- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03166722
Cerebral Regional Tissue Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates During Immediate Transition (COSGOD)
Cerebral Regional Tissue Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates During Immediate Transition After Birth: An Investigator-initiated Randomised Multi-centre Multinational Clinical Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background
The transition to life after birth is a complex physiological process where the neonate has to establish sufficient ventilation and changes from intra-uterine circulation to extra-uterine circulation take place. During these processes the neonate has to provide the brain with adequate perfusion and oxygen delivery to maintain normal cerebral tissue oxygenation and activity. If hypoxia and bradycardia both common events during immediate transition in preterm neonates occur, cerebral hypoxia-ischaemia may cause perinatal brain injury that is the major causes of mortality and long term neurodevelopmental impairment.
Objectives
The primary objective of the COSGOD Phase III trial is to examine, if it is possible to increase survival without cerebral injury in preterm neonates <32 weeks of gestation by monitoring the cerebral tissue oxygen saturation in addition to routine monitoring of arterial oxygen saturation (SpO2) and heart rate (HR) and specified clinical treatment guidelines during immediate transition period after birth (the first 15 minutes).
Hypothesis
The investigators hypothesise that using cerebral tissue oxygen saturation in addition to SpO2 and HR monitoring and specified treatment guidelines during immediate transition and resuscitation would increase survival without cerebral injury in preterm neonates.
Trial design
An investigator-initiated randomised, multi-centre, multinational, phase III clinical trial involving preterm infants from European countries and North America.
Inclusion and exclusion criteria
The inclusion criteria are: neonates born more than 8 weeks preterm (gestational age up to 31 weeks and 6 days); decision to conduct full life support; parental informed consent; and cerebral NIRS oximeter placed within three minutes after birth.
Sample size
According to actual data of two European centres (Graz and Rotterdam) and one Canadian centre (Edmonton) the percentage of neonates not affected by mortality and cerebral injury is 65%. Assuming an increase of not affected neonates from 65% to 75% and a dropout rate of 10% a total of 724 neonates are required to detect this difference with a two group χ² test (alpha: 0.05, power: 80%).
Intervention
The premature infants will be randomised into experimental or control group. Both groups will have a near infrared spectroscopy (NIRS) device (left frontal), pulse-oximeter (right wrist) and electrocardiogram placed within three minutes after birth. In the study group, the cerebral tissue saturation, SpO2 and HR readings are visible, and the infant will be treated accordingly using a defined treatment guideline. In the control group, only SpO2 and HR will be visible, and the infant will be treated according routine treatment.
Duration of intervention Monitoring will be started within 3 minutes after birth and the intervention will last during immediate transition period and resuscitation up to 15 minutes after birth.
Follow up
Thereafter, each neonate will be followed up for primary outcome to term date or discharge.
Outcome measures
The primary outcome is mortality and/or cerebral injury defined as any intraventricular bleeding and/or cystic periventricular leucomalacia.
The secondary outcomes are neonatal morbidities.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Innsbruck, Austria
- Medical University Innsbruck
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Vienna, Austria
- Medical University Vienna
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Styria
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Graz, Styria, Austria, 8036
- Department of Pediatrics, Medical University of Graz
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Alberta
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Edmonton, Alberta, Canada, T5H 3V9
- Royal Alexandra Hospital
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Freiburg, Germany
- Universitätsklinikum Freiburg
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Tübingen, Germany
- Centre for Pediatric Clinical Studies
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Cork, Ireland
- University College Cork
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Milano, Italy
- Ospedale dei Bambini "V.Buzzi" Milano
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Trieste, Italy
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo
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Poznań, Poland
- Poznan University of Medical Sciences
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Poznań, Poland
- Uniwersytetu Medycznego im. Karola Marcinkowskiego
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Ljubljana, Slovenia
- University Medical Centre Ljubljana
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Preterm neonates less than completed 32 weeks,
- Decision to conduct full life support,
- Written informed consent.
Exclusion Criteria:
- No decision to conduct full life support,
- No written informed consent,
- Congenital malformation.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Study group: Invos 5100
Supplemental oxygen support and respiratory/circulatory support is guided by cerebral regional tissue oxygenation (crSO2) measured with near-infrared spectroscopy ("INVOS 5100" ), in addition to the SpO2/HR (oxygen saturation/heart rate) monitoring according to routine.
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Cerebral NIRS measurement with INVOS 5100 during immediate transition in addition to SpO2 and HR monitoring
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Active Comparator: Control group: Routine care
Supplemental oxygen support and respiratory/circulatory support is guided by SpO2/HR monitoring according to routine - The resuscitation team is blinded to the crSO2 monitoring.
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SpO2 and HR monitoring and routine treatment during immediate transition
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mortality and/or occurrence of cerebral injury
Time Frame: up to 19 weeks after birth
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Number of patients, who die or have intraventricular hemorrhage or have periventricular leucomalacia
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up to 19 weeks after birth
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Frequency of neonatal morbidities
Time Frame: up to 19 weeks after birth
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Number of patients, who have infection and/or sepsis and/or necrotizing enterocolitis bronchoplumonary dysplasia, retinopathia prematurorumand/or bronchoplumonary dysplasia and /or retinopathia prematurorum
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up to 19 weeks after birth
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Sex
Time Frame: up to 19 weeks after birth
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Number of male and female patients, who die or have intraventricular hemorrhage or have periventricular leucomalacia
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up to 19 weeks after birth
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Gestational age
Time Frame: up to 19 weeks after birth
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Number of patients with less than 28 weeks of gestation and more than or equal 28 weeks of gestation, who die or have intraventricular hemorrhage or have periventricular leucomalacia
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up to 19 weeks after birth
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Gerhard Pichler, MD, Medical University of Graz, Austria
- Principal Investigator: Georg M Schmölzer, MD, PhD, Royal Alexandra Hospital, Edmonton, Canada
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 (Actual)
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
- COSGOD Phase III
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- Study Protocol
- Statistical Analysis Plan (SAP)
- Informed Consent Form (ICF)
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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