- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00966823
Fetal Tracheal Balloon Study in Diaphragmatic Hernia
Phase 2 Fetal Tracheal Balloon (IDE G080077) Study in Diaphragmatic Hernia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Congenital diaphragmatic hernia (CDH) has traditionally been associated with very high mortality rates. Most infants died of pulmonary hypoplasia and severe pulmonary hypertension. This led to correction of CDH and pulmonary hypoplasia before birth. Unfortunately, maternal morbidity of open fetal surgery was significant and fetal mortality was very high (>60%). Moreover, the results of postnatal therapy for CDH improved dramatically, from less than 20% survival several decades ago to more than 70% today.
Fetal intervention has evolved as well, to a minimally invasive approach that involves a single endoscopic port and occlusion of the fetal trachea. While this has considerably decreased the morbidity and fetal mortality of the in utero procedure, its results do not exceed the overall (i.e., non-stratified) results of contemporary postnatal treatment. Most recently, a multicentric cooperative study under (Eurofoetus) has conducted a clinical trial comparing postnatal treatment with endoscopic fetal tracheal occlusion for the most severe forms of CDH. Results of the Eurofoetus trial and of a recent retrospective review involving European and North-American centers have shown the following: 1) It is possible to identify a specific subgroup of fetuses with CDH in whom survival can be predicted to be less than 10%, despite all current methods of postnatal treatment, 2) Survival of fetuses with predicted postnatal survival of 8% was >50% following endoscopic fetal tracheal occlusion, and 3) Fetal tracheal occlusion in that group resulted in an increase in lung size (LHR), from an average of 0.7 pre-intervention, to 1.7 post-intervention.
Based on the available research literature, the results of the Eurofoetus trial, and this institution's experience with endoscopic fetal surgery, we hypothesize that in the highest risk group of fetuses with congenital diaphragmatic hernia, where chances of survival is estimated at less than 10%, endoscopic fetal tracheal occlusion in late second trimester, with reversal of occlusion in mid-third trimester, allows catch-up lung growth and maturation and converts the condition into one with intermediate to good prognosis (predicted survival 50-60%). We propose to offer this form of treatment, under an FDA-approved Investigational Device Exemption (G080077), to eligible patients, on a case-by-case basis, after discussion before a multidisciplinary board.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02903
- Rhode Island Hospital/Women & Infants' Hospital of Rhode Island
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Singleton pregnancies
- Isolated congenital diaphragmatic hernia
- Normal karyotype (amniocentesis)
- Initial diagnosis before 26 weeks gestation
- Competent cervix
- Severity of CDH: lung-to-head ratio (LHR) ≤0.8 at 22-26 weeks gestation
- Liver herniation in the chest
- Informed consent
Exclusion Criteria:
- Preterm labor, premature rupture of membranes or amniotic leak
- Significant maternal morbidity
- Minor (<18 years)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Detachable balloon
Intervention: Fetuses treated with endoscopic tracheal occlusion
|
Fetal tracheal obstruction with detachable balloon (device): Endoscopic placement of a detachable balloon in the fetal trachea at 28-30 weeks gestation. - Ultrasound-guided puncture of balloon or, if not feasible, repeat endoscopic tracheoscopy with puncture and retrieval of the balloon at 34 weeks gestation.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Newborn Survival at Birth
Time Frame: Newborn period (1 day)
|
Newborn period (1 day)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Newborn Survival at 30 Days
Time Frame: 30 days
|
30 days
|
|
Maternal Complications
Time Frame: Intervention to 30 days postpartum
|
Intervention to 30 days postpartum
|
|
Fetal Morbidity
Time Frame: Intervention to delivery
|
Fetal morbidity, fetal mortality
|
Intervention to delivery
|
Number of Participants With In Utero Lung Growth (LHR) >1.4
Time Frame: Intervention to 2 weeks post-intervention
|
Inclusion criterion for the study is LHR<0.9 (extreme pulmonary hypoplasia). Given that LHR is relatively constant during 2nd and 3rd trimester of gestation, "In utero lung growth" is defined as LHR>1.4 (definition of mild/moderate pulmonary hypoplasia) within 2 weeks of intervention. Outcome measure = number of participants with LHR>1.4 at 2 weeks post-intervention |
Intervention to 2 weeks post-intervention
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Francois I Luks, MD, PhD, Rhode Island Hospital
Publications and helpful links
General Publications
- Jani JC, Nicolaides KH, Gratacos E, Valencia CM, Done E, Martinez JM, Gucciardo L, Cruz R, Deprest JA. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol. 2009 Sep;34(3):304-10. doi: 10.1002/uog.6450.
- De Paepe ME, Johnson BD, Papadakis K, Sueishi K, Luks FI. Temporal pattern of accelerated lung growth after tracheal occlusion in the fetal rabbit. Am J Pathol. 1998 Jan;152(1):179-90.
- Wild YK, Piasecki GJ, De Paepe ME, Luks FI. Short-term tracheal occlusion in fetal lambs with diaphragmatic hernia improves lung function, even in the absence of lung growth. J Pediatr Surg. 2000 May;35(5):775-9. doi: 10.1053/jpsu.2000.6067.
- Luks FI, Wild YK, Piasecki GJ, De Paepe ME. Short-term tracheal occlusion corrects pulmonary vascular anomalies in the fetal lamb with diaphragmatic hernia. Surgery. 2000 Aug;128(2):266-72. doi: 10.1067/msy.2000.107373.
