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The study was terminated due to slow enrollment.
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| Name | Class |
|---|---|
| St. Louis University | OTHER |
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Neonates with congenital/acquired gastrointestinal disorders are at high risk for Parenteral Nutrition Associated Cholestasis (PNAC). Besides enteral nutrition, standard therapies to prevent and treat PNAC have been limited and marginal. Recently, the dose and composition of standard intravenous fat emulsions have implicated in the development and progression of PNAC.
In this study, neonates with congenital/acquired gastrointestinal disorders will be randomized, in a unblinded fashion, to receive either the standard dose of an intravenous omega-6 fatty acid emulsion or a low dose of an intravenous omega-6 fatty acid emulsion throughout their course of PN or until hospital discharge, death or 100 days of life, whichever comes first. The primary outcome will be the presence of cholestasis.
Parenteral Nutrition (PN) acts as an intravenous source of both macronutrients and micronutrients when enteral feeds are not possible. Intravenous fat emulsions often supplement PN and provide a dense source of non-protein calories and essential fatty acids. Although PN is life-sustaining, it is associated with a myriad of life-threatening complications including Parenteral Nutrition Associated Cholestasis (PNAC). Children dependent on PN for an extended period of time are high risk for liver failure.
The etiology of PNAC remains poorly understood. Neonates with congenital and acquired gastrointestinal disorders are at high risk for PNAC and its subsequent complications. Examples of these gastrointestinal disorders include gastroschisis, volvulus, atresias, dysmotility and malabsorption disorders, pseudo-obstruction, and Hirschsprung's disease. These disorders often render the gut non-functional for extended periods of time. As a result, these patients become PN-dependent and develop PNAC.
Specific PN components have been implicated in the pathogenesis of PNAC. More recently, standard intravenous fat emulsions have been labeled as one of the main culprits contributing to PNAC. Standard intravenous fat emulsions are dosed as high as 4 g/kg/d and are derived from soybean and/or safflower oil, which are rich in omega-6 fatty acids and phytosterols and contain a paucity of omega-3 fatty acids. It is unclear if the dose or high omega-6 fatty acid:omega-3 fatty acid ratio and phytosterols is responsible for the development of PNAC.
The primary specific aim of this study is to determine if PNAC is related to the amount of standard intravenous fat emulsion administered to neonates with congenital/acquired gastrointestinal disorders. The investigators hypothesize that the PNAC is unrelated to the dose of intravenous fat emulsions. To test this hypothesis, neonates with congenital/acquired gastrointestinal disorders will be randomized to low dose standard soybean based parenteral fat, 1 g/kg/d, or standard dose soybean parenteral fat, 3 g/kg/d. Secondary outcomes include: mortality rate, length of stay, and anthropometric measurements at 28 days of life and at the end of the hospital stay, which is expected to be an average of 5 weeks.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| low dose intravenous fat emulsion | Experimental | Subjects in this arm will receive approximately 1 g/kg/d IV of intravenous soybean oil (Intralipid). |
|
| standard dose intravenous fat emulsion | Active Comparator | Subjects in this arm will receive approximately 3 g/kg/d IV of intravenous soybean oil (Intralipid). |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Intralipid | Drug | The subject will receive 1 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
| Measure | Description | Time Frame |
|---|---|---|
| Presence of Cholestasis | Cholestasis will be defined by a direct bilirubin > 2 mg/dL | prior to 100 days of life, hospital discharge, or death whichever comes first |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality Rate | death | at the end of the hospital stay which is expected to be an average of 5 weeks |
| Anthropometric Measurements | Growth will be assessed by growth velocity at 28 days of age |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kara L Calkins, MD | University of California, Los Angeles | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California, Los Angeles | Los Angeles | California | 90095 | United States | ||
| Saint Louis University |
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41 subjects were enrolled in the study. Only subjects who required > 14 days of parenteral nutrition and who had an abdominal surgery were included in the final analysis.
