Emollient Therapy for Premature Infants in Zimbabwe

NCT ID: NCT05461404

Last Updated: 2023-04-19

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

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

520 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-08-01

Study Completion Date

2025-12-31

Brief Summary

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The purpose of this study is to assess the efficacy of topical emollient treatments in improving neonatal growth and mortality rates.

Detailed Description

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For infants whose parent/caretaker provides written informed consent, the study nurse coordinator on-site will allocate infants to one of two strata (700- \<1000 g or 1000-1500 g). Participants within each stratum will be randomly assigned in a 1:1 ratio to one of two treatment groups: 1) high-linoleate SSO, or 2) standard-of-care treatment without use of topical emollients or massage.

Conditions

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Very Low Birth Weight Infant

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Infants will be enrolled after informed consent, stratified by birthweight (700- \<1000 g, 1000-1500 g) and randomly allocated 1:1 to the two arms of the trial which will be run in parallel.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Due to the visible nature of the intervention, it is not possible to completely mask allocation; thus, the trial will be open-label. However, study physicians will not have access to patient randomization lists.

Study Groups

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Emollient arm

Infants will receive gentle, hygienic whole-body massage by trained nurses (not parents or other family members) with 3g of SSO per kg of body weight - a dose sufficient to saturate the skin - three times daily for the first 14 days and twice daily thereafter during the duration of their stay in the hospital until death, discharge or through day 28 after birth.

Group Type EXPERIMENTAL

Topical Emollient Therapy

Intervention Type OTHER

Application of high-linoleate (\>60% linoleic acid) SSO to the epidermis.

Control arm

Infants in the control group will receive the standard of care for infants in the neonatal care unit, which does not include use of topical emollients or massage (i.e., family members will not be allowed to apply skin care products to their infants), or other particular measures to prevent skin breakdown or to modulate skin barrier function.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Topical Emollient Therapy

Application of high-linoleate (\>60% linoleic acid) SSO to the epidermis.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* infants \<72 hours of age
* weigh 700-1500 at birth
* hospitalized at SMCH

Exclusion Criteria

* infants who are moribund and highly likely not to survive despite any intervention
* significant breaches in their skin barrier
* conditions indicating failure to gain weight
* critically ill (definition below):

1. Oxygen saturation \<88% on oxygen therapy AND ≥2 of the following conditions:
2. respiratory rate \<20 or \>100 breaths per minute
3. apnea requiring bag-mask ventilation
4. heart rate \<100 or \>200 beats per minute
* congenital syphilis
* hydrops fetalis
* a life-threatening congenital anomaly or major surgical condition requiring intervention
* generalized skin disease or a structural defect involving \>5% body surface area likely to produce a defect in epidermal barrier function
Maximum Eligible Age

28 Days

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Zimbabwe

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role collaborator

Stanford University

OTHER

Sponsor Role lead

Responsible Party

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Gary Darmstadt

Professor of Pediatrics

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Hilda A. Mujuru, MBChB, MMed, MSc

Role: PRINCIPAL_INVESTIGATOR

University of Zimbabwe

Locations

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Sally Mugabe Central Hospital (SMCH)

Harare, , Zimbabwe

Site Status

Countries

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Zimbabwe

Central Contacts

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Gary Darmstadt, MD, MS

Role: CONTACT

650-724-6014

Facility Contacts

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Hilda A Mujuru, MBChB, MMed, MSc

Role: primary

References

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Fischer N, Darmstadt GL, Shahunja KM, Crowther JM, Kendall L, Gibson RA, Ahmed T, Relman DA. Topical emollient therapy with sunflower seed oil alters the skin microbiota of young children with severe acute malnutrition in Bangladesh: A randomised, controlled study. J Glob Health. 2021 Jul 17;11:04047. doi: 10.7189/jogh.11.04047. eCollection 2021.

Reference Type BACKGROUND
PMID: 34386216 (View on PubMed)

Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, Santosham M, Elias PM. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr. 2002;91(5):546-54. doi: 10.1080/080352502753711678.

Reference Type BACKGROUND
PMID: 12113324 (View on PubMed)

Cleminson J, McGuire W. Topical emollient for preventing infection in preterm infants. Cochrane Database Syst Rev. 2021 May 7;5(5):CD001150. doi: 10.1002/14651858.CD001150.pub4.

