nCPAP-NAVA-Backup Versus Standard nCPAP for Severe Apnea in Preterm Infants ≤28 Weeks (NAVAPNEA)
Effect of nCPAP-NAVA-backup Mode Versus Standard nCPAP Mode on the Reduction of Severe Apnea in Preterm Infants ≤ 28 Weeks - a Crossover Trial
The goal of this clinical trial is to determine whether nasal continuous positive airway pressure (nCPAP) with neurally adjusted ventilatory assist (NAVA) backup ventilation (nCPAP-NAVA-backup mode) reduces the rate of severe apnea in extremely preterm infants ≤28 weeks' gestation compared with standard nasal continuous positive airway pressure (nCPAP mode). Severe apnea episodes is defined as breathing pause with oxygen levels ( SpO2) below 85% lasting at least 5 seconds and/or heart rate (HR) below 100 beats/minute lasting at least 5 seconds.
Each participant will receive both interventions in a randomized order, serving as their own control. The total duration of the intervention will be 24h. Each intervention period will last 12 hours. A washout period of 3 hours will be included between intervention periods to minimize potential carryover effects.
Randomized sequences to avoid order effects:
- Sequence A: nCPAP mode → nCPAP-NAVA-backup mode
- Sequence B: nCPAP-NAVA-backup mode →nCPAP mode
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Unzutreffend
Kontakte und Standorte
Studienorte
-
-
-
Geneva, Schweiz
- University hospital of Geneva
-
Kontakt:
- Dimitra Papasavva
- E-Mail: dimitra.papasavva@hug.ch
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
- Kind
- Erwachsene
- Älterer Erwachsener
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
- Born at ≤28 weeks gestational age
- Currently receiving nCPAP mode as part of routine care
- Receiving caffeine citrate at a maintenance dose of 10 mg/kg/day
- An average of ≥1 severe apnea per hour over a 6-hour period (apnea associated with SpO₂<85% during ≥ 5 seconds and/or HR <100 bpm during ≥ 5 seconds) or an average of >2 severe apnea per hour over a 2-hour period
- Written informed consent obtained from the legal representatives before inclusion.
Exclusion Criteria:
- Major congenital anomalies (e.g., congenital diaphragmatic hernia, significant cardiac malformations)
- Known genetic syndrome affecting respiratory function
- Immediate indication for endotracheal intubation or noninvasive ventilation (NIV)
- Parental refusal or withdrawal of consent
- Previous inclusion in the study
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Crossover-Aufgabe
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: Sequence A: nCPAP then nCPAP-NAVA-Backup
Preterm infants randomized to receive 12 hours of standard nCPAP mode followed by 12 hours of nCPAP-NAVA-backup mode (total 24 hours) on a Servo-n ventilator. A 3-hour washout period at the start of each period is excluded from analysis. |
Standard nasal CPAP delivered via a Servo-n ventilator, with continuous monitoring of the electrical activity of the diaphragm (Edi) through an Edi catheter that also serves as the feeding tube. When an apnea exceeds the preset apnea time, pressure-controlled backup ventilation is triggered automatically. Backup and PEEP settings follow unit standards, and PEEP is kept constant throughout the study. Duration: 12 hours. Standard nasal CPAP delivered via nasal prongs or mask on the same Servo-n ventilator and circuit, with PEEP and FiO₂ managed according to standard clinical practice. Duration: 12 hours. |
|
Experimental: Sequence B: nCPAP-NAVA-backup then nCPAP
Preterm infants randomized to receive 12 hours of nCPAP-NAVA-backup mode followed by 12 hours of standard nCPAP mode (total 24 hours) on a Servo-n ventilator. A 3-hour washout period at the start of each period is excluded from analysis. |
Standard nasal CPAP delivered via a Servo-n ventilator, with continuous monitoring of the electrical activity of the diaphragm (Edi) through an Edi catheter that also serves as the feeding tube. When an apnea exceeds the preset apnea time, pressure-controlled backup ventilation is triggered automatically. Backup and PEEP settings follow unit standards, and PEEP is kept constant throughout the study. Duration: 12 hours. Standard nasal CPAP delivered via nasal prongs or mask on the same Servo-n ventilator and circuit, with PEEP and FiO₂ managed according to standard clinical practice. Duration: 12 hours. |
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Number of severe apnea episodes per 9-hour observation period
Zeitfenster: Per 9-hour observation period
|
Number of severe apnea episodes per 9-hour observation period, defined as an apnea associated with oxygen desaturation (SpO₂ < 85%) lasting ≥ 5 seconds and/or bradycardia (Heart rate (HR) < 100 bpm) lasting ≥ 5 seconds |
Per 9-hour observation period
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Number of isolated oxygen desaturation episodes
Zeitfenster: Per 9-hour observation period
|
SpO₂ < 85% for ≥ 5 seconds, not associated with a severe apnea episode |
Per 9-hour observation period
|
|
Number of isolated bradycardia episodes
Zeitfenster: per 9-hour observation period
|
HR < 100 bpm for ≥ 5 seconds, not associated with a severe apnea episode |
per 9-hour observation period
|
|
Number of hyperoxia episodes (SpO₂ > 94% for ≥ 5 seconds)
Zeitfenster: per 9-hour observation period
|
per 9-hour observation period
|
|
|
Percentage of time spent with SpO₂ < 85%
Zeitfenster: per 9-hour observation period
|
per 9-hour observation period
|
|
|
Percentage of time spent with SpO₂ > 94%
Zeitfenster: per 9-hour observation period
|
per 9-hour observation period
|
|
|
Percentage of time spent with HR < 100 bpm
Zeitfenster: per 9-hour observation period
|
per 9-hour observation period
|
|
|
Number of apnea episodes requiring nurse intervention
Zeitfenster: per 9-hour observation period
|
tactile stimulation and/or increase in FiO₂ |
per 9-hour observation period
|
|
Need for escalation of respiratory support during the observation period
Zeitfenster: per 9-hour observation period
|
Defined as requirement for transition to non-invasive ventilation mode or endotracheal intubation |
per 9-hour observation period
|
|
Infant comfort assessed using the EDIN score (Échelle Douleur Inconfort Nouveau-Né)
Zeitfenster: per 9-hour observation period
|
EDIN will be recorded every 3 hours (0-15), yielding up to 3 measurements per 9-hour observation period. The mean EDIN score over each observation period will be used |
per 9-hour observation period
|
|
Gastrointestinal tolerance
Zeitfenster: per 9-hour observation period
|
Grade 1: good tolerance - enteral feeding maintained at prescribed volume with no significant gastric residuals ; Grade 2: moderate intolerance - enteral feeding volume reduced due to gastric residuals or clinical concern ;Grade 3: poor tolerance - enteral feeding discontinued with initiation of continuous gastric suctioning. The worst grade recorded during each 9-hour observation period will be used as the summary measure for analysis. |
per 9-hour observation period
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Geschätzt)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Urogenitale Erkrankungen
- Herz-Kreislauf-Erkrankungen
- Pathologische Prozesse
- Weibliche Urogenitalerkrankungen und Schwangerschaftskomplikationen
- Herzkrankheiten
- Geburtshilfe, Frühgeburt
- Geburtsbedingte Geburtskomplikationen
- Schwangerschaftskomplikationen
- Erkrankungen der Atemwege
- Arrhythmien, Herz
- Atemstörungen
- Anzeichen und Symptome, Atmung
- Pathologische Zustände, Anzeichen und Symptome
- Anzeichen und Symptome
- Frühgeburt
- Apnoe
- Bradykardie
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- 2026-00663
- HumRes (Andere Kennung: Human research in Switzerland)
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .