BuS: Intratracheal Budesonide With Surfactant to Prevent Bronchopulmmonary Dysplasia.
Study Details
Study Description
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).
Condition or Disease | Intervention/Treatment | Phase |
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Phase 3 |
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.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Active Comparator: Standard treatment group 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). |
Drug: Poractant Alfa Intratracheal Suspension [Curosurf]
Poractant alfa (Curosurf®):
First dose of treatment: 200mg/Kg. Further doses (up to a total maximum of 3 within first 48 hours of life): 100mg/Kg.
Other Names:
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Experimental: Interventional treatment group 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. |
Drug: Poractant Alfa Intratracheal Suspension [Curosurf]
Poractant alfa (Curosurf®):
First dose of treatment: 200mg/Kg. Further doses (up to a total maximum of 3 within first 48 hours of life): 100mg/Kg.
Other Names:
Drug: Budesonide 0.5 MG/ML
Poractant alfa (Curosurf®) + Budesonide nebulizer solution (Budesonida Aldo-Unión 0.5mg/mL suspensión para inhalación por nebulizador®):
First dose: 200mg/Kg of surfactant + 0.25mg/Kg of budesonide. Further doses (up to a total maximum of 3 within first 48 hours of life): 100mg/Kg of surfactant + 0.25mg/Kg of budesonide.
Other Names:
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No Intervention: Control group Infants ≤32 weeks with no indications for surfactant administration. Their clinical management will be the usual in our neonatal unit. |
Outcome Measures
Primary Outcome Measures
- 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
- 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).
- 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 ventilation
- Mean 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).
- Respiratory status and neurodevelopment [24 months of age.]
Neurodevelopment will be assessed using Bayley-III test.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Infants born equal or earlier than 32 weeks of gestational age admitted in the Neonatal Intensive Care Unit.
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Parental consent signed.
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Less than or equal to 48 hours postnatal age.
Exclusion Criteria:
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Infants with known major congenital anomalies (eg. congenital upper airwayobstruction, congenital lung anomaly, severe pulmonary hypoplasia, hydrops,neuromuscular diseases, chromosomopaties)
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Infants with poor prognosis and risk of imminent death
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Infants who have received the first dose of surfactant before of the enrolment to the study.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Hospital Clinic of Barcelona
Investigators
- Principal Investigator: Marta Teresa-Palacio, MD, Hospital Clinic of Barcelona
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Aldecoa-Bilbao V, Balcells-Esponera C, Herranz Barbero A, Borràs-Novell C, Izquierdo Renau M, Iriondo Sanz M, Salvia Roigés M. Lung ultrasound for early surfactant treatment: Development and validation of a predictive model. Pediatr Pulmonol. 2021 Feb;56(2):433-441. doi: 10.1002/ppul.25216. Epub 2020 Dec 23.
- Alonso-Ojembarrena A, Lubián-López SP. Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants. Pediatr Pulmonol. 2019 Sep;54(9):1404-1409. doi: 10.1002/ppul.24410. Epub 2019 Jun 10.
- Förster K, Sass S, Ehrhardt H, Mous DS, Rottier RJ, Oak P, Schulze A, Flemmer AW, Gronbach J, Hübener C, Desai T, Eickelberg O, Theis FJ, Hilgendorff A. Early Identification of Bronchopulmonary Dysplasia Using Novel Biomarkers by Proteomic Screening. Am J Respir Crit Care Med. 2018 Apr 15;197(8):1076-1080. doi: 10.1164/rccm.201706-1218LE.
- Heo M, Jeon GW. Intratracheal administration of budesonide with surfactant in very low birth weight infants to prevent bronchopulmonary dysplasia. Turk J Pediatr. 2020;62(4):551-559. doi: 10.24953/turkjped.2020.04.004.
- Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001 Jun;163(7):1723-9.
- Kuo HT, Lin HC, Tsai CH, Chouc IC, Yeh TF. A follow-up study of preterm infants given budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants. J Pediatr. 2010 Apr;156(4):537-41. doi: 10.1016/j.jpeds.2009.10.049. Epub 2010 Feb 6.
- Oulego-Erroz I, Alonso-Quintela P, Terroba-Seara S, Jiménez-González A, Rodríguez-Blanco S. Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study. J Perinatol. 2021 Jan;41(1):62-68. doi: 10.1038/s41372-020-0724-z. Epub 2020 Jul 14.
- Venkataraman R, Kamaluddeen M, Hasan SU, Robertson HL, Lodha A. Intratracheal Administration of Budesonide-Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis. Pediatr Pulmonol. 2017 Jul;52(7):968-975. doi: 10.1002/ppul.23680. Epub 2017 Feb 6. Review.
- Yeh TF, Chen CM, Wu SY, Husan Z, Li TC, Hsieh WS, Tsai CH, Lin HC. Intratracheal Administration of Budesonide/Surfactant to Prevent Bronchopulmonary Dysplasia. Am J Respir Crit Care Med. 2016 Jan 1;193(1):86-95. doi: 10.1164/rccm.201505-0861OC.
- Yeh TF, Lin HC, Chang CH, Wu TS, Su BH, Li TC, Pyati S, Tsai CH. Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants: a pilot study. Pediatrics. 2008 May;121(5):e1310-8. doi: 10.1542/peds.2007-1973. Epub 2008 Apr 21.
- BuS2020