- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03387579
Comparison of Smoflipid to Soy-based Lipid Reduction for Cholestasis Prevention in Surgical Neonates
May 19, 2023 updated by: Charles P.B. Vanderpool, Indiana University
Comparison of Composite Lipid Emulsion Containing Fish Oil to Soy-based Lipid Reduction for Cholestasis Prevention in Neonates Requiring Abdominal Surgery
Intestinal failure associated liver disease is a cholestatic liver disease associated with prolonged need for parenteral nutrition that can lead to such significant complications as liver failure.
In the neonatal population, infants with history of intestinal resection and short bowel syndrome are at increased risk for this disease.
The investigators plan to compare two possible lipid dosing preventative strategies including a composite, fish oil lipid and soy-based lipid reduction.
Study Overview
Status
Active, not recruiting
Conditions
Detailed Description
Intestinal failure associated liver disease (IFALD) is a cholestatic liver disease associated with prolonged need for parenteral nutrition.
This disease can lead to such serious complications as liver failure and need for transplantation.
In the neonatal population, short bowel syndrome, due to intestinal resection, is the most common cause of intestinal failure.
While the exact cause is yet to be determined, it is felt the lipid component of parenteral nutrition is a large contributor to the development of this disease.
Currently, there is no standard preventative strategy to attempt to decrease the risk of IFALD in the high risk, post-surgical neonatal population.
The investigators aim to complete a randomized trial comparing two possible preventative strategies.
One group will receive a composite lipid containing fish oil (Smoflipid) and the other group will receive soy-based lipid at reduced dosing.
Study Type
Interventional
Enrollment (Actual)
24
Phase
- Phase 3
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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Indiana
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Indianapolis, Indiana, United States, 46202
- Riley Hospital for Children at IU Health
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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
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Description
Inclusion Criteria: Neonates with anticipated need for parenteral nutrition (based on primary physicians opinion) for greater than or equal to four weeks and one of the following diagnoses:
- Anatomic: Neonate with intestinal atresia, omphalocele, gastroschisis, or volvulus with or without intestinal resection.
- Ischemic/perforation: Neonates with spontaneous intestinal perforation or necrotizing enterocolitis requiring surgical intervention.
Exclusion Criteria:
- Current weight less than 750 grams
- AST or ALT greater than 5 times the upper limit of normal within 2 weeks of enrollment
- Direct bilirubin greater than 2 mg/dL on any consecutive measurements 5 - 7 days apart within 2 weeks of enrollment
- Severe coagulopathy with INR greater than 95th percentile for age (>1.7 at less than 5 days of age, > 1.5 older than five days of age)
- Culture confirmed sepsis with positive blood, urine, or CSF culture within 2 weeks of enrollment
- Renal failure requiring dialysis
- Cyanotic heart disease requiring prostaglandin therapy
- Hypertriglyceridemia (greater than 250mg/dL) at time of enrollment
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: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Smoflipid 20%
Patients randomized to this arm will receive the composite fish oil lipid, Smoflipid, at standard dosing up to 3 g/kg/day.
Patients will be started on a dose of 1 g/kg/day and titrated up to maximum dose.
As enteral nutrition is advanced the lipid dose will be weaned per study protocol and dietary recommendations.
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Intravenous lipid containing soy, MCT, olive, and fish oils at goal doses of 3 g/kg/day
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Experimental: Intralipid 20% Reduction
Patients randomized to this arm will receive soy-based lipid (Intralipid) at a dose of 1 g/kg/day throughout their enrollment in the study.
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Intravenous lipid emulsion of 20% soy oil at goal doses of 1 g/kg/day
Other Names:
Intravenous lipid emulsion of 20% soy oil at goal doses of 2-3 g/kg/day
Other Names:
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Other: Intralipid 20% Historic
Patients who retrospectively received soy-based lipid (Intralipid) at standard dosing of 2-3 g/kg/day were eligible for inclusion.
Patients in this group were matched to prospective patients based on diagnosis, gestational age, and length of lipid therapy.
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Intravenous lipid emulsion of 20% soy oil at goal doses of 1 g/kg/day
Other Names:
Intravenous lipid emulsion of 20% soy oil at goal doses of 2-3 g/kg/day
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Cholestasis
Time Frame: Patients were monitored during time enrolled in study for a maximum of up to 12 weeks or 84 days.
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Cholestasis was defined as a direct bilirubin > 2 mg/dL on two measurements 5 to 7 days apart.
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Patients were monitored during time enrolled in study for a maximum of up to 12 weeks or 84 days.
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Weight Velocity
Time Frame: Patient weight was recorded at enrollment, weekly during time enrolled, and at end of study for up to a maximum of 12 weeks. End and enrollment weights were used to calculate velocity.
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Weight velocity was calculated as the difference in weight from end to start of study divided by number of days enrolled in study.
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Patient weight was recorded at enrollment, weekly during time enrolled, and at end of study for up to a maximum of 12 weeks. End and enrollment weights were used to calculate velocity.
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Length Velocity
Time Frame: Length was measured at enrollment, weekly during time enrolled in study, and end of study up to a maximum of 12 weeks. End and enrollment measurements were used for velocity.
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Length velocity was defined as the difference in length from end of study compared to enrollment divided by the number of days enrolled in study.
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Length was measured at enrollment, weekly during time enrolled in study, and end of study up to a maximum of 12 weeks. End and enrollment measurements were used for velocity.