Reference Type BACKGROUND
PMID: 33961715 (View on PubMed)

Elias PM, Brown BE, Ziboh VA. The permeability barrier in essential fatty acid deficiency: evidence for a direct role for linoleic acid in barrier function. J Invest Dermatol. 1980 Apr;74(4):230-3. doi: 10.1111/1523-1747.ep12541775.

Reference Type BACKGROUND
PMID: 7373078 (View on PubMed)

Prottey C, Hartop PJ, Black JG, McCormack JI. The repair of impaired epidermal barrier function in rats by the cutaneous application of linoleic acid. Br J Dermatol. 1976 Jan;94(1):13-21. doi: 10.1111/j.1365-2133.1976.tb04336.x.

Reference Type BACKGROUND
PMID: 1252336 (View on PubMed)

Darmstadt GL, Badrawi N, Law PA, Ahmed S, Bashir M, Iskander I, Al Said D, El Kholy A, Husein MH, Alam A, Winch PJ, Gipson R, Santosham M. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J. 2004 Aug;23(8):719-25. doi: 10.1097/01.inf.0000133047.50836.6f.

Reference Type BACKGROUND
PMID: 15295221 (View on PubMed)

Kumar V, Kumar A, Mishra S, Kan P, Ashraf S, Singh S, Blanks KJH, Baiocchi M, Limcaoco M, Ghosh AK, Kumar A, Krishna R, Stevenson DK, Tian L, Darmstadt GL; Shivgarh Emollient Research Group. Effects of emollient therapy with sunflower seed oil on neonatal growth and morbidity in Uttar Pradesh, India: a cluster-randomized, open-label, controlled trial. Am J Clin Nutr. 2022 Apr 1;115(4):1092-1104. doi: 10.1093/ajcn/nqab430.

Reference Type BACKGROUND
PMID: 34982820 (View on PubMed)

Darmstadt GL, Saha SK, Ahmed AS, Chowdhury MA, Law PA, Ahmed S, Alam MA, Black RE, Santosham M. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet. 2005 Mar 19-25;365(9464):1039-45. doi: 10.1016/S0140-6736(05)71140-5.

Reference Type BACKGROUND
PMID: 15781099 (View on PubMed)

Darmstadt GL, Saha SK, Ahmed AS, Ahmed S, Chowdhury MA, Law PA, Rosenberg RE, Black RE, Santosham M. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics. 2008 Mar;121(3):522-9. doi: 10.1542/peds.2007-0213.

Reference Type BACKGROUND
PMID: 18310201 (View on PubMed)

Salam RA, Darmstadt GL, Bhutta ZA. Effect of emollient therapy on clinical outcomes in preterm neonates in Pakistan: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2015 May;100(3):F210-5. doi: 10.1136/archdischild-2014-307157. Epub 2015 Jan 30.

Reference Type BACKGROUND
PMID: 25637007 (View on PubMed)

Salam RA, Das JK, Darmstadt GL, Bhutta ZA. Emollient therapy for preterm newborn infants--evidence from the developing world. BMC Public Health. 2013;13 Suppl 3(Suppl 3):S31. doi: 10.1186/1471-2458-13-S3-S31. Epub 2013 Dec 20.

Reference Type BACKGROUND
PMID: 24564550 (View on PubMed)

Kumar A, Mishra S, Singh S, Ashraf S, Kan P, Ghosh AK, Kumar A, Krishna R, Stevenson DK, Tian L, Elias PM, Darmstadt GL, Kumar V; Shivgarh Emollient Research Group. Effect of sunflower seed oil emollient therapy on newborn infant survival in Uttar Pradesh, India: A community-based, cluster randomized, open-label controlled trial. PLoS Med. 2021 Sep 28;18(9):e1003680. doi: 10.1371/journal.pmed.1003680. eCollection 2021 Sep.

Reference Type BACKGROUND
PMID: 34582448 (View on PubMed)

Hui A, Chimhini G, Saungweme M, Kaisi D, Munetsi E, Mujuru HA, Darmstadt GL. Postnatal care and acceptability of emollient therapy in very low birthweight infants in Harare, Zimbabwe: a qualitative analysis. BMC Pediatr. 2024 Mar 16;24(1):187. doi: 10.1186/s12887-024-04661-x.

Reference Type DERIVED
PMID: 38493088 (View on PubMed)

Other Identifiers

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66546

Identifier Type: -

Identifier Source: org_study_id

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