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| ID | Title | Description |
|---|---|---|
| FG000 | Low Dose Intravenous Fat Emulsion | Subjects in this arm will receive approximately 1 g/kg/d IV of intravenous soybean oil (Intralipid). Intralipid: The subject will receive 1 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
| FG001 | Standard Dose Intravenous Fat Emulsion | Subjects in this arm will receive approximately 3 g/kg/d IV of intravenous soybean oil (Intralipid). Intralipid: The subject will receive 3 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Low Dose Intravenous Fat Emulsion | Subjects in this arm will receive approximately 1 g/kg/d IV of intravenous soybean oil (Intralipid). Intralipid: The subject will receive 1 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Presence of Cholestasis | Cholestasis will be defined by a direct bilirubin > 2 mg/dL | Posted | Number | participants | prior to 100 days of life, hospital discharge, or death whichever comes first |
|
Til hospital discharge, which is an average of approximately 5 weeks
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Low Dose Intravenous Fat Emulsion | Subjects in this arm will receive approximately 1 g/kg/d IV of intravenous soybean oil (Intralipid). Intralipid: The subject will receive 1 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| hyperglycemia | Metabolism and nutrition disorders | Systematic Assessment |
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Early termination leading to small number of subjects analyzed.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Kara L. Calkins | University of California, Los Angeles | 310 825-9330 | KCalkins@mednet.ucla.edu |
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| ID | Term |
|---|---|
| D002779 | Cholestasis |
| D006963 | Hyperphagia |
| D005767 | Gastrointestinal Diseases |
| ID | Term |
|---|---|
| D001649 | Bile Duct Diseases |
| D001660 | Biliary Tract Diseases |
| D004066 | Digestive System Diseases |
| D012817 | Signs and Symptoms, Digestive |
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| ID | Term |
|---|---|
| C545823 | soybean oil, phospholipid emulsion |
| D013024 | Soybean Oil |
| ID | Term |
|---|---|
| D004042 | Dietary Fats, Unsaturated |
| D004041 | Dietary Fats |
| D005223 | Fats |
| D008055 | Lipids |
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|
| Intralipid | Drug | The subject will receive 3 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
|
|
| 28 days of age |
| Anthropometric Measurements | Growth will be assessed by weight at the time of hospital discharge (approximately 5 weeks) | approximately 5 weeks |
| St Louis |
| Missouri |
| 63104 |
| United States |
| BG001 |
| Standard Dose Intravenous Fat Emulsion |
Subjects in this arm will receive approximately 3 g/kg/d IV of intravenous soybean oil (Intralipid). Intralipid: The subject will receive 3 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. |
| BG002 | Total | Total of all reporting groups |
| days |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
|
|
| Secondary | Mortality Rate | death | Posted | Number | participants | at the end of the hospital stay which is expected to be an average of 5 weeks |
|
|
|
| Secondary | Anthropometric Measurements | Growth will be assessed by growth velocity at 28 days of age | Posted | Mean | Standard Deviation | g/d | 28 days of age |
|
|
|
| Secondary | Anthropometric Measurements | Growth will be assessed by weight at the time of hospital discharge (approximately 5 weeks) | Posted | Mean | Standard Deviation | g | approximately 5 weeks |
|
|
|
| 2 |
| 20 |
| 0 |
| 20 |
| EG001 | Standard Dose Intravenous Fat Emulsion | Subjects in this arm will receive approximately 3 g/kg/d IV of intravenous soybean oil (Intralipid). Intralipid: The subject will receive 3 g/kg/d of the standard intravenous fat emulsion while receiving Parenteral Nutrition until discharge from the hospital, death or 100 days of life, whichever comes first. | 1 | 16 | 0 | 16 |
| hypertriglyceridemia | Metabolism and nutrition disorders | Systematic Assessment |
|
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| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D005224 |
| Fats, Unsaturated |
| D010938 | Plant Oils |
| D009821 | Oils |
| D028321 | Plant Preparations |
| D001688 | Biological Products |
| D045424 | Complex Mixtures |
| D005502 | Food |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D019602 | Food and Beverages |