Investigation of the Mechanisms of the Tendency to Hypothermia in Newborns and Premature Neonates

NCT ID: NCT06803069

Last Updated: 2025-02-19

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

RECRUITING

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-07-01

Study Completion Date

2029-07-01

Brief Summary

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Newborns have thermoregulatory mechanisms that differ from those of adults. Instead of producing heat through shivering, newborns primarily rely on non-shivering thermogenesis by the brown adipose tissue. The development of this thermogenic tissue starts around the 26th gestational week and continues until shortly before birth, after which no further growth occurs. As a result, premature infants, who have less developed brown fat, are more prone to reduced heat production and are at higher risk for hypothermia. There are few human studies examining the thermoregulatory differences and mechanisms between full-term and premature neonates, and the findings remain inconclusive.

In this study, the investigators aim to conduct a prospective, observational research. Researchers will compare body temperature, brown adipose tissue activity, and specific plasma markers between full-term and premature neonates in insensive care units and during elective surgeries.

Detailed Description

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Test Methods:

Both substudies involve the use of a FLIR C3 mobile thermal camera to create thermograms. Thermal images of the full-term and preterm infants are taken from a distance of 20 cm while the participants lie in a supine position. The area examined spans from the upper edge of the diaper to the top of the head.

Substudy 1:

1\. a) In case of neonates in the intensive care unit or waiting for short procedures (e.g., ophthalmic surgery), thermal images are taken before transport to the operating room and after surgery, before transferring back to the ward. For infants receiving incubator care, both images are taken inside the transport incubator. The test duration is about 5 minutes.

1\. b) Images are captured before kangaroo care, before and after transferring the infant to the ward (both images taken in the transport incubator if the infant is in incubator care).

1\. c) Thermal images are taken before and after the insertion of an epicutaneous cannula.

1. d) For post-asphyxic infants undergoing therapeutic hypothermia, images are taken immediately before starting cooling on the therapeutic mattress, once midway through the cooling process; once immediately after reaching the target core temperature; then daily while in the hypothermic state; once immediately before the rewarming process, and every hour during rewarming until the desired core temperature is reached.

Substudy 2:
2. a) In case of neonates waiting for surgeries lasting more than 30 minutes, thermal images are taken before the surgery; every 10 minutes during the operation; after surgery, following the same protocol as in Substudy 1.

2\. b) Thermal images are taken before and after inserting a central cannula.

Parameters recorded in the substudies:

1. Blood tests, including c-reactive protein (CRP), procalcitonin (PCT), blood count, glucose, bilirubin, thyroid hormones, urea, creatinine, glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), and blood gas, as part of routine blood sampling.
2. Rectal core temperature, as well as episodes of shivering or heat production.
3. Changes in body temperature during surgery along with other routinely measured physiological parameters (e.g., blood pressure, respiratory indicators).
4. Type and dosage of anesthetics used, as well as any side effects (e.g., post-surgery vomiting).
5. Additional parameters such as gestational age, Apgar score, birth weight, body weight at the time of examination, and environmental temperature (e.g., clinic, incubator, operating room).

Examination process:

The parents/guardians/legal representatives of the selected patients will be provided with detailed information, and consent forms will be signed by them.

Conditions

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Neonatal Hypothermia Brown Adipose Tissue Preterm and Term Infants Neonate Thermogenesis Blood Markers

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Preterm neonates

Group of neonates who were born before the 37th gestational week.

No interventions assigned to this group

Full-term neonates

Group of neonates who were born after the 37th gestational week.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* For Substudy 1: Patients admitted to the Neonatal Intensive Care Unit at the University of Pécs, Department of Obstetrics and Gynaecology (premature infants or those in neonatal intensive care).
* For Substudy 2: Patients under 2 years of age undergoing elective surgery lasting more than 30 minutes at the University of Pécs, Department of Paediatrics.
* For both substudies: Written consent for participation in the study has been provided by the patient's parent, guardian, or legal representative.

Exclusion Criteria

* For both substudies: If the patient cannot be mobilized (e.g., during the post-operative phase of abdominal or thoracic surgery; presence of chest tubes for pneumothorax or other reasons; hemodynamic instability; need for continuous electrocardiogram (ECG) monitoring; or use of an external pacemaker).
* The patient's parent, guardian, or legal representative does not consent to the study or withdraws their consent at any point.
* For Substudy 2: if the patient is older than 2 years.
Maximum Eligible Age

2 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Pecs

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Tamás Kövesi, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pecs, Department of Anaesthesiology and Intensive Therapy

András Garami, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pecs, Institute for Translational Medicine

Simone Funke, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pecs, Department of Obstetrics and Gynaecology

Locations

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University of Pécs, Department of Obstetrics and Gynaecology

Pécs, Baranya, Hungary

Site Status RECRUITING

University of Pécs, Department of Paediatrics

Pécs, Baranya, Hungary

Site Status RECRUITING

Countries

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Hungary

Central Contacts

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András Garami, MD, PhD

Role: CONTACT

+3672536000 ext. 38607

Kata Fekete, MSc

Role: CONTACT

+3672536000 ext. 38604

Facility Contacts

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Simone Funke, MD, PhD

Role: primary

+3672536370

Gergely Stankovics, MD

Role: backup

Tamás Kövesi, MD, PhD

Role: primary

+3672535-832

Zsolt Fehér, MD

Role: backup

+3672535-832

References

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Nedergaard J, Cannon B. Brown adipose tissue as a heat-producing thermoeffector. Handb Clin Neurol. 2018;156:137-152. doi: 10.1016/B978-0-444-63912-7.00009-6.

Reference Type BACKGROUND
PMID: 30454587 (View on PubMed)

Symonds ME, Pope M, Sharkey D, Budge H. Adipose tissue and fetal programming. Diabetologia. 2012 Jun;55(6):1597-606. doi: 10.1007/s00125-012-2505-5. Epub 2012 Mar 9.

Reference Type BACKGROUND
PMID: 22402988 (View on PubMed)

Lunze K, Hamer DH. Thermal protection of the newborn in resource-limited environments. J Perinatol. 2012 May;32(5):317-24. doi: 10.1038/jp.2012.11. Epub 2012 Mar 1.

Reference Type BACKGROUND
PMID: 22382859 (View on PubMed)

Silverman WA, Sinclair JC. Temperature regulation in the newborn infant. N Engl J Med. 1966 Jan 13;274(2):92-4 contd. doi: 10.1056/NEJM196601132740207. No abstract available.

Reference Type BACKGROUND
PMID: 5322157 (View on PubMed)

Knobel R, Holditch-Davis D. Thermoregulation and heat loss prevention after birth and during neonatal intensive-care unit stabilization of extremely low-birthweight infants. J Obstet Gynecol Neonatal Nurs. 2007 May-Jun;36(3):280-7. doi: 10.1111/j.1552-6909.2007.00149.x.

Reference Type BACKGROUND
PMID: 17489935 (View on PubMed)

Lidell ME. Brown Adipose Tissue in Human Infants. Handb Exp Pharmacol. 2019;251:107-123. doi: 10.1007/164_2018_118.

Reference Type BACKGROUND
PMID: 29675580 (View on PubMed)

Other Identifiers

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NKFIH-FK-138722

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

BM/17552-3/2024

Identifier Type: -

Identifier Source: org_study_id

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