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Vitamin D Supplementation for Extremely Preterm Infants

8 februari 2017 uppdaterad av: Namasivayam Ambalavanan, University of Alabama at Birmingham

Early Vitamin D Supplementation for Prevention of Respiratory Morbidity in Extremely Preterm Infants: A Randomized Clinical Trial

The study hypothesis states that giving early enteral Vitamin D supplementation to preterm infants will decrease respiratory morbidity in extremely preterm infants.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

After informed consent obtained, infants will be randomized using computer-generated stratified randomization codes by the pharmacy. Clinicians, researcher, and primary caregivers will be masked. Subjects will be randomly assigned to one of the treatment arms or to a placebo concurrent control.

Early vitamin D supplementation/placebo will be initiated within the first 7 days after birth. Premature infants will be randomized to receive one of the 3 fixed doses of vitamin D: either placebo (zero dose), 200 IU/day, or 800 IU/day. The supplementation will be started within 72 hours of enteral feeds being initiated and will continue until postnatal day 28. After this period of supplementation, routine supplementation will be conducted in all groups.

Remnant cord blood samples will be analyzed for vitamin D levels (serum hydroxyvitamin D [25(OH)D]. Two circulating vitamin D concentrations (25(OH)D concentrations) will be measured on postnatal days 14 and 28. Urine samples will be collected weekly, to determine calcium excretion if high serum calcium concentrations are found.

Supplementation will be discontinued and infant will exit the study if surgical necrotizing enterocolitis/bowel perforation is diagnosed, if 25 (OH)D concentrations >60ng/mL (>150nmol/L; potentially toxic) are detected or, if infant NPO for greater than 24 hours. If infant made briefly NPO (<24h) for feeding intolerance, suspected sepsis, hypotension,hemodynamically significant PDA, or respiratory difficulties, enteral vitamin D will not be discontinued.

All infants will be followed to discharge for primary, secondary outcomes as well as adverse events.

Studietyp

Interventionell

Inskrivning (Faktisk)

100

Fas

  • Fas 2
  • Fas 3

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • Alabama
      • Birmingham, Alabama, Förenta staterna, 35249
        • University of Alabama at Birmingham

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

1 minut till 1 vecka (Barn)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Infants admitted to the Regional Newborn ICU of the University of Alabama with gestational age between 23-27 completed weeks

Exclusion Criteria:

  • Major congenital/chromosomal anomalies
  • Moribund infant with low likelihood of survival, in opinion of the clinical team

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Förebyggande
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Fyrdubbla

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Aktiv komparator: Oral Vitamin D--200 IU/day
Cholecalciferol 200 IU given orally once per day
Kosttillskott: Cholecalciferol
200 IU/day given orally once per day as one of 4 doses of 0.5ml each given every 6 hours. Other 3 doses will be placebo (sterile water). Duration of 28 postnatal days
Andra namn:
  • Vitamin D
Kosttillskott: Cholecalciferol
800 IU/day given orally per day as 4 doses of 200 IU/0.5ml each every 6 hours. Duration of 28 postnatal days
Andra namn:
  • Vitamin D
Placebo-jämförare: Placebo
Identical-appearing treatment that does not contain the test drug given orally four times per day.
Kosttillskott: Placebo
Sterile water 0.5ml given orally every 6 hours. Duration of 28 postnatal days
Aktiv komparator: Oral Vitamin D--800 IU/day
Cholecalciferol 800 IU given orally once per day
Kosttillskott: Cholecalciferol
200 IU/day given orally once per day as one of 4 doses of 0.5ml each given every 6 hours. Other 3 doses will be placebo (sterile water). Duration of 28 postnatal days
Andra namn:
  • Vitamin D
Kosttillskott: Cholecalciferol
800 IU/day given orally per day as 4 doses of 200 IU/0.5ml each every 6 hours. Duration of 28 postnatal days
Andra namn:
  • Vitamin D

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Total number of days alive and off respiratory support in the first 28 days
Tidsram: 28 days
The total number of days alive and off respiratory support. Respiratory support is defined as need of supplemental oxygen and/or positive pressure ventilation to maintain normal target oxygen saturations (88-95%).
28 days
Serum vitamin D concentration
Tidsram: Day after birth 28
Serum vitamin D levels determined by enzyme immunoassay obtained from whole blood (remnant sample or obtained during clinical blood draw)
Day after birth 28

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Number of sepsis episodes treated with antibiotics for at least 5 days
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Number of episodes of culture proven or clinically suspected sepsis episodes treated with antibiotics for at least 5 days
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Sepsis
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Culture proven or culture negative clinically treated course consistent with sepsis
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Need for supplemental oxygen at 36 weeks of corrected age (Physiologic definition)
Tidsram: 36 weeks gestational age corrected
A physiologic oxygen challenge test will be administered to infants from 36.0 weeks gestation to 37.0 weeks gestation to determine a need for supplemental oxygen to keep saturation levels between 88-95%.
36 weeks gestational age corrected
Duration of mechanical ventilation after randomization
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Counted as number of days on which an infant is on mechanical ventilation for any part of a calendar day
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Days alive and off mechanical ventilation in the first 28 days after birth
Tidsram: 28 days
Counted as days alive without mechanical ventilation for any part of a day
28 days
Number of re-intubation events
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Counted as number of reintubations for purposes of respiratory support
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Death
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Cardiorespiratory failure
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Surgical necrotizing enterocolitis or intestinal perforation
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Radiographic documentation of pneumatosis or intestinal perforation or treatment course for clinical necrotizing enterocolitis per Bell's stage greater than 1.
Participants will be followed for the duration of hospital stay, an expected average of 4 months
25(OH)D concentrations >60ng/ml (150 nmol/L)
Tidsram: 14 postnatal (+/- 2 days)
Vitamin D measurement per blood obtained either centrally or by heel stick.
14 postnatal (+/- 2 days)
25(OH)D concentrations >60ng/ml (150 nmol/L)
Tidsram: 28 days postnatal age (+/- 3 days)
Vitamin D measurement per blood obtained either centrally or by heel stick.
28 days postnatal age (+/- 3 days)
Serum calcium level
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Serum calcium measurement per blood obtained either centrally or by heel stick, performed for clinical care. High serum calcium level is greater than 3 mmol/l of total calcium or total calcium of >12 mg/dL, or ionized calcium >2 mml/L.
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Urine calcium level
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Calcium measurement per urine, random sampling. High level (>95%tile) urine calcium to creatinine ratio is >3.8 mmol/mmol.
Participants will be followed for the duration of hospital stay, an expected average of 4 months
Meningitis
Tidsram: Participants will be followed for the duration of hospital stay, an expected average of 4 months
Culture proven or culture negative clinically treated course consistent with meningitis
Participants will be followed for the duration of hospital stay, an expected average of 4 months

Andra resultatmått

Resultatmått
Tidsram
Death or Neurodevelopmental Impairment
Tidsram: Birth to 22-26 months of age
Birth to 22-26 months of age

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

University of Alabama at Birmingham

Samarbetspartners

Children's Health System, Alabama

Utredare

  • Studierektor: Ariel A. Salas, MD, University of Alabama at Birmingham

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 juni 2012

Primärt slutförande (Faktisk)

1 december 2014

Avslutad studie (Faktisk)

1 december 2016

Studieregistreringsdatum

Först inskickad

14 maj 2012

Först inskickad som uppfyllde QC-kriterierna

15 maj 2012

Första postat (Uppskatta)

17 maj 2012

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

10 februari 2017

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

8 februari 2017

Senast verifierad

1 februari 2017

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • UAB Neo 006

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