- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01609894
Individualized Fortification of Breast Milk (IFO)
Individualized Fortification of Breast Milk With Fat, Carbohydrate and Protein for Preterm Infants
The proposed research will investigate individualized fortification of breast milk based on daily milk analysis of carbohydrate, protein, and fat content in a randomized double blind controlled trial. The combination of additional fat, carbohydrate and protein and commercial fortifier will be added to ensure that the milk contains the target amounts of nutrient. Growth and development of these infants will be compared with that of infants fed mother's milk that has been supplemented with the current standard amounts. The postnatal growth of the infants will be assessed by measuring weight, length and head circumference and fat and lean mass using highly accurate, non-invasive methods throughout the intervention period and at the first follow-up visit after discharge at 3 months. Neurological development will be analyzed at the age of 18 months.
The investigators hypothesize that individualized fortification of breast milk improves the nutritional intake of preterm infants, optimizing growth, and thus this will positively impact neurodevelopment and health.
Study Overview
Status
Conditions
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Christoph Fusch, MD, PhD, FRCPC
- Phone Number: 75721 +1 905 521 2100
- Email: fusch@mcmaster.ca
Study Contact Backup
- Name: Niels Rochow, MD
- Phone Number: 23106 +1 905 521 2100
- Email: rochow@mcmaster.ca
Study Locations
-
-
Ontario
-
Hamilton, Ontario, Canada, L8S 4K1
- Recruiting
- Faculty of Health Science, McMaster Children's Hospital
-
Contact:
- Christoph Fusch, MD, PhD, FRCPC
- Phone Number: 75721 +1 905 521 2100
- Email: fusch@mcmaster.ca
-
Principal Investigator:
- Christoph Fusch, MD, PhD, FRCPC
-
Sub-Investigator:
- Niels Rochow, MD
-
Sub-Investigator:
- Gerhard Fusch, PhD
-
Sub-Investigator:
- Salhab el Helou, MD, FRCPC
-
Sub-Investigator:
- Sabiha Ahmad
-
Sub-Investigator:
- Akshdeep Singh Bhatia
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Sub-Investigator:
- Klaus Wutzke, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion criteria:
- Gestational age < 32weeks (maternal dates or early fetal ultrasound);
- Tolerating an enteral intake of ≥ 100 ml/kg/d for ≥ 24h;
- Subject is anticipated to receive the intervention for ≥ 3 consecutive weeks after full enteral feeding (≥ 150 mL/kg/d) has been achieved; and
- Written informed consent has been obtained from the infant's legal representative.
Exclusion criteria:
- Infants with intrauterine growth restriction, small for gestational age defined by a weight less than 3rd percentile using sex specific reference data for birth weight
- Gastrointestinal malformation, major congenital anomalies and chromosomal abnormalities;
- Babies with enterostoma or short gut syndrome;
- Necrotizing enterocolitis, defined by feeding intolerance associated with positive x-ray findings (pneumatosis intestinalis - Bell Stage 2; air in the biliary tract or free air in the peritoneum - Bell Stage 3);
- Renal disease, defined by symptoms (oliguria, anuria, proteinuria, hematuria) associated with an increased blood urea nitrogen 10 mmol/L79 and creatinine of 130 mmol/L80;
- Hepatic dysfunction, defined by jaundice (direct bilirubin >1.0 mg/dl) that is associated with one or more abnormal liver function tests (AST, ALT or GGT);
- Participation in another clinical trial that may affect outcomes of this study; or
- Probability of transfer to another NICU or level II nursery outside the McMaster Children's Hospital before the minimum period of three weeks is completed.
Post-randomisation exclusion criteria:
- Infants fed more than 25% of mean caloric intake for a consecutive week with formula milk;
- Fluid restriction < 140mL/kg/d for ≥ 3 consecutive days;
- Sepsis - all infants with gram-negative sepsis will be removed from the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Individualized fortification of breast milk
|
Lactose, fat and protein content will be measured prior to breast milk fortification. Subsequently, breast milk for preterm infants will individually fortified adjusted by using data from milk analysis. |
Active Comparator: Routine fortification of breast milk
|
Infants will be fed routine fortified breast milk.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
growth during first three weeks of intervention
Time Frame: first three weeks during intervention before 36 weeks of gestation
|
change in body weight gain will be accessed daily.
|
first three weeks during intervention before 36 weeks of gestation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
enteral energy intake
Time Frame: from inclusion at postmentrual age <32 weeks until 36 weeks
|
fat, carbohydrate, protein, and caloric intake by enteral feeding will be assesed daily
|
from inclusion at postmentrual age <32 weeks until 36 weeks
|
neurodevelopment
Time Frame: at 18 month corrected age
|
Bayley Scales of Infant Development III
|
at 18 month corrected age
|
weight gain
Time Frame: from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
change in body weight [g]
|
from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
body length
Time Frame: from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
change in body length [cm]
|
from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
head circumference
Time Frame: from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
change in head circumference [cm]
|
from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
body composition
Time Frame: from inclusion at postmentrual age <32 weeks until 3 month corrected age
|
change in body composition measured with air displacement plethysmography (body weight, body volume, calculated fat and lean mass)
|
from inclusion at postmentrual age <32 weeks until 3 month corrected age
|
body composition (bio-electrical impedance analysis)
Time Frame: from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
change in body composition measured with bio-electrical impedance analysis (impedance at 5, 50, 100 and 200 kHz, resistance at 50 kHz, reactance at 50 kHz, phase angle at 50 kHz)
|
from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
skin fold thickness
Time Frame: from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
change in skin fold thickness [cm]
|
from inclusion at postmentrual age <32 weeks until 18 month corrected age
|
feeding intolerance
Time Frame: during intervention (postmentrual age <32 weeks until 36 weeks)
|
occurence of feeding intolerance defined by vomitting, bloody gastric residuals, or abnormal abdomen (tender, discolored, absent bowel sounds)
|
during intervention (postmentrual age <32 weeks until 36 weeks)
|
morbidity
Time Frame: during intervention (postmentrual age <32 weeks until 36 weeks)
|
during intervention (postmentrual age <32 weeks until 36 weeks)
|
|
nutrient's blood parameter
Time Frame: during intervention (postmentrual age <32 weeks until 36 weeks)
|
triglycerides, glucose, blood urea nitrogen, blood gases, electrolytes, pH
|
during intervention (postmentrual age <32 weeks until 36 weeks)
|
breast milk analysis
Time Frame: during intervention (postmentrual age <32 weeks until 36 weeks)
|
using near-infrared analysis breast milk's macronutrients (fat, lactose and protein) will be measured daily
|
during intervention (postmentrual age <32 weeks until 36 weeks)
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Christph Fusch, MD, PhD, FRCPC, McMaster Children's Hospital
Publications and helpful links
General Publications
- Fabrizio V, Trzaski JM, Brownell EA, Esposito P, Lainwala S, Lussier MM, Hagadorn JI. Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk. Cochrane Database Syst Rev. 2020 Nov 23;11(11):CD013465. doi: 10.1002/14651858.CD013465.pub2.
- Rochow N, Fusch G, Ali A, Bhatia A, So HY, Iskander R, Chessell L, El Helou S, Fusch C. Individualized target fortification of breast milk with protein, carbohydrates, and fat for preterm infants: A double-blind randomized controlled trial. Clin Nutr. 2021 Jan;40(1):54-63. doi: 10.1016/j.clnu.2020.04.031. Epub 2020 May 6.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 201205IFO
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.
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