- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03977259
Targeting Human Milk Fortification to Improve Preterm Infant Growth and Brain Development
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Human milk is the recommended diet for preterm infants and it requires fortification to meet their high nutrient requirements. This study addresses a gap in knowledge about the optimal strategy for human milk fortification in the neonatal intensive care unit (NICU).
Infants will be recruited from a single site (Brigham and Women's Hospital, Boston MA). Eligible infants are NICU inpatients born <31 weeks' gestation and enrolled within 21 days of birth, whose mothers are providing breast milk. Exclusion criteria include major congenital anomalies, severe fetal growth restriction (weight <3rd percentile), clinically significant gastrointestinal pathology, triplets or higher order multiples, and expected death or transfer. Infants who require fluid restriction <140 mL/kg/day will also be excluded.
The study period begins when infants have reached full volume (150-160 mL/kg/day) human milk feedings fortified to 24 kcal per ounce. Participants will be randomized to one of two diet groups; twins will be randomized separately. The study diet will continue until 36 weeks' postmenstrual age or hospital discharge, whichever comes first.
Available maternal milk will be pooled with donor milk (if needed) to reach the total daily fluid volume; this "base" milk will be analyzed with a point-of-care human milk analyzer (Miris, AB). All infants will receive at minimum the standard human milk fortification (multicomponent fortifier to 24 kcal/oz plus liquid protein 0.27 g/dL). In one group (control), we will follow the standard of care for milk fortification, only adding more protein and/or energy if weight gain is lagging. In the other group (intervention), we will individually target fortification with additional protein and/or energy so that the "base" milk always contains protein 1 g/dL and energy 67 kcal/dL.
Outcome measures will include physical growth during the diet intervention period, including gain in weight, length, and head circumference and body composition with air displacement plethysmography at the end of the diet intervention. At term equivalent age, participants will undergo brain magnetic resonance imaging. At 2 years corrected age, outcomes include standard and novel neurodevelopmental tests including the Bayley-III and tests of emerging executive function; and physical size.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Kaitlin Drouin, MA
- Phone Number: 617-732-8546
- Email: kdrouin@bwh.harvard.edu
Study Contact Backup
- Name: Tina Steele, RN
- Phone Number: 617-525-7376
- Email: tdufresne@bwh.harvard.edu
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02115
- Recruiting
- Brigham and Women's Hospital
-
Contact:
- Kaitlin Drouin, MA
- Phone Number: 617-732-8546
- Email: kdrouin@bwh.harvard.edu
-
Contact:
- Tina Steele, RN
- Phone Number: 617-525-7376
- Email: tdufresne@bwh.harvard.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Inpatient in Brigham and Women's Hospital NICU
- Gestational age 24 0/7 to 30 6/7 weeks
- Chronologic age <21 days
- Mother providing breast milk
Exclusion Criteria:
- Major congenital anomaly
- Severe fetal growth restriction (birth weight <3rd percentile by Olsen reference)
- Necrotizing enterocolitis, intestinal perforation, other major gastrointestinal pathology
- Triplets or higher order multiples
- Plan for redirection of care and/or anticipated death
- Clinically significant renal or hepatic dysfunction
- Inborn error of metabolism
- Fluid restriction <140 mL/kg/day for 3 or more days
- Grade 3 or 4 intraventricular hemorrhage detected prior to enrollment
- Anticipated transfer <36 weeks' postmenstrual age
- Parents do not consent to use of pasteurized donor human milk
- Infant in non-parental custody
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Standard fortification
Standard of care fortification with multicomponent human milk fortifier (24 kcal/oz) and liquid protein (0.27 g/dL); additional protein and/or calories added only for growth faltering.
|
|
Experimental: Individually targeted fortification
Standard of care fortification plus extra protein and/or calories to ensure that "base" milk has protein 1 g/dL and calories 67/dL.
|
Abbott liquid protein and/or medium chain triglyceride are added routinely to ensure that the "base" milk has protein 1 g/dL and calories 67/dL.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Weight
Time Frame: at study endpoint (36 weeks' postmenstrual age or discharge)
|
Weight z-score
|
at study endpoint (36 weeks' postmenstrual age or discharge)
|
Length
Time Frame: at study endpoint (36 weeks' postmenstrual age or discharge)
|
Length z-score
|
at study endpoint (36 weeks' postmenstrual age or discharge)
|
Fat free mass
Time Frame: at study endpoint (36 weeks' postmenstrual age or discharge)
|
Fat free mass estimated with air displacement plethysmography (z-score)
|
at study endpoint (36 weeks' postmenstrual age or discharge)
|
Total brain volume
Time Frame: at term equivalent age (38 to 41 weeks' postmenstrual age)
|
Total brain volume by MRI
|
at term equivalent age (38 to 41 weeks' postmenstrual age)
|
Cerebellar volume
Time Frame: at term equivalent age (38 to 41 weeks' postmenstrual age)
|
Cerebellar volume by MRI
|
at term equivalent age (38 to 41 weeks' postmenstrual age)
|
Bayley-III cognitive score
Time Frame: at 2 years' corrected age
|
Scaled composite score (continuous), higher score indicates better performance, range of possible scores 55-145
|
at 2 years' corrected age
|
Bayley-III motor score
Time Frame: at 2 years' corrected age
|
Scaled composite score (continuous), higher score indicates better performance, range of possible scores 46-154
|
at 2 years' corrected age
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fat mass
Time Frame: at study endpoint (36 weeks' postmenstrual age or discharge)
|
Fat mass estimated with air displacement plethysmography (z-score)
|
at study endpoint (36 weeks' postmenstrual age or discharge)
|
Weight
Time Frame: at 2 years' corrected age
|
Weight z-score
|
at 2 years' corrected age
|
Height
Time Frame: at 2 years' corrected age
|
Height z-score
|
at 2 years' corrected age
|
Low Bayley-III cognitive score
Time Frame: At 2 years' corrected age
|
Scaled composite score <85 (>1 standard deviation below the normative mean)
|
At 2 years' corrected age
|
Low Bayley-III motor score
Time Frame: At 2 years' corrected age
|
Scaled composite score <85 (>1 standard deviation below the normative mean)
|
At 2 years' corrected age
|
Bayley-III language score
Time Frame: At 2 years' corrected age
|
Scaled composite score (continuous), higher score indicates better performance, range of possible scores 46-154
|
At 2 years' corrected age
|
Bayley-III language score
Time Frame: At 2 years' corrected age
|
Scaled composite score <85 (>1 standard deviation below the normative mean)
|
At 2 years' corrected age
|
Spacial working memory
Time Frame: at 2 years' corrected age
|
Spin the Pots task (number of trials, search time)
|
at 2 years' corrected age
|
Behavioral inhibition
Time Frame: at 2 years' corrected age
|
Mommies and Babies task (number of trials, errors)
|
at 2 years' corrected age
|
Executive function
Time Frame: at 2 years' corrected age
|
Behavioral Rating Inventory of Executive Function - Preschool Version, higher scores indicate more problems
|
at 2 years' corrected age
|
Behavioral difficulties
Time Frame: at 2 years' corrected age
|
Infant-Toddler Symptom Checklist - Long Version, higher scores indicate more problems
|
at 2 years' corrected age
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Mandy B Belfort, MD, MPH, Brigham and Women's Hospital
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- 2019P000893
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
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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