Transpyloric Versus Gastric Feeding in Bronchopulmonary Dysplasia

Not Applicable

Not yet recruiting

• Conditions: Gastroesophageal Reflux; Bronchopulmonary Dysplasia
• Interventions: Other: Transpyloric tube feeding; Other: Gastric tube feeding

• Registration Number: NCT06534359
• Lead Sponsor: Children's Hospital of Philadelphia

Brief Summary

The goal of this clinical trial is to learn if transpyloric tube feeding (feeding directly into the small intestine) versus gastric tube feeding tolerably and effectively reduces gastroesophageal reflux in infants born premature who have been diagnosed with bronchopulmonary dysplasia. The main questions this trial aims to answer are:

Does transpyloric as compared to gastric tube feeding result in differences in the amount of experienced hypoxemia (low oxygen level in the blood) or serious adverse events?

Does transpyloric as compared to gastric tube feeding reduce the frequency and severity of gastroesophageal reflux (GER) measured using 24 hour esophageal pH-multichannel intraluminal impedance (pH-MII) monitoring?

Participants will:

Undergo pre-trial 24 hour pH-MII monitoring to determine baseline severity of GER.

Be randomly assigned to receive transpyloric or gastric tube feeding for 2 weeks.

Undergo repeat pH-MII at the end of the 2 week trial to assess for change in GER.

Undergo continuous pulse oximetry to record level of hypoxemia during the 2 week trial.

Undergo saliva and airway (if supported by a breathing tube) fluid collection to measure biomarkers of GER.

Be monitored clinically for possible adverse events.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2024-07-30
• Study First Submitted QC: 2024-07-30
• Study First Posted: 2024-08-02
• Status Verified: 2025-01
• Last Update Submitted: 2025-01-30
• Last Update Posted: 2025-02-03
• Study Start: 2025-03-01
• Primary Completion: 2026-12-31
• Study Completion: 2026-12-31

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

1. Birth <32 weeks' gestation
2. Current postmenstrual age of 36-65 weeks
3. Grade 2-3 bronchopulmonary dysplasia (BPD: treatment with positive airway pressure at 36 weeks' PMA) or grade 1 BPD (treatment with ≤2L/min flow nasal cannular at 36 weeks' PMA) with subsequent need for prolonged positive airway pressure and full enteral tube feedings
4. Treatment with positive airway pressure (high flow nasal cannula, non-invasive positive airway pressure, or invasive ventilation) at enrollment

(4) Full gastric tube feedings (≥100mL/kg/d) at the time of enrollment (5) Parental consent to participate

Note: At least 20 infants receiving invasive ventilation will be enrolled to enable endotracheal biomarker testing.

Exclusion Criteria

1. Transpyloric feedings received within 7d of enrollment
2. Use of a gastric acid suppression, GI promotility drug, or caffeine within 7d of enrollment
3. History of gastrostomy tube placement, gastric fundoplication, or bowel resection resulting in short gut with contraindication to transpyloric feeding
4. Plan to wean off positive airway pressure (for non-intubated subjects) or to be extubated to non-invasive support (for subjects receiving invasive ventilation) within the 2wk trial
5. Known intolerance to transpyloric feeding
6. Persistent >20% endotracheal tube leak (for intubated subjects only)
7. Active treatment with an investigational therapy as part of another interventional trial
8. severe congenital or genetic abnormality that adversely affects GI or cardiopulmonary function

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Transpyloric tube feeding	Transpyloric tube feeding	Nasal or oral placed feeding tube with the distal end located within the second or third portion of the duodenum. Correct placement confirmed by radiograph.
Gastric tube feeding	Gastric tube feeding	Nasal or oral placed feeding tube with distal end located within the stomach. Correct placement confirmed by point of care aspirate pH testing or radiograph based on local clinical standard.

Primary Outcome Measures

Name	Time	Method
Serious adverse events	Until hospital discharge	A serious adverse event (SAE) will be defined as any adverse experience that is at least possibly related to the study intervention and results in any of the following outcomes: * death,; * a life-threatening event (at risk of death at the time of the event),; * prolongation of existing hospitalization beyond what would be expected for a preterm infant who requires extended respiratory support near and beyond term corrected gestation, or; * a persistent or significant disability/incapacity.
Proportion (%) of time per day with oxygen saturation <80%	During the 2 week trial	Oxygen saturation will be measured by continuous pulse oximetry throughout the 2 week trial. The proportion of time per day with an oxygen saturation (SpO2) less than 80% will be calculated and reported as a median value observed over the 2 week trial.

