- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03963011
NEC Screening Abdominal Radiograph vs Bowel Ultrasound in Preemies
Pilot Randomized Control Trial of Necrotizing Enterocolitis Screening Abdominal Radiograph Versus Bowel Ultrasound Plus Abdominal Radiograph in Premature Neonates
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Necrotizing enterocolitis (NEC) is the most common bowel disease in premature and low birth weight neonates. NEC is defined by the loss of mucosal integrity of the bowel wall enabling bacteria and other toxins to permeate into the bowel causing ischemia and necrosis which can lead to bowel perforation and sepsis. NEC can result in substantial morbidity and mortality and prolonged hospital stay.
In the past, abdominal radiography has been scored on a standard scale that correlated with outcomes. Duke University Medical Center developed a standardized ten-point radiographic scale, the Duke Abdominal Assessment Scale (DAAS) (Appendix B) and was proven to be directly proportional to the severity of NEC on patients that underwent surgery. Abdominal radiographs are assessed for gas pattern, bowel distention, location and features, pneumatosis (gas in bowel wall), portal venous gas, and pneumoperitoneum (free air in peritoneal cavity) to indicate the level of suspicion of NEC. The use of abdominal radiographs is the most common assessment for suspected NEC in infants, however, there have been recent studies done on the utility of bowel ultrasound to aid in early diagnosis of NEC due to the ability to evaluate peristalsis, echogenicity and thickness of bowel wall, pneumatosis and the capability of doing color Doppler to evaluate blood perfusion. A University of Toronto study used ultrasound to assess bowel perfusion with color Doppler in neonates and found a correlation between absence of bowel wall perfusion and the increased severity of NEC on surgical pathology. Although there are similar signs found between abdominal radiography and bowel ultrasound, some of the more severe features such as, pneumoperitoneum, were found to be more sensitive on bowel ultrasound, thus potentially leading to more definitive treatment. Currently, there is no good study evaluating whether the use of bowel ultrasound affects clinical outcomes in VLBW patients over the use of abdominal radiography alone.
The use bowel ultrasound has yet to be adopted in the setting of suspicion for NEC at our institution. This is primarily due to the lack of expertise of the ultrasound technologists, radiologists and clinicians. With literature dating back to 2005 supporting the use of bowel ultrasound in diagnosis of severity of NEC, we would like to see if a regimen involving combined ultrasound and radiograph screening for NEC would make a difference in clinical outcomes (morbidity, mortality, and length of stay (LOS)) compared with radiograph screening alone.
Calprotectin is a protein found in the stool that, at elevated levels, indicates gastrointestinal inflammation. The addition of fecal biomarkers to the diagnostic work up for NEC also has promising impact. It has been suggested that fecal calprotectin levels obtained at the time of suspicion of NEC may be a useful noninvasive indicator to determine the severity of inflammation in the intestine and whether it is related to NEC or other forms of inflammation. Correlation of the fecal biomarkers with findings on BUS may be helpful to more definitively diagnose NEC.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Missouri
-
Kansas City, Missouri, United States, 64108
- Children's Mercy Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- • Neonates born prior to or at 28 weeks gestation admitted to NICU at CMH
Exclusion Criteria:
- Infants with chromosomal or multiple congenital anomalies
- Unable to ultrasound the bowel (e.g. gut in silo, omphalocele, gastroschisis)
- Infants who are greater than 36 corrected weeks upon admission
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Arm A: AXR Only
Infants randomized to Arm A will obtain an abdominal x-ray (AXR) as per standard of care
|
|
Active Comparator: Arm B: AXR + Bowel US
Infants randomized to Arm B will obtain an abdominal x-ray (AXR) as per standard of care and a bowel ultrasound (BUS) as the intervention
|
Ultrasound imaging of the bowel
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants Requiring Medical Management
Time Frame: First 12 months
|
Evaluate the difference between medical and surgical management between study arms. Medical management is defined as subjects whom did not undergo surgery for their NEC diagnosis. Surgical management is defined as subjects that had a surgical intervention for the NEC diagnosis. Please note that the study was terminated due to low enrollment numbers, thus statistically relevant and applicable numbers cannot be generated from this small study sample. |
First 12 months
|
Number of Days Between NEC Diagnosis and Surgical Intervention
Time Frame: 12 months
|
The number of days between NEC diagnosis and surgical intervention for those that need it. Days were continuously counted until subject was discharged from the hospital. Please note that the study was terminated due to low enrollment numbers, thus statistically relevant and applicable numbers cannot be generated from this small study sample. |
12 months
|
Number of NPO Days
Time Frame: 12 months
|
Number of nothing by mouth (NPO) days between subject diagnosis of NEC to when subject was placed back on continuous feeds. Please note that the study was terminated due to low enrollment numbers, thus statistically relevant and applicable numbers cannot be generated from this small study sample. |
12 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Erin Opfer, DO, Children's Mercy Hospital Kansas City
Publications and helpful links
General Publications
- Epelman M, Daneman A, Navarro OM, Morag I, Moore AM, Kim JH, Faingold R, Taylor G, Gerstle JT. Necrotizing enterocolitis: review of state-of-the-art imaging findings with pathologic correlation. Radiographics. 2007 Mar-Apr;27(2):285-305. doi: 10.1148/rg.272055098.
