Pasteurised Donor Human Milk Supplementation for Term Babies

NCT ID: NCT06993103

Last Updated: 2025-05-28

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

PHASE4

Total Enrollment

1444 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-02

Study Completion Date

2028-12-31

Brief Summary

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PRESENT is a multi-center randomised controlled trial that aims to assess whether access to pasteurized donor human milk as supplementary nutrition in the first five days of life for term infants born to women with diabetes in pregnancy reduces the proportion of infants who are admitted to a neonatal unit for management of hypoglycemia compared with current standard hospital care. The trial will also assess other important outcomes including breastfeeding rates, maternal mental health, and infant cow's milk allergy.

There will be two treatment arms. In the intervention arm, PDHM will be made available to infants from randomisation until day 5 of life. Infants allocated to the control arm will receive care as per local unit policy, including supplemental nutrition as recommended by the treating clinician. After hospital discharge, participants will be asked to complete an electronic questionnaire at 2 \& 6 weeks and 6 \& 12 months after birth. Questionnaires will assess infant feeding practices, maternal quality of life \[including anxiety and depression symptoms and health-related quality of life\] along with infant cow's milk allergy symptoms.

Detailed Description

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Diabetes in pregnancy is becoming increasingly common globally, with more than 40 000 infants born to women with gestational diabetes alone in Australia each year. These infants are at a high risk of hypoglycaemia and often require admission to the neonatal intensive care unit (NICU) and frequent blood tests for glucose monitoring. Many lack access to sufficient maternal milk partly due to delayed lactogenesis, leading to reliance on cow's milk formula, which may increase risks of cow's milk allergy, early breastfeeding cessation, and long-term metabolic complications.

Pasteurized Donor Human milk (PDHM) supplementation represents an alternative to infant formula when sufficient mother's own milk is not available. In Australia, donor milk is already in use for more vulnerable populations (those born very preterm or of a very low birth weight). However, PDHM is not currently available for term infants, despite strong clinician and community demand.

Expanding the availability of PDHM to term infants has the potential to improve health outcomes for a much larger proportion of the population, with potential benefits for mothers and infants including a reduction in admissions to neonatal intensive care units, a reduction in cow's milk allergy in infants, and improved maternal mental health and breastfeeding outcomes.

Our project will assess the provision of PDHM as in-hospital supplementation for term infants who would otherwise be given cow's milk formula. This trial will address a significant gap in neonatal care and provide evidence to determine whether broader PDHM use could improve both mothers' and infants' and long-term health outcomes.

Conditions

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Neonatal Hypoglycemia Metabolic Complication Cows Milk Allergy Hospital Length of Stay Neonatal Intensive Care Unit Breastfeeding Mental Health Issue

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized controlled intervention trial - control and intervention arm
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

This study has 2 treatment arms. In the intervention arm, pasteurised donor human milk (PDHM) is provided to infants needing nutritional supplementation for the first 5 days of life, compared to standard hospital care.

Participants will not be blinded to study group allocation, because a key research question concerns the consumer experience of accessing PDHM, including how maternal behaviors differ when receiving PDHM. The idea is that having human milk is a "bridge" to exclusive breast milk feeding, rather than a path to continued formula feeding and shorter breastfeeding duration. Many outcomes, such as maternal mental health, breastfeeding impact of access to PDHM) cannot be assessed in a blinded study. The primary outcome is unlikely to be impacted by lack of clinician blinding.

Outcome assessments (analysis of questionnaire responses, skin prick testing for cow's milk allergy) and statistical analyses will be done by assessors blinded to study group allocation.

Study Groups

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PDHM - Pasteurised donor human milk

All infants in this group will get access to Pasteurised donor human milk (PDHM) as supplementary nutrition. PDHM will be made available to the intervention group from the time of randomisation until day 5 of life. Families will be provided with a sufficient supply of frozen PDHM for home use to ensure an exclusively human milk diet up to day 5 of life if their infant is discharged before day 5. Access to PDHM will cease after 120 hours of life, and the infant will be fed according to standard hospital protocols or as per parent's decision.

