- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01891500
Early iNO for Oxidative Stress, Vascular Tone and Inflammation in Babies With Hypoxic Respiratory Failure
January 5, 2020 updated by: University of Florida
Effect of Early iNO on Oxidative Stress, Vascular Tone and Inflammation in Term and Late-Preterm Infants With Hypoxic Respiratory Failure
The investigators in this study are concerned about the harmful effects of oxygen exposure in newborn infants, particularly at high concentrations.
Inhaled nitric oxide (iNO) is an FDA approved drug for the treatment of hypoxic respiratory failure (HRF) in term and late-preterm babies greater than 34 weeks gestation.
Hypoxic respiratory failure occurs when a patient's lungs cannot get enough oxygen into their bloodstream.
This condition is traditionally treated with high concentrations of oxygen and most often requires the patient be placed on a ventilator (breathing machine).
The administration of inhaled nitric oxygen directly into the lungs often improves blood oxygen levels and allows caretakers to reduce the amount of oxygen given to the baby.
The purpose of this research study is to evaluate if giving the inhaled nitric oxide earlier in the course of disease improves the effectiveness of the drug, reduces the amount of cellular injury from oxygen exposure, and decreases the total amount of time a patient requires supplemental oxygen.
This study uses an FDA approved drug in a new manner.
Study Overview
Status
Withdrawn
Conditions
Intervention / Treatment
Study Type
Interventional
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Florida
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Gainesville, Florida, United States, 32610
- Shands Hospital at the University of Florida
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
1 year to 1 year (Child)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Gestational age ≥ 35 weeks gestation
- Age of life ≤ 48 hours
- Diagnosis of hypoxic respiratory failure (HRF) as defined by a post-ductal SaO2 ≤90% in ≥50% oxygen with a PEEP of ≥ 6cm or an oxygenation index (OI) ≥ 10 but ≤ 15 when mean airway pressure and PaO2 are known.
- Mothers (ages 18 - 65) of eligible subjects for additional data collection
Exclusion Criteria:
- Gestational age < 35 weeks gestation.
- Post-natal age > 48 hours.
- Previous treatment with 100% oxygen for longer than 4 hours.
- Confirmed congenital diaphragmatic hernia.
- Suspected or confirmed congenital airway or pulmonary anomaly.
- Suspected or confirmed chromosomal anomaly or genetic aberration, with the exception of patients with trisomy 21 who do not have complex congenital heart disease.
- Infants with pneumothorax as the primary cause of their HRF.
- Infants with confirmed complex congenital heart disease.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Early inhaled nitric oxide
Patients randomized to receive iNO at OI 10-15.
|
Drug is initiated at 20ppm.
Patients randomized to receive iNO at OI 10-15.
Other Names:
|
Placebo Comparator: Bioinert inhaled gas (nitrogen gas)
Patients randomized to bioinert inhaled gas at OI 10-15.
|
Placebo gas (bioinert), Patients randomized to bioinert inhaled gas at OI 10-15.
Other Names:
|
Active Comparator: Crossover iNO
Patients who deteriorate (OI >20 on two consecutive blood gases) will be unblinded.
If they are receiving placebo gas, they will be started on iNO and make up the crossover cohort.
|
Patients who deteriorate (OI >20 on two consecutive blood gases) will be unblinded.
If they are receiving placebo gas, they will be started on iNO and make up the crossover cohort.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Biomarkers of oxidative injury.
Time Frame: Urine samples will be collected upon enrollment and then at specific time points within the first 48 hours of study intervention to compare the change in biomarker concentrations from baseline up to hour 48.
|
Early administration of iNO to infants with HRF will result in reduced hyperoxia-mediated oxidative injury as measured by known biomarkers of oxygen free radical injury, including malondialdehyde and 8-hydroxy-2'-deoxyguanosine.
|
Urine samples will be collected upon enrollment and then at specific time points within the first 48 hours of study intervention to compare the change in biomarker concentrations from baseline up to hour 48.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Responsiveness to study treatment.
Time Frame: Arterial oxygen concentration will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in arterial oxygen concentration from baseline up to hour 36.
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Earlier administration of iNO to infants with HRF/PPHN (persistent pulmonary hypertension of the newborn) will lessen reactive oxygen species formation resulting in improved responsiveness to the drug as measured by the initial changes in arterial oxygen concentration after administration of the drug.
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Arterial oxygen concentration will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in arterial oxygen concentration from baseline up to hour 36.
|
Expression of endothelin-1.
Time Frame: Concentration of endothelin-1 will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in concentration from baseline up to hour 36.
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Earlier treatment with iNO may potentiate pulmonary vasodilation by modulating endothelin-1 expression.
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Concentration of endothelin-1 will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in concentration from baseline up to hour 36.
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Markers of inflammation.
Time Frame: Concentrations of pro and anti-inflammatory markers will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in concentrations from baseline up to hour 36.
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Early iNO may up-regulate production of endogenous anti-inflammatory eicosanoids such as PGE2 (prostaglandin E2).
Additionally, avoidance of hyperoxia in these patients may mitigate pro-inflammatory cytokines known to potentiate lung injury.
|
Concentrations of pro and anti-inflammatory markers will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in concentrations from baseline up to hour 36.
|
Duration of oxygen treatment.
Time Frame: Participants will be followed for the duration of their hospital stay, with an expected average stay of 4 weeks.
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Early administration of iNO to infants with HRF will result in at least a 15% reduction in total days of oxygen therapy.
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Participants will be followed for the duration of their hospital stay, with an expected average stay of 4 weeks.
|
Expression of VEGF (vascular endothelial growth factor).
Time Frame: Concentration of VEGF will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in concentration from baseline up to hour 36.
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Earlier treatment with iNO may potentiate pulmonary vasodilation by preventing hyperoxic down regulation of VEGF.
|
Concentration of VEGF will be measured upon enrollment and at specific time points in the first 36 hours of study intervention to compare the change in concentration from baseline up to hour 36.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Catalina Bazacliu, MD, University of Florida
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 1, 2016
Primary Completion (Actual)
September 18, 2019
Study Completion (Actual)
September 19, 2019
Study Registration Dates
First Submitted
June 19, 2013
First Submitted That Met QC Criteria
June 28, 2013
First Posted (Estimate)
July 3, 2013
Study Record Updates
Last Update Posted (Actual)
January 7, 2020
Last Update Submitted That Met QC Criteria
January 5, 2020
Last Verified
January 1, 2020
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Respiratory Tract Diseases
- Respiration Disorders
- Lung Diseases
- Infant, Newborn, Diseases
- Hypertension
- Inflammation
- Respiratory Insufficiency
- Hypertension, Pulmonary
- Persistent Fetal Circulation Syndrome
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Vasodilator Agents
- Autonomic Agents
- Peripheral Nervous System Agents
- Protective Agents
- Bronchodilator Agents
- Anti-Asthmatic Agents
- Respiratory System Agents
- Antioxidants
- Free Radical Scavengers
- Endothelium-Dependent Relaxing Factors
- Gasotransmitters
- Nitric Oxide
Other Study ID Numbers
- IRB201400791
- 00089105 (Other Identifier: RAC)
- OCR17867 (Other Identifier: Universiy of Florida)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
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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