- Deprest JA, Flemmer AW, Gratacos E, Nicolaides K. Antenatal prediction of lung volume and in-utero treatment by fetal endoscopic tracheal occlusion in severe isolated congenital diaphragmatic hernia. Semin Fetal Neonatal Med. 2009 Feb;14(1):8-13. doi: 10.1016/j.siny.2008.08.010. Epub 2008 Oct 8.
- Bealer JF, Skarsgard ED, Hedrick MH, Meuli M, VanderWall KJ, Flake AW, Adzick NS, Harrison MR. The 'PLUG' odyssey: adventures in experimental fetal tracheal occlusion. J Pediatr Surg. 1995 Feb;30(2):361-4; discussion 364-5. doi: 10.1016/0022-3468(95)90590-1.
- Luks FI, Roggin KK, Wild YK, Piasecki GJ, Rubin LP, Lesieur-Brooks AM, De Paepe ME. Effect of lung fluid composition on type II cellular activity after tracheal occlusion in the fetal lamb. J Pediatr Surg. 2001 Jan;36(1):196-201. doi: 10.1053/jpsu.2001.20051.
- De Paepe ME, Johnson BD, Papadakis K, Luks FI. Lung growth response after tracheal occlusion in fetal rabbits is gestational age-dependent. Am J Respir Cell Mol Biol. 1999 Jul;21(1):65-76. doi: 10.1165/ajrcmb.21.1.3511.
- De Paepe ME, Papadakis K, Johnson BD, Luks FI. Fate of the type II pneumocyte following tracheal occlusion in utero: a time-course study in fetal sheep. Virchows Arch. 1998 Jan;432(1):7-16. doi: 10.1007/s004280050128.
- Papadakis K, Luks FI, De Paepe ME, Piasecki GJ, Wesselhoeft CW Jr. Fetal lung growth after tracheal ligation is not solely a pressure phenomenon. J Pediatr Surg. 1997 Feb;32(2):347-51. doi: 10.1016/s0022-3468(97)90208-6.
- Luks FI, Deprest JA, Gilchrist BF, Peers KH, van der Wildt B, Steegers EA, Vandenberghe K. Access techniques in endoscopic fetal surgery. Eur J Pediatr Surg. 1997 Jun;7(3):131-4. doi: 10.1055/s-2008-1071072.
- Yang SH, Nobuhara KK, Keller RL, Ball RH, Goldstein RB, Feldstein VA, Callen PW, Filly RA, Farmer DL, Harrison MR, Lee H. Reliability of the lung-to-head ratio as a predictor of outcome in fetuses with isolated left congenital diaphragmatic hernia at gestation outside 24-26 weeks. Am J Obstet Gynecol. 2007 Jul;197(1):30.e1-7. doi: 10.1016/j.ajog.2007.01.016.
- Luks FI, Carr SR, Muratore CS, O'Brien BM, Tracy TF. The pediatric surgeons' contribution to in utero treatment of twin-to-twin transfusion syndrome. Ann Surg. 2009 Sep;250(3):456-62. doi: 10.1097/SLA.0b013e3181b45794.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- G080077
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Lung Disease
-
Schön Klinik Berchtesgadener LandCompletedChronic Obstructive Lung Disease (n=10) | Interstitial Lung Disease (n=10)Germany
-
New Aera, IncUnknownInterstitial Lung Disease | Chronic Obstructive Lung Disease
-
Assistance Publique - Hôpitaux de ParisCompletedChronic Obstructive Lung Disease (COLD)France
-
Centre Hospitalier Intercommunal CreteilRecruitingChronic Obstructive Pulmonary Disease | Chronic Obstructive Lung DiseaseFrance
-
Philip DiazCompletedChronic Obstructive Lung DiseaseUnited States
-
University Hospital, Gentofte, CopenhagenCompletedChronic Obstructive Lung DiseaseDenmark
-
Schön Klinik Berchtesgadener LandCompletedChronic Obstructive Lung Disease
-
Rigshospitalet, DenmarkLundbeck FoundationCompleted
-
Jorgen VestboWithdrawn
-
University of British ColumbiaUnknownChronic Obstructive Lung DiseaseCanada
Clinical Trials on Fetal tracheal obstruction with detachable balloon (device)
-
University of Colorado, DenverRecruiting
-
University Hospital, GasthuisbergThe University of Texas Health Science Center, Houston; Hospital Clinic of... and other collaboratorsCompletedCongenital Diseases | Pulmonary Hypoplasia | Diaphragmatic HerniaUnited Kingdom, Canada, United States, Belgium, Italy, Germany, France, Japan, Australia, Poland, Spain
-
University of California, San FranciscoNo longer availableSevere Congenital Diaphragmatic HerniaUnited States
-
University of California, DavisNot yet recruitingCongenital Diaphragmatic HerniaUnited States
-
Dr Erin PerroneRecruitingCongenital Diaphragmatic HerniaUnited States
-
Universitaire Ziekenhuizen KU LeuvenRecruitingCongenital Diaphragmatic HerniaBelgium
-
Aimen F. Shaaban, MDRecruitingCongenital Diaphragmatic HerniaUnited States
-
Duke UniversityCompletedVentilator-Induced Lung Injury | Mechanical Ventilation Complication | Acute Respiratory FailureUnited States
-
Hillel Yaffe Medical CenterUnknownCervix; Insufficient Dilatation in LaborIsrael
-
Boston Scientific CorporationActive, not recruitingCoronary Artery DiseaseJapan