Group Type EXPERIMENTAL

Dietary Supplement: PDHM Pasteurised Donor Human Milk

Intervention Type DIETARY_SUPPLEMENT

PDHM will be given to infants randomised to the intervention group

Standard Care

All infants in this group will receive the standard care as per local unit policy, including supplemental nutrition (e.g. infant cow's milk formula or IV fluids) as recommended by the treating clinician

Group Type ACTIVE_COMPARATOR

Standard care Cow's milk based formula

Intervention Type DIETARY_SUPPLEMENT

Standard hospital care would be given as as per local unit policy at the site.

Interventions

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Standard care Cow's milk based formula

Standard hospital care would be given as as per local unit policy at the site.

Intervention Type DIETARY_SUPPLEMENT

Dietary Supplement: PDHM Pasteurised Donor Human Milk

PDHM will be given to infants randomised to the intervention group

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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Standard Care_Formula milk PDHM_Donor milk

Eligibility Criteria

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Inclusion Criteria

Each participant must meet all the following criteria to be enrolled in this trial:

* Mother is \>18 years at the time of consent
* Mother has diabetes in pregnancy (type 1, type 2 or gestational diabetes)
* Mother intends to breastfeed for at least 6 weeks at the time of consent.
* Infant is born at ≥ 37 weeks and weighs \> 2.5kg
* Clinician caring for infant decides that supplementary nutrition (in addition to maternal breast milk) is required within the first 48 hours after birth.
* Parent/s provide/s a signed and dated informed consent form and has a legally acceptable representative capable of understanding the informed consent document and providing consent on the participant's behalf.

Exclusion Criteria

Mother/infant pairs meeting any of the following criteria will be excluded from the trial:

* Multiple pregnancy
* Mother has a condition that precludes maternal breast milk consumption e.g. HIV, receiving chemotherapy
* Infant has clinically significant congenital abnormality interfering with effective breastfeeding or breast milk consumption (e.g., cleft lip and palate, metabolic disorder) and/or requiring immediate care in a neonatal unit (e.g., congenital heart disease).
* Infant has received infant formula prior to randomisation.
* Infant admitted to neonatal intensive care prior to randomisation.
* More than 48 hours old at the time of recruitment
Minimum Eligible Age

0 Hours

Maximum Eligible Age

48 Hours

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Murdoch Childrens Research Institute

OTHER

Sponsor Role collaborator

La Trobe University

OTHER

Sponsor Role collaborator

University of Melbourne

OTHER

Sponsor Role collaborator

South Australian Health and Medical Research Institute

OTHER

Sponsor Role collaborator

Australian Red Cross Lifeblood

UNKNOWN

Sponsor Role collaborator

Ramsay Hospital Research Foundation

UNKNOWN

Sponsor Role collaborator

Monash University

OTHER

Sponsor Role collaborator

The Royal Women Hospital

UNKNOWN

Sponsor Role collaborator

Greenslopes Private Hospital

UNKNOWN

Sponsor Role collaborator

Frances Perry House

UNKNOWN

Sponsor Role collaborator

The University of Queensland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jennifer Koplin, PhD

Role: PRINCIPAL_INVESTIGATOR

Child Health Research Centre, University Of Queensland

Locations

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Royal Brisbane and Womens Hospital (QLD)

Brisbane, Queensland, Australia

Site Status

Greenslope Hospital (QLD)

Brisbane, Queensland, Australia

Site Status

Frances Perry House (VIC)

Melbourne, Victoria, Australia

Site Status

Royal Womens Hospital (VIC)

Melbourne, Victoria, Australia

Site Status

Countries

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Australia

Central Contacts

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Jennifer Koplin, PhD

Role: CONTACT

061+0400032577

Vanessa Clifford, PhD

Role: CONTACT

061+0437 527 044

References

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Griffith RJ, Harding JE, McKinlay CJD, Wouldes TA, Harris DL, Alsweiler JM; CHYLD Study Team. Maternal glycemic control in diabetic pregnancies and neurodevelopmental outcomes in preschool aged children. A prospective cohort study. Early Hum Dev. 2019 Mar;130:101-108. doi: 10.1016/j.earlhumdev.2019.01.010. Epub 2019 Feb 1. No abstract available.

Reference Type BACKGROUND
PMID: 30716594 (View on PubMed)

Shah R, Harding J, Brown J, McKinlay C. Neonatal Glycaemia and Neurodevelopmental Outcomes: A Systematic Review and Meta-Analysis. Neonatology. 2019;115(2):116-126. doi: 10.1159/000492859. Epub 2018 Nov 8.