Secondary Outcome Measures

Name	Time	Method
Proportion of GER episodes reaching the proximal pH-MII sensor	24 hours	The number of GER episodes detected by 24 hour esophageal pH-MII monitoring that reach the proximal sensor will be recorded and divided by the total number of recorded impedance episodes (regardless of esophageal height)
Salivary and tracheal pepsin concentration	1 day prior to initiating the trial and on trial day 7 and 14.	Saliva and tracheal samples will be collected by gentle suctioning and analyzed for concentration of pepsin, a biomarker of GER. Quantification will be performed using commercially available assay.
Respiratory severity score	During the 2 week trial	Respiratory severity score is calculated as the delivered mean airway pressure multiplied by supplemental oxygen level. Values will be computed as the daily time weighted average.
Total number of pH (acid) only reflux episodes	24 hours	The total number of reflux episodes with a pH\<4 will be recorded during 24 hour pH-MII monitoring
Intermittent hypoxemic episodes	During the 2 week trial	Occurrence of hypoxemic episodes will be recorded using continuous pulse oximetry. Intermittent episodes will be defined as oxygen saturation (SpO2) values \<80% lasting longer than 10 seconds.
Total number of gastroesophageal reflux (GER) episodes	24 hours	The total number of GER episodes during a 24 hour period will be measured using 24 hour esophageal pH-multichannel intraluminal impedance (pH-MII) monitoring. Testing is performed by inserting a pH-MII catheter into the esophagus via the nasal or oral route. Reflux episodes are recorded during a 24 hour monitoring period and the total number is tabulated. 24 hour pH-MII testing will be performed prior to randomization and on day 14 (last day) of the clinical trial.
Clinically diagnosed aspiration events	During the 2 week trial	Aspiration events will be diagnosed as will define aspiration as a witnessed regurgitation (milk in the mouth, clothing respiratory equipment, etc.) event with subsequent clinical decompensation (increase in inspired oxygen by an absolute difference of 20% or more or an increase in delivered mean airway pressure by at least 5cm H2O for ≥ 24 hours beginning within 24 hours of the observed regurgitation event.
Total daily narcotic exposure	During the 2 week trial	Total dose of narcotic medications received during the 2 week trial will be tabulated in morphine and midazolam equivalents and summarized as mg/kg exposure.
Salivary and tracheal total bile acid concentration	1 day prior to initiating the trial and on trial day 7 and 14.	Saliva and tracheal samples will be collected by gentle suctioning and analyzed for concentration of bile acids, a biomarker of gastro-duodeno reflux. Quantification will be performed using commercially available assay.
Prolonged hypoxemic episodes	During the 2 week trial	Occurrence of hypoxemic episodes will be recorded using continuous pulse oximetry. Prolonged episodes will be defined as oxygen saturation (SpO2) values \<80% lasting longer than 60 seconds.
Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain scale	During the 2 week trial	The FLACC scale assesses pain by observing five categories of behaviors and assigning a score of 0-2 to each category, resulting in a total score of 0-10: Face: Facial expressions, such as a smile, grimace, or frown Legs: Leg movement, such as kicking, drawing legs up, or remaining relaxed Activity: Movement, such as lying quietly, squirming, or remaining tense Cry: Crying, moaning, whimpering, or complaining Consolability: Response to comfort, such as being reassured by touching or hugging, or being difficult to console; FLACC scores will be assessed during routine nursing care (at least twice daily) and summarized as median daily values
Feeding tube replacement	During the 2 week trial	Number of times the feeding tube is replaced due to dysfunction or inadvertent dislodgment.

Trial Locations

Locations (3)

Children's Hospital of Philadelphia; 🇺🇸 Philadelphia, Pennsylvania, United States

Children's Mercy Hospital; 🇺🇸 Kansas City, Missouri, United States

Stanford University; 🇺🇸 Palo Alto, California, United States