PAEAN - Erythropoietin for Hypoxic Ischaemic Encephalopathy in Newborns
- Conditions
- Hypoxic-Ischemic Encephalopathy
- Interventions
- Drug: Epoetin AlfaDrug: Normal saline
- Registration Number
- NCT03079167
- Lead Sponsor
- University of Sydney
- Brief Summary
Double-blind, placebo controlled Phase III trial of erythropoietin for hypoxic ischaemic encephalopathy in infants receiving hypothermia. The study aim is to determine whether Epo in conjunction with hypothermia in infants with moderate/severe hypoxic ischaemic encephalopathy (HIE) will improve neurodevelopmental outcomes at 2 years of age, without significant adverse effects, when compared to hypothermia alone.
- Detailed Description
A lack of oxygen (hypoxia) or low blood supply (ischaemia) before or during birth can destroy cells in a newborn baby's brain. The damage caused by the lack of oxygen continues for some time afterwards. One way to try to reduce this damage is to induce hypothermia cooling the baby or just the baby's head for hours to days. Erythropoietin (Epo) given in the first week after birth shows promise as a treatment that may also help. This study is to find out whether Epo plus induced hypothermia (cooling) of near-term newborn babies who have suffered from low blood or oxygen supply to the brain at birth reduces death and disability in survivors at two years of age.
The target population is 300 newborn term or near term infants (greater than or equal to 35+0 weeks gestation) with hypoxic ischaemic encephalopathy who are receiving, or planned to receive hypothermia and who are able to be recruited in time to allow study treatment to commence before 24 hours of age.
This is a double blind, placebo controlled, parallel, 2 arm randomised, phase III multicentre trial, stratified by study site and by severity of encephalopathy at study entry.
The treatment group of 150 infants will receive human recombinant Epo, 1000 IU/kg IV on days 1, 2, 3, 5 \& 7 of life. The control group will receive 0.9% sodium chloride as a placebo on days 1, 2, 3, 5 \& 7 of life.
Families will be followed up every 6 months until the primary assessment of death and disability at 2 years of age.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 313
-
Male or female infants born greater than or equal to 35+0 weeks gestation and able to be randomised less than 23 hours after birth
-
One or more of the following indicators of perinatal depression:
- Apgar less than or equal to 5 at 10 minutes after birth, OR
- Receiving ongoing resuscitation e.g. assisted ventilation (positive pressure ventilation or CPAP) or chest compressions at 10 minutes after birth, OR
- on cord blood or arterial or venous blood obtained at less than 60 minutes after birth, either pH less than 7.00 OR base deficit greater than or equal to 12.0 mmol/L
-
Moderate to severe encephalopathy, defined between one and six hours after birth by one or both of the following:
- 3 out of 6 modified Sarnat criteria indicating moderate/severe encephalopathy, OR
- 2 out of 6 modified Sarnat criteria plus seizure(s) requiring anticonvulsant treatment (diagnosed either clinically or using EEG monitoring) at any time prior to randomisation
-
Hypothermia treatment initiated by 6 hours ofa ge; i.e. controlled whole-body cooling planned to continue for 72 hours to a target temperature (adjusted manually or with a device) and subsequent controlled re-warming
-
Study treatment planned to start within 24 hours after birth (as soon as feasible after randomisation)
-
At least one parent greater than or equal to 18 years of age
-
Anticipated ability to collect primary endpoint at 2 years of age
-
Signed, written informed parental consent
- Contraindications to investigational product
- Indication prior to randomisation for erythropoietin or any other erythropoietic stimulating agent to be given during the first two weeks of life
- Severe intrauterine growth restriction (birth weight less than 1800g)
- Suspected major chromosomal or congenital anomalies
- Head circumference less than 3rd centile below the mean for gestation and gender
- Infant for whom imminent withdrawal of care is being planned
