Comparison Of Respiratory Support After Delivery on Infants Born Before 28 Weeks Gestational Age (CORSAD)

May 28, 2020 updated by: Baldvin Jonsson

A Randomised Controlled Trial of Delivery Room Intubation Rates Comparing a New System and T-piece Resuscitation System for Initial Stabilisation of Infants Born <28 Weeks

Trial purpose: For infants born <28 weeks of age, can initial respiratory resuscitation with new system (low imposed work of breathing and prongs) reduce the frequency of delivery room intubations compared to standard treatment with T-piece resuscitator system (high imposed work of breathing and face mask)?

Trial summary: This is a randomised controlled trial of delivery room intubation rates comparing a new system and T-piece resuscitation system for initial stabilisation of infants born <28 weeks.

Study Overview

Detailed Description

The study is a two arm randomised comparison of two systems (T-piece device and the new system) for respiratory support after delivery of an infant born less than 28 weeks gestational age (GA). This multicentre trial will start at Karolinska University Hospital and other sites can join throughout the study period. The trial is academic with the coordinating investigator as sponsor. No company funding will be considered.

The new device has been designed for neonatal resuscitation and CE-marked for this intended use. The device is operated/handled in a similar way to existing devices and can provide support according to resuscitation guidelines.

During spontaneous breathing the continuous positive airway pressure (CPAP) provided with the new system is more pressure stable and has low imposed work of breathing. The benefits of decreased imposed work of breathing during resuscitation have not previously been investigated. The new system has the option of using prongs as the patient interface. Prongs have shown promising results in trials and have theoretical benefits. We hypothesis that the combined use of prongs and low imposed work of breathing could reduce the number of infants that need mechanical ventilation.

Screening for eligibility and consent will be performed on mothers with threatening delivery of an extremely premature infant (<28 weeks gestational age). There is no lower gestational age limit but patients should not be included if there is a decision to intubate prior to delivery or treatment limitations.

After a patient has been enrolled the randomisation will be on hold until delivery is imminent. Randomisation will be stratified on centre, gestational age and antenatal steroid treatment. The interventions cannot be blinded.

The management of respiratory support is according to international guidelines and a detailed description is provided in the clinical management appendix. The intervention is respiratory support for the first 10-30 minutes of life and will begin after birth when the infant is transferred to the resuscitation team. The intervention ends 1) when an infant is intubated (primary outcome), 2) after a minimum of 10 minutes support, with the randomized system, the patient is stable and breathing adequately, 3) at 30 minutes when the respiratory support can continue as decided by the clinicians (cross-over not allowed).

Apart from the system used for respiratory support all patients will receive standard care. No assessments or investigations of the trial subjects are planned. Data will be reported by the resuscitation team and collected from records.

The primary outcome is delivery room intubation or death. The secondary outcomes include time to intubation, use of surfactant, use of positive pressure ventilation, respiratory support at 72 hours and temperature on intensive care admission. Safety variables include pneumothorax, intraventricular haemorrhage and problems with ventilation and equipment.

All analysis will be on intention to treat and p<0.05 considered statistically significant. The primary outcome variable (delivery room intubation or death) will represent a 2x2 cross table and analysed with Pearson chi-square test. The secondary outcomes include Kaplan Meier analysis of time to intubation and comparisons of means for continuous variables. There are no predetermined subgroups. Subgroup analysis will be used to describe the population and to generate hypotheses.

Study Type

Interventional

Enrollment (Actual)

250

Phase

  • Not Applicable

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

      • Reykjavík, Iceland, 101
        • Department of neonatology, University Hospital of Iceland
      • Vilnius, Lithuania, LT-08406
        • Neonatal Unit, Vilnius University Hospital Santaros Klinikos
      • Stavanger, Norway, 4011
        • Stavanger University Hospital, Department of Pediatrics
      • Poznan, Poland, 60-535
        • Department of Neonatology, Poznan University of Medical Sciences
      • Linköping, Sweden, 58185
        • University Hospital Linköping, Department of Pediatrics
      • Stockholm, Sweden, 171 76
        • Karolinska University Hospital, Neonatology department

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

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Born <28 weeks gestational age at a university hospital
  2. Delivery can be vaginal or with caesarean section and steroid prophylaxis to mother can be complete, incomplete or not given

Exclusion Criteria:

  1. Decision on treatment limitations before randomisation
  2. Decision to intubate infant made before delivery (for example local routine for infants born before 23 weeks GA)
  3. Known airway, pulmonary, cardiac, gastro-intestinal tract malformations
  4. Known neuromuscular disease
  5. No study neonatologist available

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Reference Device: T-piece System
Infants will receive support by a standard T-piece resuscitator system (manufacturer not dictated in protocol). Apart from the system used for respiratory support all patients will receive standard care (specified in management protocol)
Other Names:
  • Neopuff™ Infant T-Piece Resuscitator
  • T-piece Disposable Circuit Kit (GE Healthcare)
  • Other T-piece manufacturers
Active Comparator: Investigational Device: The New System
Infants will receive support by the new system (manufactured by Inspiration Healthcare, UK). Apart from the system used for respiratory support all patients will receive standard care (specified in management protocol)
Other Names:
  • Manufacturing and CE-marking by Inspiration Healthcare, UK