Reference Type BACKGROUND
PMID: 30408811 (View on PubMed)

Forster DA, Moorhead AM, Jacobs SE, Davis PG, Walker SP, McEgan KM, Opie GF, Donath SM, Gold L, McNamara C, Aylward A, East C, Ford R, Amir LH. Advising women with diabetes in pregnancy to express breastmilk in late pregnancy (Diabetes and Antenatal Milk Expressing [DAME]): a multicentre, unblinded, randomised controlled trial. Lancet. 2017 Jun 3;389(10085):2204-2213. doi: 10.1016/S0140-6736(17)31373-9.

Reference Type BACKGROUND
PMID: 28589894 (View on PubMed)

Gertz B, DeFranco E. Predictors of breastfeeding non-initiation in the NICU. Matern Child Nutr. 2019 Jul;15(3):e12797. doi: 10.1111/mcn.12797. Epub 2019 Apr 2.

Reference Type BACKGROUND
PMID: 30767426 (View on PubMed)

De Bortoli J, Amir LH. Is onset of lactation delayed in women with diabetes in pregnancy? A systematic review. Diabet Med. 2016 Jan;33(1):17-24. doi: 10.1111/dme.12846. Epub 2015 Aug 18.

Reference Type BACKGROUND
PMID: 26113051 (View on PubMed)

Clifford V, Klein LD, Brown R, Sulfaro C, Hoad V, Gosbell IB, Pink J. Donor and recipient safety in human milk banking. J Paediatr Child Health. 2022 Sep;58(9):1629-1634. doi: 10.1111/jpc.16066. Epub 2022 Jul 2.

Reference Type BACKGROUND
PMID: 35779010 (View on PubMed)

Clifford V, Klein LD, Sulfaro C, Karalis T, Hoad V, Gosbell I, Pink J. What are Optimal Bacteriological Screening Test Cut-Offs for Pasteurized Donor Human Milk Intended for Feeding Preterm Infants? J Hum Lact. 2021 Feb;37(1):43-51. doi: 10.1177/0890334420981013. Epub 2020 Dec 22.

Reference Type BACKGROUND
PMID: 33351688 (View on PubMed)

Urashima M, Mezawa H, Okuyama M, Urashima T, Hirano D, Gocho N, Tachimoto H. Primary Prevention of Cow's Milk Sensitization and Food Allergy by Avoiding Supplementation With Cow's Milk Formula at Birth: A Randomized Clinical Trial. JAMA Pediatr. 2019 Dec 1;173(12):1137-1145. doi: 10.1001/jamapediatrics.2019.3544.

Reference Type BACKGROUND
PMID: 31633778 (View on PubMed)

Halken S, Muraro A, de Silva D, Khaleva E, Angier E, Arasi S, Arshad H, Bahnson HT, Beyer K, Boyle R, du Toit G, Ebisawa M, Eigenmann P, Grimshaw K, Hoest A, Jones C, Lack G, Nadeau K, O'Mahony L, Szajewska H, Venter C, Verhasselt V, Wong GWK, Roberts G; European Academy of Allergy and Clinical Immunology Food Allergy and Anaphylaxis Guidelines Group. EAACI guideline: Preventing the development of food allergy in infants and young children (2020 update). Pediatr Allergy Immunol. 2021 Jul;32(5):843-858. doi: 10.1111/pai.13496. Epub 2021 Mar 29.

Reference Type BACKGROUND
PMID: 33710678 (View on PubMed)

Titmuss A, Longmore DK, Barzi F, Barr ELM, Webster V, Wood A, Simmonds A, Brown ADH, Connors C, Boyle JA, Oats J, McIntyre HD, Shaw JE, Craig ME, Maple-Brown LJ; PANDORA Study Research Team. Association between hyperglycaemia in pregnancy and growth of offspring in early childhood: The PANDORA study. Pediatr Obes. 2022 Oct;17(10):e12932. doi: 10.1111/ijpo.12932. Epub 2022 May 29.

Reference Type BACKGROUND
PMID: 35644889 (View on PubMed)

Other Identifiers

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2024607

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2024-607

Identifier Type: -

Identifier Source: org_study_id

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