- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04535375
Sonographic QUantification of Venous Circulation In the Preterm Brain (SQUIB)
Sonographic Quantification of Venous Circulation in the Preterm Brain
The aim of the study is to develop an accessible, reproducible ultrasound tool for objective clinical measurement of brain circulation in preterm infants in order to identify infants being at risk for preterm brain injury at an early stage. In the future, the results of this study might be useful to select those infants for early interventions aimed at preventing brain injury.
In this study we will identify the normative values of the internal cerebral vein velocity in a reference cohort of stable preterm infants. This stable group of preterm infants is defined as all preterm infants with a birth weight appropriate for gestational age, and without major complications (such as a severe intracranial hemorrhage, severe hemodynamical instability, birth asphyxia) or major congenital malformations.
In this group we will identify subgroups based on moments of clinical instability (sepsis, temporary hypotension, NEC, need for invasive respiratory support) or based on outcome parameters (IVH, PVL, developmental outcomes)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The aim of the study is to develop an accessible, reproducible ultrasound tool for objective clinical measurement of brain circulation in preterm infants in order to identify infants being at risk for preterm brain injury at an early stage. In the future, the results of this study might be useful to select those infants for early interventions aimed at preventing brain injury.
In this study we will identify the normative values of the internal cerebral vein velocity in a reference cohort of stable preterm infants. This stable group of preterm infants is defined as all preterm infants with a birth weight appropriate for gestational age, and without major complications (such as a severe intracranial hemorrhage, severe hemodynamical instability, birth asphyxia) or major congenital malformations.
In this group we will identify subgroups based on moments of clinical instability (sepsis, temporary hypotension, NEC, need for invasive respiratory support) or based on outcome parameters (IVH, PVL, developmental outcomes)
Serial brain ultrasound examinations are routinely performed as standard of care after preterm birth for timely de-tection of brain hemorrhage in the first week of life and brain injury in the weeks thereafter until term equivalent age. For infants born between 28 0/7 and 31 6/7 weeks, brain ultrasound is performed on admission, once between day 1 and 3, once between day 7 and 10, and then 2-weekly until discharge or transfer. For infants born before 28 0/7 weeks, standard of care consists of brain ultrasound performed on admission, day 1, day 2, day 3, day 7, and then weekly until discharge.
No additional ultrasound examinations, specifically for the purpose of this study, will be performed. Instead, with each routine ultrasound examination, additional images on top of the routine frames will be collected. Those images will document the velocity and flow in the internal cerebral veins bilaterally using the standard Color Doppler tech-nique. Taking these additional images will prolong the time of ultrasound examination only minimally (with a few minutes).
The ultrasound will be performed using a standardized ultrasound protocol according to Ecury-Goossen et al (18) us-ing the Esaote MyLab Twice (Genova, Italy) with a linear (Esaote LA 435 Linear Array Ultrasound Probe, 6.0-18.0 MHz) and convex probe (Esaote CA123 Convex Array Ultrasound Probe, 3.3-9.0 MHz). This is the standard ultra-sound machine for ultrasound investigations at our neonatology ward.
For routine cranial ultrasound, ten images are generally made through the anterior fontanelle: five in the coronal and five in the sagittal plane. In addition to that, color Doppler or power Doppler is commonly performed in one of the pericallosal arteries in order to evaluate the arterial circulation, quantified by calculating a resistency index (RI). Usually routine ultrasound takes up to 10-15 minutes.
After routine scanning, four extra images will be acquired. These are power doppler images, one per insonated ves-sel of interest. The vessels of interest are the internal cerebral vein (left and right separate, if feasible) and one small tributary (the posterior caudate vein) on each side. To derive these images the duration of the US will be prolonged with approximately 3-5 minutes.
Blood flow velocities (maximum velocity and velocity pattern (17)) can be calculated offline in the anonymously ex-ported dicom file of these four images.
In addition to the ultrasound data, the following clinical patient data will be collected during the study:
- Data on systemic perfusion immediately before each ultrasound: arterial blood pressure, mixed cerebral oxygen saturation using near infrared spectroscopy (NIRS), fractional oxygen extraction, limb oxygen satu-ration, heart rate and use of inotropes.
- Demographic data during hospitalization, such as gender, gestational age, birth weight, head circumfer-ence and complications during hospitalization (infection, surgery, etcetera).
