- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02567292
Human Milk for Congenital Gastrointestinal Disorders (HM for CGD)
Effects of an Exclusive Human Milk Diet on Enteral Feeding Outcomes of Neonates With Congenital Gastrointestinal Disorders
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Infants born with congenital gastrointestinal disorders (CGD) can be very challenging to treat. The CGD require surgery shortly after birth to correct the problems and recovery can take a long time.
During the period of time the infant's intestines are sick or don't work properly, they rely on parenteral nutrition (IV fluids containing carbohydrates, proteins and fats) to meet their nutritional needs. Being on PN for a long time requires special intravenous lines, and increases the risk of blood stream infections and can make the liver sick.
Feeding babies who have these CGD is often very difficult, as the intestine needs to adapt. It needs to make appropriately formed stool to eliminate wastes, but not lose too much water or too many electrolytes. There is often a lot of starting and stopping of feeds. Human milk (HM) is considered the ideal source of nutrition for all infants.
This study aims to identify whether an exclusive human milk diet (EHMD) would improve outcomes in neonates with congenital gastrointestinal disorders (CGD) and by facilitating an earlier transition off of parenteral nutrition (PN).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Georgia
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Atlanta, Georgia, United States, 30322
- Children's Healthcare of Atlanta-Egleston
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Admission to participating NICU at less than 7 days of age
- Birthweight >1250g and/or gestational age at birth >32 weeks
- Less than 7 days of enteral feedings
- Diagnosis of eligible primary "Congenital Gastointestinal Disorders" defined as: gastroschisis, omphalocele and intestinal atresias
- Consent to the use of donor human milk products
- Consent to participate in this study
Exclusion Criteria:
- Admission to participating NICU at >7 days of age
- Birthweight <1250g and/or gestational age <32 weeks
- Diagnosis of non-eligible gastrointestinal disorders: congenital diaphragmatic hernia, midgut volvulus, Hirschsprung's disease, esophageal atresia, imperforate anus
- Evidence of significant liver dysfunction at time of enrollment (direct bilirubin >4 and transaminases elevated more than 2 SD above upper limit of normal for age)
- Liver malformations such as biliary atresia and choledochal cyst
- Refusal of consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Non-Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Retrospective Control Group
Approximately 150 patients with congenital gastrointestinal disorders who were treated in the neonatal intensive care unit (NICU) at Children's Healthcare of Atlanta-Egleston and other participating institutions from 2012 to 2015, who had non-human milk (HM) diets will be identified as retrospective controls using the electronic medical records system.
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Experimental: Exclusive Human Milk Diet Group
A minimum of 150 patients with CGD admitted to participating NICUs who meet inclusion criteria and provide informed consent will be enrolled in the prospective arm of the study.
These patients will be fed an EHMD comprised of mother's own milk (MOM) or pasteurized donor human milk (DM).
Fortification will be provided with human milk derived human milk fortifier, either a human milk-based fortifier (Prolact+ H2MF®) for infants born at less than 37 weeks GA or <2,200g birth weight or the term-equivalent version (PBCLN-002) formulated for infants >37 weeks and/or >2,200g at birth.
Infants will receive this EHMD until they have achieved full enteral feedings for 7 days with bowel in continuity
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Participants will receive an exclusive human milk diet comprised of mother's own milk (MOM, pasteurized donor human milk (DM) fortified with a donor-milk based fortifier (DMBF): Prolact+ for infants <37 weeks PMA and/or or weight <2,200g or PBCLN-002 for infants >37 weeks PMA and/or weight >2,200g)
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to full enteral feeding
Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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The number of days to achieve full enteral feeding after the initial human milk feeding
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From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of days of parenteral nutrition
Time Frame: Through study completion, up to 1 year
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The total number of days parenteral nutrition is required.
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Through study completion, up to 1 year
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Length of hospital stay
Time Frame: Through study completion, up to 6 months
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The length of hospital stay described as the number of days spent in the hospital
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Through study completion, up to 6 months
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Difference in conjugated bilirubin levels
Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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The difference in average bilirubin level will be compared between the non-human milk diet (retrospective control group) and the breast milk diet group.
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From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Feeding intolerance
Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Number of days when one or more feedings were held for clinical concerns
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From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Feeding interruptions
Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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NPO for at least 24 hours.
NPO due to elective surgeries or procedures will not be defined as feeding interruptions
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From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Episodes of Necrotizing Enterocolitis
Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Number of episodes of Stage IIb NEC or greater
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From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Number of sepsis episodes
Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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The number of sepsis episodes will be compared between the non-breast milk diet (retrospective control group) and the breast milk diet group.
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From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days)
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Death rate
Time Frame: Through study completion, up to 1 year
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The number of deaths between participants who receive breast milk only diets as compared to the non-breast milk diet (retrospective control group while in the neonatal intensive care unit (NICU).
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Through study completion, up to 1 year
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Growth
Time Frame: Through study completion, up to 1 year
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Compare growth parameters (weight, length and head circumference) as daily g/kg/d and z-scores birth to discharge
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Through study completion, up to 1 year
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Heidi Karpen, MD, Emory University
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
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
- IRB00080481
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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