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Head Circumference (OFC) Velocity
Time Frame: OFC was measured at enrollment, weekly, and end of study. Enrollment and end of study measurements used for velocity.
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OFC velocity was calculated as difference end and start of study divided by number of days enrolled in study.
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OFC was measured at enrollment, weekly, and end of study. Enrollment and end of study measurements used for velocity.
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Average Total Calorie Intake
Time Frame: Daily calorie intake was recorded and averaged on a weekly basis for duration of study enrollment up to max of 12 weeks.
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Total calorie intake, including parenteral and enteral sources, were averaged on a weekly basis.
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Daily calorie intake was recorded and averaged on a weekly basis for duration of study enrollment up to max of 12 weeks.
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Number of Patients With Enteral Autonomy at End of Study
Time Frame: Enteral autonomy was recorded at the study end point for each individual patient. This end point was at time of stopping study lipid, discharge from hospital, or maximum of 12 weeks.
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Percentage of patients with enteral autonomy at time of leaving or stopping study was calculated.
Enteral autonomy was defined as relying on enteral nutrition only for nutrition intake with no need for parenteral nutrition supplementation.
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Enteral autonomy was recorded at the study end point for each individual patient. This end point was at time of stopping study lipid, discharge from hospital, or maximum of 12 weeks.
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Number of Patients With Essential Fatty Acid Deficiency (EFAD)
Time Frame: Essential fatty acid levels were measured every 4 weeks during enrollment for a maximum of up to 12 weeks.
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Essential fatty acid deficiency was defined as a triene to tetraene ratio greater than 0.05.
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Essential fatty acid levels were measured every 4 weeks during enrollment for a maximum of up to 12 weeks.
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AST Change Over Time
Time Frame: AST was recorded at enrollment and every 2 weeks while enrolled in the study up to a maximum of 12 weeks.
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The change of AST over time was calculated and compared between groups.
AST change was calculated as AST end - AST enrollment.
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AST was recorded at enrollment and every 2 weeks while enrolled in the study up to a maximum of 12 weeks.
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ALT Change Over Time
Time Frame: ALT measured at enrollment and every 2 weeks for max 12 weeks.
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The rate of change of ALT over time was compared between groups using mixed model analysis.
Change of ALT was calculated as ALT at end of study compared to ALT at enrollment.
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ALT measured at enrollment and every 2 weeks for max 12 weeks.
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Alkaline Phosphatase Change Over Time
Time Frame: Alkaline phosphatase was measured at enrollment and every 2 weeks for max of 12 weeks.
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Alkaline phosphatase was recorded at enrollment and every 2 weeks.
The change in alkaline phosphatase was calculated as alkaline phosphatase at end minus enrollment.
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Alkaline phosphatase was measured at enrollment and every 2 weeks for max of 12 weeks.
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Triglyceride Level Over Time
Time Frame: Serum triglyceride levels monitored at enrollment and weekly during time enrolled in study for a maximum of 12 weeks.
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All enrolled patients had serum triglyceride levels monitored at enrollment and weekly.
The triglyceride level changes was calculated using values at the end of study compared to enrollment with mean and standard deviation calculated for each treatment group.
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Serum triglyceride levels monitored at enrollment and weekly during time enrolled in study for a maximum of 12 weeks.
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Gamma Glutamyl Transferase (GGT) Over Time
Time Frame: GGT was measured at enrollment and every 2 weeks while enrolled in the study for a maximum of up to 12 weeks.
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GGT was documented at baseline and regularly intervals with level compared over time between groups.
GGT was compared by treatment group for levels at end of study and enrollment.
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GGT was measured at enrollment and every 2 weeks while enrolled in the study for a maximum of up to 12 weeks.
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Number of Patients With Retinopathy of Prematurity
Time Frame: Diagnosis was based on diagnosis during time of initial hospitalization to level 4 NICU.
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The rate of retinopathy of prematurity (ROP) was compared between groups.
ROP was diagnosed based on ophthalmologist examination with all stages included.
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Diagnosis was based on diagnosis during time of initial hospitalization to level 4 NICU.
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Number of Patients With Bronchopulmonary Dysplasia (BPD) or Chronic Lung Disease
Time Frame: All patient had diagnosis of BPD documented from admission at level 4 NICU.
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The rate of BPD was documented and compared between groups.
BPD was diagnosed based on need for respiratory support at 28 days of age.
All levels of severity were included.
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All patient had diagnosis of BPD documented from admission at level 4 NICU.
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NICU Length of Stay
Time Frame: Length of stay will be calculated based on documenting each patient's admission date and date leaving the NICU.
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The length of stay at the level 4 NICU was compared between groups.
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Length of stay will be calculated based on documenting each patient's admission date and date leaving the NICU.
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Three Year Development
Time Frame: ASQ will be completed anytime during the third year of life from 3 years 0 days to 3 years 364 days of chronologic age.
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During the third year of chronological age an Ages and Stages questionnaire (ASQ) will be completed by the parents.
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ASQ will be completed anytime during the third year of life from 3 years 0 days to 3 years 364 days of chronologic age.
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
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)
November 30, 2018
Primary Completion (Actual)
March 28, 2021
Study Completion (Anticipated)
March 1, 2024
Study Registration Dates
First Submitted
December 3, 2017
First Submitted That Met QC Criteria
December 22, 2017
First Posted (Actual)
January 2, 2018
Study Record Updates
Last Update Posted (Actual)
May 23, 2023
Last Update Submitted That Met QC Criteria
May 19, 2023
Last Verified
May 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 1708745276
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
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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