Optimal Settings of Non Invasive Respiratory Support in Preterm Newborns

Choice and Optimal Settings of Non Invasive Respiratory Support in Preterm Newborns < 30 Gestational Weeks

Noninvasive respiratory supports (NRS), such as continuous positive airway pressure (CPAP), noninvasive ventilation, high flow nasal cannula (HFNC) or nasal oxygen (O2), are commonly used in preterm newborns hospitalized in neonatal intensive care unit. However, given the lack of validated criteria, clinicians usually choose the NRS according to clinical parameters and patients' comfort. Several studies have demonstrated the interest of the measurement of the work of breathing (WOB) to optimize the settings of NRS in children, but no study has already demonstrated the utility of WOB to optimize the settings of NRS in preterm infants. Therefore, the aim of this study is to measure the WOB during the utilisation of three different NRS (CPAP, HFNC, O2), in order to optimize the choice of the type and settings of NRS in a randomized group of 30 newborns born prematurely before 30 gestational weeks and still requiring NRS at 29 post conceptual weeks. Moreover, the investigators will compare in the newborns with the optimized NRS by WOB vs. a standard care control group (NRS type and settings determined as clinical routine): 1) the respiratory morbidity and mortality one month after the initial assessment, and at the time of hospital discharge (or transfer) or at 36 weeks of age corrected (whatever comes first), 2) the weaning time of the NRS, 3) the incidence and severity of broncho-pulmonary dysplasia (BPD) at 36 weeks of age corrected. Indeed, incidence of BPD is still around 40% in premature infants born before 28 gestational weeks. The hypothesis of the investigators' study is that the optimization of the type and settings of the NRS could reduce the weaning delay and contribute to reduce the incidence and severity of BPD in premature newborns.

Study Overview

• Status: Unknown
• Conditions: Respiratory Distress Syndrome; Preterm Infant
• Intervention / Treatment: Other: esophageal pressure measurement

• Study Type: Observational
• Enrollment (Anticipated): 60

Contacts and Locations

• Study Contact: Name: Brigitte Fauroux, MD, PhD; Phone Number: +33144496092; Email: brigitte.fauroux@aphp.fr
• Study Contact Backup: Name: Sonia Khirani, PhD; Phone Number: +33144494091; Email: sonia_khirani@yahoo.fr

Study Locations

• France
  • Paris, France, 75015
    • Recruiting
    • AP-HP Hôpital Necker
    • Contact: Brigitte Fauroux, MD, PhD; Phone Number: +33144496092; Email: brigitte.fauroux@aphp.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 4 weeks to 1 month (CHILD)
• Accepts Healthy Volunteers: N/A
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Preterm infants needing a non invasive respiratory support after 4 weeks of life

Description

Inclusion Criteria:

• Preterm infants born between 23 and 30 GA
• Aged over 29 weeks of corrected age at the time of assessment and needing a non invasive respiratory support since at least 4 weeks of age

Exclusion Criteria:

• Hemodynamic and/or neurologic instability
• Invasive ventilation
• Congenital cardiopathy and/or significant patent ductus arteriosus
• Sedation
• Congenital pulmonary disease and/or other malformations

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Clinical settings; Infants with the choice of the non respiratory support and settings of the non respiratory support defined by clinical practice (nocturnal gas exchange, apneas, bradycardia, oxygen desaturation)
Physiological settings; Infants with the choice of the non respiratory support and settings of the non respiratory support defined by the measurement of work of breathing	Other: esophageal pressure measurement; Measurement of esophageal pressure to determine the optimal non invasive respiratory support

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximal variation of esophageal pressure	Maximal variation of esophageal pressure will be compared for the different respiratory supports and the different settings	at participant inclusion day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
occurrence of bronchopulmonary dysplasia at 36 Gestational age (GA)		From 2 to 7 weeks after participant's inclusion (day 1)
need for nutritional support		From 2 to 7 weeks after participant's inclusion (day 1)
definitive weaning delay	weaning from noninvasive respiratory support and oxygen supplementation	From 2 to 7 weeks after participant's inclusion (day 1)

Collaborators and Investigators

• Sponsor: Hôpital Necker-Enfants Malades
• Investigators: Principal Investigator: Brigitte Fauroux, MD, PhD, AP-HP Hôpital Necker

Publications and helpful links

General Publications

• Liptsen E, Aghai ZH, Pyon KH, Saslow JG, Nakhla T, Long J, Steele AM, Habib RH, Courtney SE. Work of breathing during nasal continuous positive airway pressure in preterm infants: a comparison of bubble vs variable-flow devices. J Perinatol. 2005 Jul;25(7):453-8. doi: 10.1038/sj.jp.7211325.
• Shetty S, Hickey A, Rafferty GF, Peacock JL, Greenough A. Work of breathing during CPAP and heated humidified high-flow nasal cannula. Arch Dis Child Fetal Neonatal Ed. 2016 Sep;101(5):F404-7. doi: 10.1136/archdischild-2015-309310. Epub 2016 Jan 14.
• de Jongh BE, Locke R, Mackley A, Emberger J, Bostick D, Stefano J, Rodriguez E, Shaffer TH. Work of breathing indices in infants with respiratory insufficiency receiving high-flow nasal cannula and nasal continuous positive airway pressure. J Perinatol. 2014 Jan;34(1):27-32. doi: 10.1038/jp.2013.120. Epub 2013 Sep 26.
• Saslow JG, Aghai ZH, Nakhla TA, Hart JJ, Lawrysh R, Stahl GE, Pyon KH. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol. 2006 Aug;26(8):476-80. doi: 10.1038/sj.jp.7211530. Epub 2006 May 11.

Study record dates

Study Major Dates

• Study Start (Actual): February 22, 2018
• Primary Completion (Anticipated): September 21, 2018
• Study Completion (Anticipated): November 9, 2018

Study Registration Dates

• First Submitted: July 5, 2018
• First Submitted That Met QC Criteria: July 17, 2018
• First Posted (Actual): July 19, 2018

Study Record Updates

• Last Update Posted (Actual): July 19, 2018
• Last Update Submitted That Met QC Criteria: July 17, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Lung Diseases; Infant, Newborn, Diseases; Pregnancy Complications; Obstetric Labor Complications; Obstetric Labor, Premature; Infant, Premature, Diseases; Premature Birth; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn
• Other Study ID Numbers: 2017-A00535-48

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: No
• Studies a U.S. FDA-regulated device product: No