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Fleur A Camfferman, MD
- Phone Number: 02 477 7721
- Email: Fleur.Camfferman@uzbrussel.be
Study Contact Backup
- Name: Filip Cools, MD PhD
- Phone Number: 02 477 7721
- Email: Filip.Cools@uzbrussel.be
Study Locations
-
-
Brussels Capital
-
Brussel, Brussels Capital, Belgium, 1090
- Recruiting
- UZ Brussel
-
Contact:
- Fleur A Camfferman, MD
- Phone Number: 024777721
- Email: Fleur.Camfferman@uzbrussel.be
-
Contact:
- Filip Cools, MD PhD
- Phone Number: 024777721
- Email: Filip.Cools@uzbrussel.be
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Preterm infant with a gestational age below 32 0/7 weeks
- birth weight between the 3rd and 97th percentile.
- No cerebral Doppler abnormalities on prenatal ultrasound (i.e. brain sparing)
Exclusion Criteria:
- Brain vessel anomaly
- Major congenital malformation
- No parental consent
- IVH > grade 2 (Papile classification or structural brain abnormalities on the first ultrasound
- Severe hemodynamic instability in the first 6 hours of life requiring treatment with inotropes.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Preterm infants < 28 weeks gestational age
For infants born before 28 0/7 weeks, standard of care consists of brain ultrasound performed on admission, day 1, day 2, day 3, day 7, and then weekly until discharge.
|
No additional ultrasound examinations, specifically for the purpose of this study, will be performed.
Instead, with each routine ultrasound examination, additional images on top of the routine frames will be collected.
Those images will document the velocity and flow in the internal cerebral veins bilaterally using the standard Color Doppler tech-nique.
Taking these additional images will prolong the time of ultrasound examination only minimally (with a few minutes).
|
Other: Preterm infants born between 28 0/7 and 31 6/7 weeks
For infants born between 28 0/7 and 31 6/7 weeks, brain ultrasound is performed on admission, once between day 1 and 3, once between day 7 and 10, and then 2-weekly until discharge or transfer.
|
No additional ultrasound examinations, specifically for the purpose of this study, will be performed.
Instead, with each routine ultrasound examination, additional images on top of the routine frames will be collected.
Those images will document the velocity and flow in the internal cerebral veins bilaterally using the standard Color Doppler tech-nique.
Taking these additional images will prolong the time of ultrasound examination only minimally (with a few minutes).
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Normative values of internal cerebral vein velocity
Time Frame: 2-3 years
|
Determination of normative values of ICV velocity and their range in the first weeks of life in stable preterm infants. The Doppler measurements will be performed at several moments after birth: day 0, 1, 2, 3, 7, 14, 21, etc untill 36 weeks gestational age. For this purpose we will calculate the Maximum velocity (cm/s), the mean velocity (cm/s) and the variability (according to Ikeda et al) of the flow pattern in the Internal Cerebral Vein. These velocities will be plotted in an attempt to discover longitudinal normative values in this cohort of 50 preterm infants. |
2-3 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Short-term outcome: cerebral complications in the neonatal phase
Time Frame: 2-3 years
|
Relation of ICV flow with IVH grade 2 or more (according to the Papile classification), periventricular leukomalacia, ventriculomegaly, white matter disease, selective neuronal necrosis assessed by routinely performed MRI scan of the brain at term equivalent age.
|
2-3 years
|
Long-term outcome: neurodevelopmental impairment
Time Frame: 3-5 years
|
Relation of ICV flow with Bayley mental and motor scales at 2 years of age, as rou-tinely performed by the COS - Centrum voor Ontwikkelingsstoornissen.
|
3-5 years
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Paul Govaert, MD PhD, Universitair Ziekenhuis Brussel
Publications and helpful links
General Publications
- Kluckow M, Evans N. Low superior vena cava flow and intraventricular haemorrhage in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2000 May;82(3):F188-94. doi: 10.1136/fn.82.3.f188.
- Kluckow M, Evans N. Superior vena cava flow in newborn infants: a novel marker of systemic blood flow. Arch Dis Child Fetal Neonatal Ed. 2000 May;82(3):F182-7. doi: 10.1136/fn.82.3.f182.
- Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978 Apr;92(4):529-34. doi: 10.1016/s0022-3476(78)80282-0.
- Osborn DA, Evans N, Kluckow M. Hemodynamic and antecedent risk factors of early and late periventricular/intraventricular hemorrhage in premature infants. Pediatrics. 2003 Jul;112(1 Pt 1):33-9. doi: 10.1542/peds.112.1.33.
- Caicedo A, Naulaers G, Lemmers P, van Bel F, Wolf M, Van Huffel S. Detection of cerebral autoregulation by near-infrared spectroscopy in neonates: performance analysis of measurement methods. J Biomed Opt. 2012 Nov;17(11):117003. doi: 10.1117/1.JBO.17.11.117003.
- de Waal KA, Evans N, Osborn DA, Kluckow M. Cardiorespiratory effects of changes in end expiratory pressure in ventilated newborns. Arch Dis Child Fetal Neonatal Ed. 2007 Nov;92(6):F444-8. doi: 10.1136/adc.2006.103929. Epub 2007 Apr 25.
