- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03890211
Trial of a Non Electric Infant Warmer for Prevention and Treatment of Hypothermia in Rwanda
Stepped Wedge Randomized Control Trial of a Non Electric Infant Warmer for Prevention and Treatment of Hypothermia in Rwanda
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Hypothermia contributes to a significant portion of neonatal deaths. Kangaroo Mother Care (KMC) is a safe and effective method of warming; however, it is not always feasible, for example in settings such as resuscitation or clinical instability. Electric warmers are the standard of care in developed countries, but are extremely costly, complicated with risk of causing both hypo and hyperthermia with misuse, and often not reliable in settings without stable electricity. The Infant Warmer the investigators propose to study has previously been tested in 2 pilot studies totaling 204 uses, occurring in 2 district hospitals and 4 health centers in rural Rwanda.
The combined results of these pilot studies were extremely encouraging. This study will be a stepped wedge prospective controlled trial in hospital setting to assess safety and efficacy of the Infant Warmer based on clinical observation, and feasibility based on observer audits. A total of 10 district hospitals will participate in the study. All 10 hospitals will start with a 2 week period of observation in which "pre" data will be collected. Hospitals will then receive the warmer and be transitioned to the "post" period at a rate of one every two weeks. The primary study aim is to assess the safety, efficacy and feasibility of the Infant Warmer as an addition to KMC, and to achieve and maintain euthermia when KMC is inadequate or unavailable. The study will be conducted across a wide range of district hospitals with control data coming from pre-intervention period and treatment data coming from post intervention period, with the intervention being the introduction of the Infant Warmer.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Rwinkwavu, Rwanda
- Dr Evrard Nahimana
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Any infant with the following criteria for whom caregiver not available for KMC, or KMC is not adequate (less than 0.5°C/hour rise in temperature):
Axillary temperature < 36.5 °C
a) If an electric warmer is available and the infant's temperature is < 35°C, then the infant will start by being warmed on the electric warmer until the infant's temperature reaches 36°C, then can start non-electric Infant Warmer use.
- Infants at-risk for hypothermia (criteria: estimated post-menstrual age of < 35 weeks or current body weight of < 2.5 kg).
Exclusion Criteria:
- Any infant whose family is unwilling to consent to the study.
- Mothers who are critically ill at the time of infant eligibility or deemed not medically stable by nursing staff to be approached for consent.
- Any infant with a contraindication to KMC (medical instability) and electrical heating source available.
- Any infant with initial temperature < 35°C and electrical heating source available.
- Infants requiring phototherapy.
- Infants with significant skin condition.
Stop Criteria:
If an electric heating source is available, the infant will be taken off of the study and warmed with an appropriate source of electric heat if the infant:
If an electric heating source is available, the infant will be taken off of the study and warmed with an appropriate source of electric heat if the infant:
i. Has temp < 36 °C while receiving maximum non-electric heat exposure and temperature decreases on any measurement ii. Has temp < 36 °C while receiving maximum non-electric heat exposure and temperature does not begin to rise within 30 minutes iii.Has temp < 36 °C while receiving maximum non-electric heat exposure and not heating at a rate of > ½ °C per hour until temperature >36.5°C iv.Has a temperature that falls below 36°C despite maximum non-electric heat exposure
Definition of maximum non-electric heat exposure:
- IW, KMC, hat; if KMC available
- IW, blanket, hat; if KMC not available
- Blanket, hat; while seeking caregiver for KMC and/or preparing IW if KMC and IW not available
- Has temperature > 37.5 °C
- Is ever considered to be too severely ill by the medical team to be safely cared for in the non-electric Infant Warmer.
- The warmer will be removed once its temperature drops below phase change temperature as assessed by noting that the material begins to harden and turn white and is no longer warm in area under where baby is lying.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: SUPPORTIVE_CARE
- Allocation: NON_RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Non-Electric Infant Warmer
In line with current recommended practice, the mother will be encouraged to provide KMC whenever possible.
For hypothermic infants, if the temperature is not rising by ½°C per hour with KMC alone, the Infant Warmer will be offered as an addition.
In these cases, the heat will be provided by placing the Infant Warmer over the infant's back while the mother provides KMC.
If the mother is not available for KMC at any time, the infant will be warmed exclusively with the Infant Warmer by being placed directly on the warmer as it lies flat.
Use of hat and socks will be encouraged by additional clothes will only be added in addition to the warmer per caregiver request, as it reduces heat transfer.
|
Electric warmers are the standard of care in developed countries, but are extremely costly, complicated with risk of causing both hypo and hyperthermia with misuse, and often not feasible in settings without stable electricity.
Through a multi-institutional collaboration, the investigators have developed an electricity-free infant warmer.
|
NO_INTERVENTION: Control
Data such as infant temperature, date of birth, etc. will be collected from those who enroll in the control group.
