DIAGNOSTIC_TEST

If the AR is inconclusive or no abnormalities typical for NEC are recorded, an AUS will be ordered.

Interventions

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Plain abdominal radiography

After meeting enrolment criteria each patient will have an AR performed. One image will be obtained with a vertical beam and a horizontal beam, with the patient supine.

Intervention Type DIAGNOSTIC_TEST

Abdominal ultrasound

If the AR is inconclusive or no abnormalities typical for NEC are recorded, an AUS will be ordered.

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* Abdominal distension
* Visible bowels loops
* Feeding intolerance (defined as emesis ≥ 2 consecutive feeds, or gastric residuals of \>50% per feed in ≥ 2 consecutive feeds, bilious residuals, bilious emesis)
* Temperature instability (defined as ≥ 2 consecutive measurements)
* Frank bloody stools
* Cardiovascular instability (hypotension; defined as MAP \< 30mmHg, tachycardia \>160/' or bradycardia \< 80/')
* Recurrent apnea
* Increase of abdominal girth \> 2cm (allowing inter-observer variability of 1 cm) within 12 h
* Abdominal wall erythemia

And/or at least 2 of the below laboratory findings5:

* Thrombocytopenia \< 50 x103/uL
* Leukopenia \<6 x106/uL
* CRP \> 10 mg/L
* PCT \> 1 ng/ml
* Coagulopathy

Exclusion Criteria

* • \< 22 weeks of gestational age or \> 32 weeks (estimated by ultrasound)

* Congenital abnormalities
* No parental consent
Minimum Eligible Age

22 Weeks

Maximum Eligible Age

32 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jagiellonian University

OTHER

Sponsor Role collaborator

Ujastek Obstetrics and Gynaecology Hospital

UNKNOWN

Sponsor Role collaborator

University Children's Hospital of Cracow

UNKNOWN

Sponsor Role collaborator

Princess Anna Mazowiecka Hospital, Warsaw, Poland

OTHER

Sponsor Role lead

Responsible Party

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Renata Bokiniec

Renata Bokiniec MD PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Department of Neonatology and Neonatal Intensive Care Warsaw Medical University

Warsaw, , Poland

Site Status

Countries

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Poland

Central Contacts

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Joanna Seliga-Siwecka, MD PhD

Role: CONTACT

+48225966155

Facility Contacts

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Joanna Seliga-Siwecka, MD PhD

Role: primary

+48225966155

Joanna Seliga-Siwecka

Role: backup

References

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Seliga-Siwecka J, Rutkowski J, Margas W, Puskarz-Gasowska J, Bokiniec R. Sensitivity and specificity of different imaging modalities in diagnosing necrotising enterocolitis in a Polish population of preterm infants: a diagnostic test accuracy study protocol. BMJ Open. 2020 Jul 20;10(7):e033519. doi: 10.1136/bmjopen-2019-033519.

Reference Type DERIVED
PMID: 32690727 (View on PubMed)

Other Identifiers

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KAROWA USG VERSION 1.0

Identifier Type: -

Identifier Source: org_study_id

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