- Hamon I, Hascoet JM, Debbiche A, Vert P. Effects of fentanyl administration on general and cerebral haemodynamics in sick newborn infants. Acta Paediatr. 1996 Mar;85(3):361-5. doi: 10.1111/j.1651-2227.1996.tb14033.x.
- Skov L, Hellstrom-Westas L, Jacobsen T, Greisen G, Svenningsen NW. Acute changes in cerebral oxygenation and cerebral blood volume in preterm infants during surfactant treatment. Neuropediatrics. 1992 Jun;23(3):126-30. doi: 10.1055/s-2008-1071327.
- Caicedo A, De Smet D, Naulaers G, Ameye L, Vanderhaegen J, Lemmers P, Van Bel F, Van Huffel S. Cerebral tissue oxygenation and regional oxygen saturation can be used to study cerebral autoregulation in prematurely born infants. Pediatr Res. 2011 Jun;69(6):548-53. doi: 10.1203/PDR.0b013e3182176d85.
- van Bel F, Mintzer JP. Monitoring cerebral oxygenation of the immature brain: a neuroprotective strategy? Pediatr Res. 2018 Aug;84(2):159-164. doi: 10.1038/s41390-018-0026-8. Epub 2018 Aug 16. Erratum In: Pediatr Res. 2018 Aug 6;:
- Couture A, Veyrac C, Baud C, Saguintaah M, Ferran JL. Advanced cranial ultrasound: transfontanellar Doppler imaging in neonates. Eur Radiol. 2001;11(12):2399-410. doi: 10.1007/s00330-001-1150-z. Epub 2001 Oct 30.
- Camfferman FA, de Goederen R, Govaert P, Dudink J, van Bel F, Pellicer A, Cools F; eurUS.brain group. Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review. Pediatr Res. 2020 Mar;87(Suppl 1):50-58. doi: 10.1038/s41390-020-0777-x.
- Evans N, Kluckow M, Simmons M, Osborn D. Which to measure, systemic or organ blood flow? Middle cerebral artery and superior vena cava flow in very preterm infants. Arch Dis Child Fetal Neonatal Ed. 2002 Nov;87(3):F181-4. doi: 10.1136/fn.87.3.f181.
- McGovern M, Miletin J. A review of superior vena cava flow measurement in the neonate by functional echocardiography. Acta Paediatr. 2017 Jan;106(1):22-29. doi: 10.1111/apa.13584. Epub 2016 Sep 28.
- Lee A, Liestol K, Nestaas E, Brunvand L, Lindemann R, Fugelseth D. Superior vena cava flow: feasibility and reliability of the off-line analyses. Arch Dis Child Fetal Neonatal Ed. 2010 Mar;95(2):F121-5. doi: 10.1136/adc.2009.176883. Epub 2009 Dec 8.
- Ikeda T, Amizuka T, Ito Y, Mikami R, Matsuo K, Kawamura N, Fusagawa S. Changes in the perfusion waveform of the internal cerebral vein and intraventricular hemorrhage in the acute management of extremely low-birth-weight infants. Eur J Pediatr. 2015 Mar;174(3):331-8. doi: 10.1007/s00431-014-2396-1. Epub 2014 Aug 30.
- Ecury-Goossen GM, Camfferman FA, Leijser LM, Govaert P, Dudink J. State of the art cranial ultrasound imaging in neonates. J Vis Exp. 2015 Feb 2;(96):e52238. doi: 10.3791/52238.
- Pfannschmidt J, Jorch G. Transfontanelle pulsed Doppler measurement of blood flow velocity in the internal jugular vein, straight sinus, and internal cerebral vein in preterm and term neonates. Ultrasound Med Biol. 1989;15(1):9-12. doi: 10.1016/0301-5629(89)90126-9.
- Jansen-van der Weide MC, Caldwell PH, Young B, de Vries MC, Willems DL, Van't Hoff W, Woolfall K, van der Lee JH, Offringa M. Clinical Trial Decisions in Difficult Circumstances: Parental Consent Under Time Pressure. Pediatrics. 2015 Oct;136(4):e983-92. doi: 10.1542/peds.2014-3402.
- Woolfall K, Frith L, Gamble C, Young B. How experience makes a difference: practitioners' views on the use of deferred consent in paediatric and neonatal emergency care trials. BMC Med Ethics. 2013 Nov 6;14:45. doi: 10.1186/1472-6939-14-45.
- Woolfall K, Frith L, Gamble C, Gilbert R, Mok Q, Young B; CONNECT advisory group. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study. BMJ Open. 2015 Sep 18;5(9):e008522. doi: 10.1136/bmjopen-2015-008522.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
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
- SQUIB2020
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
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