High Protein and High Energy Intakes and Physical Activity on Growth of Extremely Low Birth Weight Infants

NCT ID: NCT03374033

Last Updated: 2019-05-09

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

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-04-10

Study Completion Date

2022-07-30

Brief Summary

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The aim of this study is to evaluate the effect of increasing amino acid and energy intake during parenteral and enteral nutrition with and without the stimulation of the infant's physical activity, on growth of extremely low birth weight infants .

Detailed Description

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Increasing protein and energy intake above the anabolic capacity of a given individual may result in increased lipogenesis and excessive fat deposition. Adults with reduced mobility or with neuromuscular conditions will develop excessive fat deposition if they receive normal to high protein and energy intakes. Excessive fat deposition have been demonstrated in preterm infants receiving high energy intakes. Given that physical activity in preterms is often reduced for the prematurity itself, the associated sickness and the numerous medications, the investigators speculate that physical stimulation may have a beneficial effect on protein accretion and on lean mass accretion. The investigators further hypothesize that today's recommended daily intakes of proteins and energy cannot be fully incorporated into lean body mass without a concomitant physical activity. In spite of the fact that this notion is well accepted in adult physiology and in the elderly, it has never been tested in preterm infants.

This factorial randomised controlled trial will evaluate the effect of increasing amino acid intake (by 1 g/kg/d) and energy intake (by 20 kcal/kg/d) during parenteral nutrition and also of increasing protein intake and energy intake by an extra 1 g/kg/d during enteral nutrition, with and without the stimulation of the infant's physical activity, on growth of extremely low birth weight infants. The investigators aim at demonstrating that increasing energy and protein intake above the standard of care intakes will result in better growth only in association with adequate physical activity, in particular in relation to body composition and lean mass accretion.

Conditions

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Infant, Very Low Birth Weight

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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NUTR (Nutrition) 0_STIMUL(Stimulation) 0

Standard Nutrition and no Physical Stimulation

Group Type NO_INTERVENTION

No interventions assigned to this group

NUTR 0_STIMUL +

Standard Nutrition and Physical Stimulation

Group Type EXPERIMENTAL

STIMUL +

Intervention Type BEHAVIORAL

Physical activity stimulation consists in flexion/extension of the 4 limbs and other motion exercises of the shoulder girdle and of the hips. This stimulation will take place before the feed for a mean of 30 times a week (minimum 24- maximum 36 times a week, 10 minutes each time) and will start within the 10th day of life until 36 weeks postmenstrual age

NUTR +_STIMUL 0

Enhanced Nutrition, and no Physical Stimulation

Group Type EXPERIMENTAL

NUTR +

Intervention Type DIETARY_SUPPLEMENT

one extra g/kg/d of protein and lipids starting before 48 hours after birth until 36 weeks postmenstrual age

NUTR +_STIMUL +

Enhanced Nutrition and Physical Stimulation

Group Type EXPERIMENTAL

NUTR +

Intervention Type DIETARY_SUPPLEMENT

one extra g/kg/d of protein and lipids starting before 48 hours after birth until 36 weeks postmenstrual age

STIMUL +

Intervention Type BEHAVIORAL

Physical activity stimulation consists in flexion/extension of the 4 limbs and other motion exercises of the shoulder girdle and of the hips. This stimulation will take place before the feed for a mean of 30 times a week (minimum 24- maximum 36 times a week, 10 minutes each time) and will start within the 10th day of life until 36 weeks postmenstrual age

Interventions

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NUTR +

one extra g/kg/d of protein and lipids starting before 48 hours after birth until 36 weeks postmenstrual age

Intervention Type DIETARY_SUPPLEMENT

STIMUL +

Physical activity stimulation consists in flexion/extension of the 4 limbs and other motion exercises of the shoulder girdle and of the hips. This stimulation will take place before the feed for a mean of 30 times a week (minimum 24- maximum 36 times a week, 10 minutes each time) and will start within the 10th day of life until 36 weeks postmenstrual age

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* 24 weeks \< gestational age \< 32 weeks
* inborn or outborn admitted before 24 hours of age
* parenteral or enteral nutrition start before 48 hours of age
* parental consent

Exclusion Criteria

* difficulty in starting physical activity stimulation before 10 days of life
* death before 36 W PMA
* diagnosis of necrotising enterocolitis (before 36 W PMA)
* any major surgery (before 36 W PMA)
* congenital syndrome, severe malformations
* inborn errors of metabolism
* parental consent withdrawn
Minimum Eligible Age

24 Weeks

Maximum Eligible Age

32 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Università Politecnica delle Marche

OTHER

Sponsor Role lead

Responsible Party

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Virgilio Paolo Carnielli

Head of Neonatology Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Virgilio P. Carnielli, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Università Politecnica delle Marche