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Erythropoietin Epoetin Alfa Erythropoietin (epoetin alfa) 1000 IU/kg birth weight (capped at 4000IU daily) IV infusion, on Days 1, 2, 3, 5 and 7 of age Placebo Normal saline IV normal saline (equiv. volume), on Days 1, 2, 3, 5 and 7 of age
- Primary Outcome Measures
Name Time Method Composite measure of death or moderate/severe disability 2 years of age Moderate/severe disability is defined as any cerebral palsy and a Gross Motor Function Classification Scale (GMFCS) score greater than or equal to 1), or Bayley Scale of Infant Development III (BSDIII) less than or equal to 80
- Secondary Outcome Measures
Name Time Method Need for supplemental respiratory support (includes tracheostomy, ventilator, high flow nasal cannula, CPAP or oxygen dependency) 2 years of age Supplemental respiratory support includes tracheostomy, ventilator, high flow nasal cannula, CPAP or oxygen dependency
Death Any time from Day 1 of treatment to 2 years of age Death from any cause
Cerebral palsy (CP), assessed by paediatric assessment 2 years of age Any incidence of CP (any of quadriplegia, triplegia, hemiplegia, diplegia or monoplegia)
Moderate/severe motor deficit 2 years of age Composite of any incidence of CP (any of quadriparesis, CP, hemiparesis or diparesis) AND any level of functional impairment using the GMFCS greater than or equal to 1.0
Moderate/severe cognitive deficit 2 years of age Defined as a BSDIII cognitive score less than or equal to 80
Need for nutritional support (includes gastrostomy or nasogastric feeds) 2 years of age Nutritional support includes gastrostomy or nasogastric feeds
Major cortical visual impairment by paediatric examination 2 years of age Impairment as assessed by paediatric assessment
Hearing impairment status by paediatric examination - requirement for hearing aids 2 years of age Defined as the requirement for hearing aids (either diagnosis of: Hears well or with only a little difficulty WITH a hearing aid OR Has severe hearing difficulty even with a hearing aid or hearing is not helped with an aid)
Epilepsy (history of 2 or more afebrile unprovoked seizures since discharge from neonatal unit where PAEAN study treatment was provided, or use of anticonvulsants at 2 years of age). 2 years of age Defined by history of 2 or more afebrile unprovoked seizures since discharge from neonatal unit where PAEAN study treatment was provided, or use of anticonvulsants at 2 years of age
Cost of healthcare and service utilisation 2 years of age Defined as a composite of parent completed questionnaire data and Medicare service use
Frequency of selected adverse events (AEs) of interest, including deaths Up to 30 days post study treatment Frequency of selected adverse events (AEs) of interest up to 30 days after the last study dose
Trial Locations
- Locations (24)
Flinders Medical Centre
🇦🇺Bedford Park, South Australia, Australia
The Royal Women's Hospital
🇦🇺Parkville, Victoria, Australia
KK Women's and Children's Hospital
🇸🇬Singapore, Singapore
Nepean Hospital
🇦🇺Kingswood, New South Wales, Australia
Canberra Hospital
🇦🇺Garran, Australian Capital Territory, Australia
Mercy Hospital for Women
🇦🇺Heidelberg, Victoria, Australia
The Royal Children's Hospital
🇦🇺Parkville, Victoria, Australia
Christchurch Hospital
🇳🇿Christchurch, New Zealand
Royal Women's & Brisbane Hospital
🇦🇺Herston, Queensland, Australia
King Edward Memorial Hospital
🇦🇺Subiaco, Western Australia, Australia
Royal Prince Alfred Hospital
🇦🇺Camperdown, New South Wales, Australia
Middlemore Hospital
🇳🇿Auckland, New Zealand
Mater Mothers' Hospital
🇦🇺South Brisbane, Queensland, Australia
Women's and Children's Hospital
🇦🇺North Adelaide, South Australia, Australia
Royal North Shore Hospital
🇦🇺St Leonards, New South Wales, Australia
Royal Hobart Hospital
🇦🇺Hobart, Tasmania, Australia
Westmead Hospital
🇦🇺Westmead, New South Wales, Australia
Princess Margaret Hospital
🇦🇺Subiaco, Western Australia, Australia
Monash Medical Centre
🇦🇺Clayton, Victoria, Australia
John Hunter Hospital
🇦🇺New Lambton, New South Wales, Australia
Royal Hospital for Women
🇦🇺Randwick, New South Wales, Australia
Auckland City Hospital
🇳🇿Auckland, New Zealand
Waikato Hospital
🇳🇿Hamilton, New Zealand
Wellington Hospital
🇳🇿Wellington, New Zealand