Medium vs Low Oxygen Threshold for the Surfactant Administration

NCT ID: NCT04199364

Last Updated: 2021-04-19

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

PHASE4

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-01

Study Completion Date

2025-04-30

Brief Summary

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The aim of this study will be to assess the better fraction inspired oxygen (FiO2) threshold for the surfactant treatment in preterm infants with respiratory distress syndrome (RDS) randomized to receive exogenous surfactant at 25% or 35% of FiO2 threshold. The pulmonary gas-exchanges will be evaluated by oxygen saturation (SpO2) to FiO2 ratio (SFR) and will be used to define the better FiO2 threshold for the surfactant treatment.

Detailed Description

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Exogenous surfactant therapy is an effective treatment of neonatal respiratory distress syndrome (RDS) and has been associated with reduced severity of respiratory distress and mortality. The 2019 European guidelines for neonatal RDS treatment suggest as the threshold of inspired oxygen (FiO2) for the surfactant treatment at 30% for all gestational age, but there are no randomized studies that confirm this indication. Some observational studies reported that a relevant number of patients who are not routinely treated with surfactant had respiratory complications, thus they received exogenous surfactant. To date, the optimal FiO2 threshold for surfactant administration remains unclear.

In this single-center, randomized, phase 4 trial, preterm infants (gestational age\<32 weeks) with RDS will be randomized to receive exogenous surfactant at 25% or 35% of FiO2 threshold. According to the unit policy, the exogenous surfactant will be administered by an endotracheal tube in intubated infants, or by Intubation-Surfactant-Extubation (InSurE) / Less Invasive Surfactant Administration (LISA) methods in infants who will not remain intubated. The method used for the surfactant administration will be at the discretion of the caring physician.

Conditions

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Respiratory Distress Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants
Participants will be masked.

Study Groups

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Low FiO2 threshold

A fraction of inspired oxygen (FiO2) of 25% to have an oxygen saturation (SpO2) of 90-92%.

Group Type EXPERIMENTAL

Poractant Alfa 80 mg/mL Intratracheal Suspension

Intervention Type DRUG

Exogenous surfactant (Poractant Alfa) administration at a dose of 200 mg/kg.

Medium FiO2 threshold

A fraction of inspired oxygen (FiO2) of 35% to have an oxygen saturation (SpO2) of 90-92%.

Group Type EXPERIMENTAL

Poractant Alfa 80 mg/mL Intratracheal Suspension

Intervention Type DRUG

Exogenous surfactant (Poractant Alfa) administration at a dose of 200 mg/kg.

Interventions

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Poractant Alfa 80 mg/mL Intratracheal Suspension

Exogenous surfactant (Poractant Alfa) administration at a dose of 200 mg/kg.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* gestational age less than 32 weeks;
* diagnosis of respiratory distress (RDS);
* need for ventilatory support;
* written informed consent.

Exclusion Criteria

* congenital malformations;
* genetic disorders;
* perinatal asphyxia.
* neonatal pneumonia or wet lung or meconium aspiration syndrome at birth.
Minimum Eligible Age

24 Weeks

Maximum Eligible Age

32 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Virgilio Paolo Carnielli

OTHER

Sponsor Role lead

Responsible Party

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Virgilio Paolo Carnielli

Director of Neonatology

Responsibility Role SPONSOR_INVESTIGATOR

Central Contacts

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Virgilio Carnielli, MD, PHD

Role: CONTACT

0715962045

Valentina Dell'Orto, MD

Role: CONTACT

0715962014

References

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update. Neonatology. 2017;111(2):107-125. doi: 10.1159/000448985. Epub 2016 Sep 21.

Reference Type BACKGROUND
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Reference Type BACKGROUND
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Narendran V, Donovan EF, Hoath SB, Akinbi HT, Steichen JJ, Jobe AH. Early bubble CPAP and outcomes in ELBW preterm infants. J Perinatol. 2003 Apr-May;23(3):195-9. doi: 10.1038/sj.jp.7210904.

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Other Identifiers

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2019-002923-13

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

2535

Identifier Type: -

Identifier Source: org_study_id

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