Locations

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Ospedale G. Salesi

Ancona, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Virgilio P. Carnielli, MD, PhD

Role: CONTACT

00390715962045

Chiara Biagetti, MD

Role: CONTACT

00390715962014

Facility Contacts

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Virgilio P. Carnielli, MD, PhD

Role: primary

00390715962045

Chiara Biagetti, MD

Role: backup

00390715962014

References

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Agostoni C, Buonocore G, Carnielli VP, De Curtis M, Darmaun D, Decsi T, Domellof M, Embleton ND, Fusch C, Genzel-Boroviczeny O, Goulet O, Kalhan SC, Kolacek S, Koletzko B, Lapillonne A, Mihatsch W, Moreno L, Neu J, Poindexter B, Puntis J, Putet G, Rigo J, Riskin A, Salle B, Sauer P, Shamir R, Szajewska H, Thureen P, Turck D, van Goudoever JB, Ziegler EE; ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2010 Jan;50(1):85-91. doi: 10.1097/MPG.0b013e3181adaee0.

Reference Type BACKGROUND
PMID: 19881390 (View on PubMed)

Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R; Parenteral Nutrition Guidelines Working Group; European Society for Clinical Nutrition and Metabolism; European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN); European Society of Paediatric Research (ESPR). 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr. 2005 Nov;41 Suppl 2:S1-87. doi: 10.1097/01.mpg.0000181841.07090.f4. No abstract available.

Reference Type BACKGROUND
PMID: 16254497 (View on PubMed)

Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001 Feb;107(2):270-3. doi: 10.1542/peds.107.2.270.

Reference Type BACKGROUND
PMID: 11158457 (View on PubMed)

Burattini I, Bellagamba MP, Spagnoli C, D'Ascenzo R, Mazzoni N, Peretti A, Cogo PE, Carnielli VP; Marche Neonatal Network. Targeting 2.5 versus 4 g/kg/day of amino acids for extremely low birth weight infants: a randomized clinical trial. J Pediatr. 2013 Nov;163(5):1278-82.e1. doi: 10.1016/j.jpeds.2013.06.075. Epub 2013 Aug 12.

Reference Type BACKGROUND
PMID: 23941670 (View on PubMed)

Bellagamba MP, Carmenati E, D'Ascenzo R, Malatesta M, Spagnoli C, Biagetti C, Burattini I, Carnielli VP. One Extra Gram of Protein to Preterm Infants From Birth to 1800 g: A Single-Blinded Randomized Clinical Trial. J Pediatr Gastroenterol Nutr. 2016 Jun;62(6):879-84. doi: 10.1097/MPG.0000000000000989.

Reference Type BACKGROUND
PMID: 26418211 (View on PubMed)

Biolo G, Ciocchi B, Stulle M, Piccoli A, Lorenzon S, Dal Mas V, Barazzoni R, Zanetti M, Guarnieri G. Metabolic consequences of physical inactivity. J Ren Nutr. 2005 Jan;15(1):49-53. doi: 10.1053/j.jrn.2004.09.009.

Reference Type BACKGROUND
PMID: 15648007 (View on PubMed)

Schulzke SM, Kaempfen S, Trachsel D, Patole SK. Physical activity programs for promoting bone mineralization and growth in preterm infants. Cochrane Database Syst Rev. 2014 Apr 22;2014(4):CD005387. doi: 10.1002/14651858.CD005387.pub3.

Reference Type BACKGROUND
PMID: 24752440 (View on PubMed)

Uthaya S, Thomas EL, Hamilton G, Dore CJ, Bell J, Modi N. Altered adiposity after extremely preterm birth. Pediatr Res. 2005 Feb;57(2):211-5. doi: 10.1203/01.PDR.0000148284.58934.1C. Epub 2004 Dec 20.

Reference Type RESULT
PMID: 15611357 (View on PubMed)

Prado CM, Heymsfield SB. Lean tissue imaging: a new era for nutritional assessment and intervention. JPEN J Parenter Enteral Nutr. 2014 Nov;38(8):940-53. doi: 10.1177/0148607114550189. Epub 2014 Sep 19.

Reference Type RESULT
PMID: 25239112 (View on PubMed)

Betto M, Gaio P, Ferrini I, De Terlizzi F, Zambolin M, Scattolin S, Pasinato A, Verlato G. Assessment of bone health in preterm infants through quantitative ultrasound and biochemical markers. J Matern Fetal Neonatal Med. 2014 Sep;27(13):1343-7. doi: 10.3109/14767058.2013.858317. Epub 2013 Nov 26.

Reference Type RESULT
PMID: 24215624 (View on PubMed)

Other Identifiers

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DG-297

Identifier Type: -

Identifier Source: org_study_id

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