- Staryszak J, Stopa J, Kucharska-Miasik I, Osuchowska M, Guz W, Blaz W. Usefulness of ultrasound examinations in the diagnostics of necrotizing enterocolitis. Pol J Radiol. 2015 Jan 1;80:1-9. doi: 10.12659/PJR.890539. eCollection 2015.
- Coursey CA, Hollingsworth CL, Gaca AM, Maxfield C, Delong D, Bisset G 3rd. Radiologists' agreement when using a 10-point scale to report abdominal radiographic findings of necrotizing enterocolitis in neonates and infants. AJR Am J Roentgenol. 2008 Jul;191(1):190-7. doi: 10.2214/ajr.07.3558. Erratum In: AJR Am J Roentgenol. 2008 Sep;191(3):931.
- Coursey CA, Hollingsworth CL, Wriston C, Beam C, Rice H, Bisset G 3rd. Radiographic predictors of disease severity in neonates and infants with necrotizing enterocolitis. AJR Am J Roentgenol. 2009 Nov;193(5):1408-13. doi: 10.2214/AJR.08.2306.
- Faingold R, Daneman A, Tomlinson G, Babyn PS, Manson DE, Mohanta A, Moore AM, Hellmann J, Smith C, Gerstle T, Kim JH. Necrotizing enterocolitis: assessment of bowel viability with color doppler US. Radiology. 2005 May;235(2):587-94. doi: 10.1148/radiol.2352031718.
- Kim WY, Kim WS, Kim IO, Kwon TH, Chang W, Lee EK. Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol. 2005 Nov;35(11):1056-61. doi: 10.1007/s00247-005-1533-4. Epub 2005 Aug 3.
- Nakayuenyongsuk W, Christofferson M, Stevenson DK, Sylvester K, Lee HC, Park KT. Point-of-Care Fecal Calprotectin Monitoring in Preterm Infants at Risk for Necrotizing Enterocolitis. J Pediatr. 2018 May;196:98-103.e1. doi: 10.1016/j.jpeds.2017.12.069. Epub 2018 Mar 6.
- Cuna A, Chan S, Jones J, Sien M, Robinson A, Rao K, Opfer E. Feasibility and acceptability of a diagnostic randomized clinical trial of bowel ultrasound in infants with suspected necrotizing enterocolitis. Eur J Pediatr. 2022 Aug;181(8):3211-3215. doi: 10.1007/s00431-022-04526-4. Epub 2022 Jun 17.
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
- 17030157
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 Enterocolitis, Necrotizing
-
Gorm GreisenCompletedComplications | NEC - Necrotizing EnterocolitisDenmark
-
Mednax Center for Research, Education, Quality...Phoenix Children's Hospital; Banner University Medical CenterCompletedTotal Parenteral Nutrition | Necrotizing Enterocolitis of NewbornUnited States
-
Ain Shams UniversityCompleted
-
Children's Hospital of PhiladelphiaBracco Diagnostics, IncRecruitingNecrotizing Enterocolitis of Newborn | Bowel IschemicUnited States
-
Medical University of WarsawNot yet recruitingNecrotizing EnterocolitisPoland
-
The University of Hong KongRecruitingNecrotizing EnterocolitisHong Kong
-
Marmara UniversityUnknownNecrotizing EnterocolitisTurkey
-
Maastricht University Medical CenterUnknown
-
Odense University HospitalCompletedNecrotizing EnterocolitisDenmark
-
Boston Children's HospitalYale University; Elizabeth Glaser Pediatric AIDS Foundation; Glaser Pediatric...Unknown
Clinical Trials on Bowel Ultrasound
-
Children's Mercy Hospital Kansas CityWithdrawnEnterocolitis, Necrotizing | Congenital Heart DiseaseUnited States
-
IRCCS San RaffaeleRecruitingUlcerative Colitis Chronic Moderate | Ulcerative Colitis Chronic SevereItaly
-
Cardiff and Vale University Health BoardRecruitingInflammatory Bowel Diseases | Crohn Disease | Ulcerative Colitis | Pediatric Ulcerative Colitis | Pediatric Crohns DiseaseUnited Kingdom
-
Children's Mercy Hospital Kansas CityUniversity of Kansas Medical Center; American College of RadiologyRecruitingNecrotizing EnterocolitisUnited States
-
WellSpan HealthChristiana Care Health Services; University of California, IrvineCompletedSmall Bowel ObstructionUnited States
-
Oslo University HospitalSt John of God Hospital, Vienna; Nepean Blue Mountains Local Health DistrictCompletedQuality of Life | Pain, Chronic | Deep Endometriosis | Bowel Dysfunction | Endometriosis Related Pain | Endometriosis Rectum | Deep Infiltrating EndometriosisNorway, Australia, Austria
-
Hacettepe UniversityCompleted
-
Children's Hospital Medical Center, CincinnatiTerminated
-
Cedars-Sinai Medical CenterUnknownCrohn's Disease | Inflammatory Bowel DiseaseUnited States
-
The Functional Gut ClinicRecruiting