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Magnetic Resonance Imaging (MRI) to Evaluate Brain Injury in Congenital Heart Disease (CHD Brain)

8. februar 2016 oppdatert av: William T. Mahle, MD, Emory University

Role of Inflammatory Response in Brain Injury Following Neonatal Cardiac Surgery

Infants with congenital heart disease (CHD) requiring surgery frequently have brain injury seen on magnetic resonance imaging (MRI). This occurs in approximately 40% of these newborns, and even though these are full-term infants, the injury seen closely resembles the same form of brain injury that can be seen in premature babies. Much like premature newborns, infants with CHD also have long-term neurodevelopmental problems (in over 50%).

The investigators do not know why infants with CHD get this specific form of brain injury. One risk factor is felt to be the inflammation that occurs in response to heart-lung bypass (cardiopulmonary bypass, or CPB), a necessary feature of open-heart surgery. Newborns have a stronger inflammatory reaction to CPB than older children or adults. The investigators do know from animal experiments and other human data that inflammation can be harmful to the developing brain.

The investigators hypothesize that children with CHD requiring surgery as a newborn have brain injury due to toxicity from the inflammatory response. The investigators will test this by enrolling newborns undergoing heart surgery to measure markers of inflammation, measure brain injury by MRI, and then test their developmental outcome at 1 and 2 years of age.

An association between inflammation and injury might impact what medicines are chosen to protect the brain in future studies, even in other populations such as preterm infants.

Studieoversikt

Status

Fullført

Forhold

Detaljert beskrivelse

Term infants with congenital heart disease (CHD) requiring neonatal surgery have an unusual susceptibility to white matter injury (WMI), a neuropathology typically seen in preterm infants. The mechanism of this brain injury is unclear. Newborns with CHD may experience a dramatic peri-operative inflammatory response during critical periods of neurodevelopment. Experimental models suggest certain pro-inflammatory cytokines can be toxic to developing oligodendrocytes, resulting in white matter pathology. The consequence of exposure to the systemic inflammatory response (SIR) in this group of patients is unknown; however, neuroimaging abnormalities (seen in approximately 40%) and neurodevelopmental impairment (noted in approximately 50%) are both well established in children with CHD. We hypothesize that term newborns with complex CHD requiring neonatal surgery have WMI due to neurotoxicity from the profound peri-operative inflammatory response. These hypotheses will be tested in a prospective longitudinal study that will characterize the SIR (Aim 1) in a heterogeneous group of congenital lesions/surgeries, assess brain injury in the post-operative period (Aim 2), asses neurodevelopment outcomes at 1 and 2 years (Aim 3), and determine whether inflammation plays a mechanistic role (Aim 2a, 3a).

Studietype

Observasjonsmessig

Registrering (Faktiske)

92

Kontakter og plasseringer

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Studiesteder

  • Forente stater
    • Georgia
      • Atlanta, Georgia, Forente stater, 30322
        • Children's Healthcare of Atlanta

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

Ikke eldre enn 4 uker (Barn)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

newborns with congenital heart disease requiring surgery during the first 30 days of life

Beskrivelse

Inclusion Criteria:

  • Term or near-term (> 35 week gestation) neonates with CHD presenting for cardiac surgery
  • Less than 30 days old
  • No patient will be excluded because of race or ethnicity
  • Parental or legal guardian consent will be obtained for all patients prior to enrollment

Exclusion Criteria:

  • Newborns with multiple organ abnormalities in addition to their heart defect such as diaphragmatic hernia, tracheo-esophageal fistula, and congenital syndromes will be excluded from participation
  • Newborns with either genetic syndromes or congenital infections that are associated with developmental delay will also be excluded
  • Newborns with perinatal depression as defined by a cord blood gas pH < 7.0 or a 5 minute Apgar score < 5, will be excluded
  • Patients with multiple organ failure, syndromes, and perinatal depression have other causes for neurodevelopmental abnormalities
  • Those patients unable to return for postoperative follow-up and neurodevelopmental testing will also be excluded from participation
  • Parent or legal guardian unable or unwilling to consent
  • Non-English speaking families

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Hva måler studien?

Primære resultatmål

Resultatmål
Tidsramme
The primary outcome will be a measure of the association of pro-inflammatory cytokines with WMI score
Tidsramme: 5 years
5 years

Sekundære resultatmål

Resultatmål
Tidsramme
Association between inflammatory response and neurodevelopmental testing
Tidsramme: 5 years
5 years
Association of neuroimaging abnormalities with neurodevelopmental testing
Tidsramme: 5 years
5 years

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Emory University

Samarbeidspartnere

Children's Healthcare of Atlanta

Etterforskere

  • Hovedetterforsker: William T Mahle, MD, Emory University

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. august 2009

Primær fullføring (Faktiske)

1. januar 2016

Studiet fullført (Faktiske)

1. januar 2016

Datoer for studieregistrering

Først innsendt

1. juli 2009

Først innsendt som oppfylte QC-kriteriene

2. juli 2009

Først lagt ut (Anslag)

3. juli 2009

Oppdateringer av studieposter

Sist oppdatering lagt ut (Anslag)

10. februar 2016

Siste oppdatering sendt inn som oppfylte QC-kriteriene

8. februar 2016

Sist bekreftet

1. februar 2016

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • IRB00017965
  • 17965 (Annen identifikator: Other)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

UBESLUTTE

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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