Intratracheal Budesonide With Surfactant to Prevent Bronchopulmmonary Dysplasia.
- Conditions
- Bronchopulmonary DysplasiaPrematurityRespiratory Distress Syndrome in Premature Infant
- Interventions
- Drug: Poractant Alfa Intratracheal Suspension [Curosurf]
- Registration Number
- NCT04862377
- Lead Sponsor
- Hospital Clinic of Barcelona
- Brief Summary
This study is designed to determine whether intratracheal administration of budesonide combined with surfactant, as compared to surfactant alone, will modify ecographic (lung ultrasound score) and biological markers (IL-6 concentration in respiratory secretions) at 7 days of life in preterm infants ≤32 weeks of gestational age (GA).
- Detailed Description
Bronchopulmonary dysplasia (BPD) is one of the main morbidities associated with extreme prematurity and, despite the improvement of respiratory care in the latest years, overall incidence is not decreasing. Etiology of BPD is multifactorial and local inflammation plays an important role in it, therfore, local anti-inflammatory drugs could be effective in preventing BPD.
Recent randomised trials have shown a lower incidence of BPD/death with the use of a combination of budesonide with surfactat compared to surfactant alone, and further clinical trials are currently ongoing.
This is a controlled phase IV, randomised, unicenter clinical trial designed to evaluate the effect of intratracheal administration of budesonide combined with surfactant, as compared to surfactant alone, in BPD in preterm infants ≤32 weeks of GA. Investigators will compare ecographic and biological markers, as well as respiratory outcomes.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 50
- Infants born equal or earlier than 32 weeks of gestational age admitted in the Neonatal Intensive Care Unit.
- Parental consent signed.
- Less than or equal to 48 hours postnatal age.
- Infants with known major congenital anomalies (eg. congenital upper airwayobstruction, congenital lung anomaly, severe pulmonary hypoplasia, hydrops,neuromuscular diseases, chromosomopaties)
- Infants with poor prognosis and risk of imminent death
- Infants who have received the first dose of surfactant before of the enrolment to the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Interventional treatment group Budesonide 0.5 MG/ML Infants randomised to the "interventional treatment" arm will receive intratracheal surfactant mixed with budesonide. Indication of surfactant, as equal as for the "standard treatment" arm, will be decided using the calculator. Interventional treatment group Poractant Alfa Intratracheal Suspension [Curosurf] Infants randomised to the "interventional treatment" arm will receive intratracheal surfactant mixed with budesonide. Indication of surfactant, as equal as for the "standard treatment" arm, will be decided using the calculator. Standard treatment group Poractant Alfa Intratracheal Suspension [Curosurf] Infants randomised to the "standard treatment" arm will receive intratracheal surfactant as per usual clinical indications of respiratory distress syndrome in these preterm infants. In that sense, and based in those clinical indications, we have developed a risk calculator for surfactant administration in preterm infants ≤32 weeks GA. We will use it to decide what patients will receive surfactant (calculator available on: https://1drv.ms/x/s!Arjkl83HIXSngP8TWh8O6oi6Ztdw3w?e=gNCMxP).
- Primary Outcome Measures
Name Time Method Lung ultrasound score at 7 days of life. 7 days of life LUS will be performed with the patients in supine position and slightly lying on the side of the taken view. Each lung will be divided in five areas through longitudinal orientation and images will be taken using the linear probe (VF 13-5MHz).
IL-6 concentration in respiratory secretions at 7 days of life. 7 days of life Nasopharyngeal aspirate (NPA) will be collected by standard procedure. IL-6 concentration will be determined by Human IL-6 Quantikine ELISA (R\&D Systems Inc., Minneapolis, MN, USA).
- Secondary Outcome Measures
Name Time Method Lung ultrasound score at 28 days of life. 28 days of life LUS will be performed with the patients in supine position and slightly lying on the side of the taken view. Each lung will be divided in five areas through longitudinal orientation and images will be taken using the linear probe (VF 13-5MHz).
IL-6 concentration in respiratory secretions at 28 days of life. 28 days of life Nasopharyngeal aspirate (NPA) will be collected by standard procedure. IL-6 concentration will be determined by Human IL-6 Quantikine ELISA (R\&D Systems Inc., Minneapolis, MN, USA).
Respiratory status and neurodevelopment 24 months of age. Neurodevelopment will be assessed using Bayley-III test.
Number of days of oxygen 7 and 28 days of age, 36 weeks of post-menstrual age. Number of days on FiO2 \>21% supplied by any respiratory support
Number of days of respiratory support 7 and 28 days of age, 36 weeks of post-menstrual age. Number of days on each level of respiratory support:
* No respiratory support
* Nasal cannula at flow rates ≤ 2L/min
* Nasal cannula at flow rates \> 2L/min
* CPAP/BIPAP
* Invasive mechanical ventilationMean airway pressure (MAP) 7 and 28 days of age, 36 weeks of post-menstrual age. Maximum MAP mesured in cmH2O at 7 and 28 days of age, 36 weeks of postmenstrual age.
Incidence of bronchopulmonary dysplasia 36 weeks of post-menstrual age. BPD will be defined according to the 2001 workshop definition (Jobe AH, Bancalari E. Bronchopulmonary dysplasia. American Journal of Respiratory and Critical Care Medicine. American Lung Association; 2001; pp 1723-9).