Clinical Trial to Evaluate Two Guidelines for the Administration of Ibuprofen in the Treatment of Persistent Ductus Arteriosus Eco-guided: Impact in the Intestinal Prognosis

NCT ID: NCT04282941

Last Updated: 2020-10-29

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

PHASE3

Total Enrollment

180 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-02-20

Study Completion Date

2020-11-30

Brief Summary

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Persistent ductus arteriosus (DA) is a common entity in the premature newborn and is associated with high morbidity and mortality. There is still controversy about which is the best treatment for its closure. Children with AD who receive pharmacological treatment present more frequently than other premature children, necrotizing enterocolitis or isolated intestinal perforation.

At the present time, the conventional treatment of DA consists in the administration of intravenous ibuprofen, slow bolus in 3 daily doses 10-5-5 mg / kg / day. Recently, it has been observed that treatment with ibuprofen in continuous iv infusion for 3 days seems to be more effective in closing DA than conventional treatment for 3 days with the same dose but in slow iv bolus. This experimental treatment reduced the incidence of associated necrotizing enterocolitis. Our group demonstrated in a previous pilot trial that the guided treatment with echocardiography (EchoG) of DA with ibuprofen compared with conventional treatment, allows to reduce the number of doses to the patient. The EchoG treatment thus presents a potential reduction of side effects associated with medication, this resulted in a tendency to have a lower incidence of necrotising enterocolitis in the experimental group. This multicenter clinical trial aims to test the hypothesis that the combination of 2 experimental treatments, the use of ibuprofen in continuous perfusion and EchoG, reduces the incidence of digestive side effects (necrotising enterocolitis or isolated intestinal perforation) compared to the treatment also guided by echocardiography but slow bolus iv.

Detailed Description

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Conditions

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Persistent Ductus Arteriosus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Administration schedule A: Ibuprofen in continuous iv infusion and EchoG. Each cycle will be 3 doses.

Administration schedule B: slow iv bolus Ibuprofen and EchoG. Each cycle will be 3 doses.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators
A randomized system with closed envelopes will be designed in which patients will be assigned to one of the 2 treatment groups, stratified by gestational age (\<28 weeks and ≥28 weeks) and by hospital center. In each center and each stratum, they will be randomly assigned in a 1: 1 ratio to each group of study. The assignment will be sequential.

The doctors responsible for the patient will be blind to the intervention but will be responsible for the sealed envelopes, and at the time of patient randomization, will deliver the sealed envelope corresponding to the nurses responsible for the preparation of the medication.

Study Groups

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Ibuprofen in continuous (24 hours) iv infusion and EchoG

The first dose of ibuprofen will be 10 mg / kg to be administered as a continuous infusion for 24 hours. An echocardiogram will be performed before each of the following 2 doses of 5 mg / Kg and will only be administered if it meets echocardiographic criteria that indicate open DA (observation of ductus permeability with color Doppler regardless of its size). Each dose will be administered as a 24-hour continuous infusion.

Group Type EXPERIMENTAL

Ibuprofen in continuous (24 hours) iv infusion and EchoG

Intervention Type DRUG

The first dose of ibuprofen will be 10 mg / kg to be administered as a continuous infusion for 24 hours. An echocardiogram will be performed before each of the following 2 doses of 5 mg / Kg and will only be administered if it meets echocardiographic criteria that indicate open DA (observation of ductus permeability with color Doppler regardless of its size). Each dose will be administered as a 24-hour continuous infusion.

IV bolus Ibuprofen slow (15 minutes) and EchoG

The first dose of ibuprofen of 10 mg / Kg to be administered in slow iv bolus (15 minutes). Before each of the following 2 doses of 5 mg / Kg, echocardiography will be performed and will only be administered if it meets the echocardiographic criteria indicated by open DA (observation of ductus permeability in color Doppler regardless of its size). Each dose will be administered in iv boluses in 15 minutes

Group Type EXPERIMENTAL

IV bolus Ibuprofen slow (15 minutes) and EchoG

Intervention Type DRUG

The first dose of ibuprofen of 10 mg / Kg to be administered in slow iv bolus (15 minutes). Before each of the following 2 doses of 5 mg / Kg, echocardiography will be performed and will only be administered if it meets the echocardiographic criteria indicated by open DA (observation of ductus permeability in color Doppler regardless of its size). Each dose will be administered in iv boluses in 15 minutes

Interventions

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Ibuprofen in continuous (24 hours) iv infusion and EchoG

The first dose of ibuprofen will be 10 mg / kg to be administered as a continuous infusion for 24 hours. An echocardiogram will be performed before each of the following 2 doses of 5 mg / Kg and will only be administered if it meets echocardiographic criteria that indicate open DA (observation of ductus permeability with color Doppler regardless of its size). Each dose will be administered as a 24-hour continuous infusion.

Intervention Type DRUG

IV bolus Ibuprofen slow (15 minutes) and EchoG

The first dose of ibuprofen of 10 mg / Kg to be administered in slow iv bolus (15 minutes). Before each of the following 2 doses of 5 mg / Kg, echocardiography will be performed and will only be administered if it meets the echocardiographic criteria indicated by open DA (observation of ductus permeability in color Doppler regardless of its size). Each dose will be administered in iv boluses in 15 minutes

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Preterm infants with less 33 weeks of gestational age
* DA ≥ 1.5 mm with decision to start pharmacological treatment
* Informed consent signed by the legal representative

Exclusion Criteria

* Consent denied
* Presence of serious congenital alterations
* Congenital heart disease
* Contraindication for the administration of IB: oligoanuria (diuresis \<1cc / kg / h), bleeding severe recent intraventricular (HIV grade III or extensive periventricular hemorrhagic infarction), serum creatinine\> 1.5 mg / dl or clinical suspicion of intestinal ischemia.
Minimum Eligible Age

0 Minutes

Maximum Eligible Age

33 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Investigación Hospital Universitario La Paz

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Hospital Universitario La Paz

Madrid, , Spain

Site Status RECRUITING

Hospital 12 de Octubre

Madrid, , Spain

Site Status RECRUITING

Hospital Quirón Salud Madrid

Madrid, , Spain

Site Status RECRUITING

Countries

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Spain

Facility Contacts

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Maria Carmen Bravo Laguna, Dr.

Role: primary

+34917277416

Paloma Moraga Alapont

Role: backup

Fernando Cabañas

Role: primary

913 90 80 00

Fernando Cabañas

Role: primary

914 52 19 00

Other Identifiers

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2016-002974-11

Identifier Type: -

Identifier Source: org_study_id