No experimental intervention will be administered.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Ability to regulate infant body temperature
Time Frame: up to 6 months
|
The infant warmer will be evaluated on its ability to achieve and maintain a normal body temperature for patients who are hypothermic and those patients at risk of hypothermia because of a < 2.5 kg birth weight or < 35 week gestational age.
Infants temperature will be measured, using a thermometer to ensure the body temperature will increase but not exceed 37.5°C.
|
up to 6 months
|
Incidence of adverse events as assessed by staff observation
Time Frame: up to 6 months
|
The investigators will assess the safety of the infant warmer by observing any adverse reactions such as skin irritations or higher than usual patient temperature (>37.5°C).
The safety of the warmer will be measured by study staff observation, measuring the temperature of the warmer with a thermistor instrument, measuring the infant's temperature with a thermometer, as well an investigator-developed Observer Audit Form.
The Observer Audit Form is a battery of nine questions which includes eight yes/no questions and one free response.
The questions evaluate such topics as whether the warmer was cleaned, the infant was positioned correctly, if adverse events were present, etc.
|
up to 6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Studying the practicality of applying the device in a clinical setting
Time Frame: up to 6 months
|
The investigators will use observation to evaluate the usability of the warmer by assessing the way that the infant is placed on the warmer and any adverse effects of infant warmer use.
This will be measured by study staff observation as well an investigator-developed Observer Audit Form.
The Observer Audit Form is a battery of nine questions which includes eight yes/no questions and one free response.
The questions evaluate such topics as whether the warmer was cleaned, the infant was positioned correctly, if adverse events were present, etc.
|
up to 6 months
|
Functionality
Time Frame: up to 6 months
|
The functionality will be assessed by the way that the warmer is prepared and cleaned, as well as any wear and tear on the warmer based on repeated use.
Functionality will be measured by study staff observation as well an investigator-developed Observer Audit Form.
The Observer Audit Form is a battery of eight questions which includes seven yes/no questions and one free response.
The questions evaluate such topics as whether the warmer was cleaned, the infant was positioned correctly, if adverse events were present, etc.
|
up to 6 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Anne Hansen, MD, MPH, Boston Children's Hospital
Publications and helpful links
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ACTUAL)
Study Completion (ANTICIPATED)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB-P00030705
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.
Clinical Trials on Hypothermia Neonatal
-
William Marsh Rice UniversityKamuzu University of Health SciencesRecruiting
-
William Marsh Rice UniversityKamuzu University of Health SciencesRecruiting
-
Boston Children's HospitalHarvard Medical School (HMS and HSDM); Brigham and Women's Hospital; Ministry... and other collaboratorsCompleted
-
Aliona Vilinsky-RedmondCompletedNeonatal HypothermiaIreland
-
William Marsh Rice UniversityUniversity of Lagos, NigeriaRecruiting
-
William Marsh Rice UniversityIfakara Health Institute; Muhimbili University of Health and Allied Sciences; Ministry of Health, Community Development, Gender, Elderly, and Children (MOHCDGEC)Recruiting
-
University Hospital PadovaCompletedNeonatal HypothermiaItaly
-
Thayyil, SudhinWayne State UniversityActive, not recruitingNeonatal Encephalopathy | Magnetic Resonance Spectroscopy | Hypothermia NeonatalUnited Kingdom, United States, Italy
-
Princess Anna Mazowiecka Hospital, Warsaw, PolandRecruitingPerinatal Asphyxia | Hypothermia Neonatal | Haemodynamic InstabilityPoland
-
University of South CarolinaGhana Health Services; Korle-Bu Teaching Hospital, Accra, Ghana; Centre for Learning...Not yet recruiting
Clinical Trials on Non-Electric Infant Warmer
-
Boston Children's HospitalHarvard Medical School (HMS and HSDM); Brigham and Women's Hospital; Ministry... and other collaboratorsCompleted
-
Danone Asia Pacific Holdings Pte, Ltd.Completed
-
Xijing HospitalAir Force Military Medical University, ChinaCompletedStroke | Brain InjuriesChina
-
Wyss Center for Bio and NeuroengineeringEcole Polytechnique Fédérale de LausanneCompleted
-
Alabama Physical Therapy & AcupunctureUniversidad Rey Juan CarlosRecruitingTension-Type HeadacheUnited States
-
The University of The West IndiesInternational Atomic Energy AgencyUnknown
-
Xijing HospitalCompletedTherapeutic (Nonsurgical) and Rehabilitative Anesthesiology Devices Associated With Adverse IncidentsChina
-
Yonsei UniversityCompletedMyofascial Pain Syndrome of the Upper TrapeziusKorea, Republic of
-
Boehringer IngelheimCompleted
-
Beijing YouAn HospitalUnknownHepatocellular CarcinomaChina