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Delivery room intubation or death
Time Frame: 0-30 minutes
The primary outcome is delivery room intubation or death. Death has to be included in the primary outcome since patients that die may not always be intubated. The variable is a dichotomous outcome and reported by the resuscitation team.
0-30 minutes

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Time to primary outcome (intubation or death)
Time Frame: up to 72 hours of age
The time (minutes:hours) that a patient reach primary outcome. Data reported by resuscitation team or collected at patient record review of the first three days of life. This is a safety endpoint.
up to 72 hours of age
Death
Time Frame: up to 72 hours of age
The time (minutes:hours) that a patient died. Data reported by resuscitation team or collected at patient record review of the first three days of life. This is a safety endpoint.
up to 72 hours of age
Intra ventricular haemorrhage grade III or more
Time Frame: up to 72 hours of age
The number of patients with an intra ventricular hemorrhage grade III or more. Data collected at patient record review of the first three days of life. This is a safety endpoint.
up to 72 hours of age
Airleaks and pneumothorax
Time Frame: up to 72 hours of age
The number of patients with airleaks or pneumothorax during resuscitation or the first 72 hours of life. Data reported by resuscitation team or collected at patient record review of the first three days of life. This is a safety endpoint.
up to 72 hours of age
Failed ventilation
Time Frame: 0-30 minutes
The number of patients with failed ventilation during resuscitation. Data reported by resuscitation team. This is a safety endpoint.
0-30 minutes
Device problems or malfunction
Time Frame: 0-30 minutes
The instances that there was a problem with the randomized intervention. Data reported by resuscitation team. This is a safety endpoint. Device problems or malfunction activates the adverse events handling protocol.
0-30 minutes

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Surfactant use in delivery room (DR) and neonatal intensive care unit (NICU)
Time Frame: up to 72 hours of age
The number of patients, method used and the number of doses that a patient received in the DR and NICU. Data reported by resuscitation team or collected at patient record review of the first three days of life.
up to 72 hours of age
The use of positive pressure ventilation (PPV) in delivery room
Time Frame: 0-30 minutes
The number of patients that needed PPV during resuscitation. Data reported by resuscitation team.
0-30 minutes
Use of sustained inflation (not recommended)
Time Frame: 0-30 minutes
The number of patients that were treated with a sustained inflation during resuscitation. This is not recommended and a violation of protocol. Data reported by resuscitation team.
0-30 minutes
Reason for DR intubation
Time Frame: 0-30 minutes
The main reason for intubating patients in the DR during resuscitation. Data reported by resuscitation team.
0-30 minutes
Response to resuscitation measured by APGAR at 1, 5 and 10 minutes
Time Frame: 1-10 minutes
The initial status of the patient and response to resuscitation measured by APGAR-scores (0-2 points on the five standard criteria). Data reported by resuscitation team.
1-10 minutes
Inspired oxygen level, oxygen saturation (SpO2) and level of CPAP support at 5 and 10 minutes
Time Frame: 5-10 minutes
The initial status of the patient and response to resuscitation measured by need for oxygen (%), SpO2 (%) and the level of CPAP support (cm H2O). Data reported by resuscitation team.
5-10 minutes
Patient temperature on NICU admission
Time Frame: 10-180 minutes
The temperature of the patients when they arrive to NICU (°C). Data collected at patient record review of the first three days of life.
10-180 minutes
Reason for NICU intubation
Time Frame: up to 72 hours of age
The main reason for intubating patients in the NICU. Data collected at patient record review of the first three days of life.
up to 72 hours of age
Mechanical ventilation at any time <72 h
Time Frame: up to 72 hours of age
The number of patients that has received mechanical ventilation at any time <72 hours. Data collected at patient record review of the first three days of life.
up to 72 hours of age
Mechanical ventilation or mode of non-invasive support at 72 h
Time Frame: at 72 hours of age
The number of patients that had mechanical ventilation or non-invasive support at three days of age (including type of support). Data collected at patient record review of the first three days of life.
at 72 hours of age
Decisions on treatment limitations during resuscitation
Time Frame: 0-30 minutes
The number of patients that had any decision on limitations of treatment during resuscitation. Data reported by resuscitation team.
0-30 minutes
Withdrawal or withholding treatment
Time Frame: up to 72 hours of age
The number of patients that had any decision on withdrawal or withholding treatment in the DR or NICU. Data collected at patient record review of the first three days of life.
up to 72 hours of age

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Principal Investigator: Baldvin Jonsson, MD, PhD, Karolinska Institutet

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

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)

March 1, 2016

Primary Completion (Actual)

May 15, 2020

Study Completion (Actual)

May 18, 2020

Study Registration Dates

First Submitted

September 24, 2015

First Submitted That Met QC Criteria

September 28, 2015

First Posted (Estimate)

September 30, 2015

Study Record Updates

Last Update Posted (Actual)

June 1, 2020

Last Update Submitted That Met QC Criteria

May 28, 2020

Last Verified

May 1, 2020

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

Undecided

IPD Plan Description

Data will be shared but method of sharing not decided

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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