- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01536483
Effects of Recto-colic Enemas of Butyrate on the Digestive Disorders of Very Low Birth Weight Preterms <1250 Grams (NEOTRANS)
Effects of Recto-colic Enemas of Butyrate on the Digestive Disorders of Very Low Birth Weight Preterms <1250 Grams. Clinical Trial Prospective, Monocentric, Randomized in Double-blinded.
Clinical management of very low birth weight newborns (VLBW <1250g) consists in several challenges to adapt immature physiological systems to extrauterine life. Advances in neonatal medicine for pulmonary and/or neurological and/or cardiovascular diseases have significantly improved outcomes of these children. However, the gastro-intestinal (GI) tract remains a major cause of morbidity due to
- the immaturity of GI functions (prolonged ileus, bacterial overgrowth and translocation),
- the complication of GI tract immaturity: intestinal perforation and enterocolitis necrotizing)
- the need of a prolonged parenteral nutrition and its complications (central venous catheter infections, sepsis, electrolyte disturbances) but without generate a high proof level on this targeted population (<1250g).
The GI functions are progressively acquired during development and are largely sensitive to the environment, especially the intestinal luminal content. Indeed, probiotics and prebiotics have shown beneficial effects upon GI functions of newborns. One of the metabolite of the gut flora potentially involved is the butyrate. Butyrate is a short chain fatty acid produced in the colon by the microbiota (carbo-hydrates degradation). The colonic amount of butyrate increases gradually after birth. The beneficial effects of butyrate are related to its properties upon the epithelial barrier (anti-inflammatory, antioxidant, barrier repair) and upon the enteric nervous system (network of neurons and glial cells) that regulate GI functions and in particular colonic motility.
To date, there is no clinical consensus to manage digestive disorders of VLBW. Several clinical studies have assessed the effects of prokinetic drugs, dietary supplements (probiotics, prebiotics) but without generate a high proof level on this targeted population. In this context, a recent study of our Research Unit (INSERM-CIC Mère-Enfant 004) has shown benefit effects of oral probiotics supplementation in children with birth weight greater than 1000g but not in extreme preterms with birth weight less than 1000g.
The main hypothesis to explain theses results lies in the intensive use of antibiotic and feeding interruption frequency in this targeted population which induce disturbances in the composition of the gut lumen (in particular the flora).
Colonic enemas assessed in various observational studies concerning VLBW seem to demonstrate a clinical efficiency upon the colonic transit, underlying by mechanical and osmotic mechanisms.
Here, the investigators propose to evaluate the clinical efficiency of butyrate enemas by a prospective randomized clinical trial blinded design.
The purpose of NEOTRANS study is to demonstrate that butyrate enemas may improve the nutritional management of extreme preterm less than 1250 grams, by facilitating the development of colic motility and clinical nutrition tolerance.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Nantes, France
- Nantes
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Any preterm infant with a birth weight less than or equal to 1250 grams admitted in the neonatal intensive care unit of Nantes Hospital
- Inborn or outborn
- No signs of gastrointestinal perforation or ECUN
- Absence of severe congenital disease
- Written informed consent of parental authority.
Exclusion Criteria:
- Newborn with birth weight greater than 1250 grams,
- Gestational age > 30 AG
- Digestive pathology diagnosed prior PND5: perforation, necrotizing enterocolitis, malformations
- Severe congenital pathology inconsistent with clinical assessment.
- Parental Refusal
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Butyrate
New born with a birth weight <1000g: Seven enemas of butyrate will be performed every 2 days from PND5 New born with a birth weight >1000g: Seven enemas of butyrate will be performed every day from PND5 |
Seven enemas
|
No Intervention: Therapeutic Abstention
The protocol will pretend enema: instillation in the diaper the product under consideration, to make the two indistinguishable processes (time, odor, wicking diaper ...)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy of colonic butyrate enemas in digestive maturation of preterms
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
The primary outcome of NEOTRANS study consists in the evaluation of the effects of colonic butyrate enemas upon the digestive maturation of preterms. This endpoint is based on a clinical criteria that is the delay of weaning of the parenteral nutrition support. An increase of 25% (50 vs 75%) will be considered clinically significant. Parenteral nutrition weaning is defined as the day where enteral caloric intake reach 80% of total calories. |
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Gastrointestinal complications frequency
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
Nosocomial infections frequency
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
Iatrogenic effect
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
whole gut transit time (red carmine test)
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
Growth
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
Comparaison between 2 arms of height, weight and head circumference
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
Invasive ventilation support
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
Bronchopulmonary dysplasia incidence
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
Hospitalization duration
Time Frame: participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
participants will be followed for the duration of hospital stay, an expected average of 5 weeks
|
|
Neuromotor development
Time Frame: 2 years
|
ASQ questionnaire
|
2 years
|
Collaborators and Investigators
Sponsor
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 (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- BRD/10/04-H
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 Very Low Birth Weight Preterms
-
Children's Hospital of Fudan UniversityCompleted
-
Princess Amalia Children's ClinicCompleted
-
The Hospital for Sick ChildrenRecruitingVery Low Birth Weight InfantCanada
-
Milton S. Hershey Medical CenterChildren's Miracle NetworkCompletedVery Low Birth Weight InfantsUnited States
-
Children's Hospital of Fudan UniversityNot yet recruitingVery Low Birth Weight InfantChina
-
Baylor College of MedicineRecruitingInfant, Very Low Birth WeightUnited States
-
Baylor College of MedicineCompletedInfant, Very Low Birth WeightUnited States
-
Wyss Institute at Harvard UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development... and other collaboratorsCompleted
-
The Hospital for Sick ChildrenUniversity of Toronto; Sinai Health SystemCompletedInfant, Very Low Birth WeightCanada
-
Children's Hospital of Fudan UniversityCompleted
Clinical Trials on Butyrate enemas
-
Children's Hospital Los AngelesRecruiting
-
Assistance Publique Hopitaux De MarseilleNot yet recruitingHirschsprung's DiseaseFrance
-
Jinling Hospital, ChinaUnknown
-
Unilever R&DLeiden University Medical CenterCompleted
-
University of Alabama at BirminghamCompletedValue of the Bowel Preparation and Diet Change Versus no Intervention | Preoperative Bowel RegimenUnited States
-
Maastricht University Medical CenterCompleted
-
Maastricht University Medical CenterCompleted
-
Duke UniversityTerminatedFeeding Behavior | Diet Habit | Behavior, HealthUnited States
-
Federico II UniversityCompleted