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The primary objective of the study is to demonstrate the safety of a daily high dose of a probiotic supplement by comparing the growth (weight gain, g/day) of formula-fed and/or breastfed infants in high dose group versus placebo group from enrolment to 8 weeks of intervention
This is a randomized, placebo-controlled, double-blind study of healthy term infants, consisting of three randomized arms: placebo control group, high dose experimental group, and low dose experimental group. The study population, approximately 228, are infants 14 - 21 days of age who are formula-fed and/or breastfed who is aligned with the intended target population for a probiotic supplement. Placebo and probiotic supplements will be mixed with formula or breastmilk and fed orally using a feeding cup or syringe. All enrolled infants will participate in the trial for approximately 8 weeks.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental Group 1 | Experimental | High dose probiotic supplement and maltodextrin as the excipient |
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| Experimental Group 2 | Experimental | Low dose probiotic supplement and maltodextrin as the excipient |
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| Control Group | Placebo Comparator | Placebo supplement containing only maltodextrin but having the same appearance as the probiotic supplements |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| High dose probiotic supplement | Other | One probiotic stick pack will be dissolved in 10 mL lukewarm formula milk or breastmilk at body temperature. The dissolved supplement will be fed orally, preferably in the morning, starting on Day 1 until Day 56. |
| Measure | Description | Time Frame |
|---|---|---|
| Safety of high dose probiotic supplement (weight gain) | Compare the growth (weight gain, g/day) of formula-fed and/or breastfed infants in EG 1 vs. CG from enrolment to 8 weeks of intervention | Day 56 |
| Measure | Description | Time Frame |
|---|---|---|
| Efficacy of two different doses of probiotic supplement | Bifidobacteria abundance measured in the fecal sample collected at home after 8 weeks of intervention (V3) analyzed by next generation sequencing (NGS) technology. | Day 0, Day 25-27, Day 53-55 |
| Measure | Description | Time Frame |
|---|---|---|
| Additional growth parameters: weight | Weight in grams and corresponding weight-for-age Z-score according WHO growth standards | Day 0, Day 28, Day 56 |
| Additional growth parameters: length | Length in centimeters and corresponding length-for-age Z-score according WHO growth standards |
Inclusion Criteria:
Evidence of personally signed and dated informed consent document indicating that the infant's parent(s)/ legally accepted representatives LAR have been informed of all pertinent aspects of the study.
Infants whose parent(s)/LAR have reached the legal age of majority in the countries where the study is conducted.
Infants whose parent(s)/LAR are willing and able to comply with scheduled visits, and the requirements of the study protocol.
Infants whose parent(s)/LAR can be contacted directly by telephone throughout the study.
Infants whose parent(s)/LAR have access to a working freezer.
Infants must meet all the following inclusion criteria to be eligible for enrolment into the study:
Exclusion Criteria:
Infants with conditions requiring specific infant feeding regimens other than those specified in the protocol.
Infants receiving complementary foods or liquids defined as 4 or more teaspoons per day or approximately 20 g per day of complementary foods or liquids at or prior to enrollment.
Infants who have a medical condition or history that could increase the risk associated with study participation or interfere with the interpretation of study results, including:
Infants who are presently receiving or have received prior to enrollment probiotic supplements or any of the following: medication(s) or supplement(s) which are known or suspected to affect the following: fat digestion, absorption, and/or metabolism (e.g., pancreatic enzymes); stool characteristics (e.g., glycerin suppositories, bismuth-containing medications, docusate, Maltsupex, or lactulose); growth (e.g. insulin or growth hormone); gastric acid secretion.
Currently participating or having participated in another clinical trial since birth.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Asian Foundation for Tropical Medicine, Inc. | City of Muntinlupa | 1781 | Philippines |
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| Low dose probiotic supplement | Other | One probiotic stick pack will be dissolved in 10 mL lukewarm formula milk or breastmilk at body temperature. The dissolved supplement will be fed orally, preferably in the morning, starting on Day 1 until Day 56. |
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| Placebo | Other | One placebo stick pack will be dissolved in 10 mL lukewarm formula milk or breastmilk at body temperature. The dissolved supplement will be fed orally, preferably in the morning, starting on Day 1 until Day 56. |
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| Day 0, Day 28, Day 56 |
| Additional growth parameters: head circumference | Head circumference in centimeters and corresponding head circumference-for-age Z-score according WHO growth standards | Day 0, Day 28, Day 56 |
| Additional growth parameters: body mass index | BMI and corresponding BMI-for-age Z-score according WHO growth standards | Day 0, Day 28, Day 56 |
| Fecal microbiome composition | Overall fecal microbiota composition, diversity, and microbiota community types will be assessed using NGS technology (including relative abundance of beneficial bifidobacteria bacteria species and pathogenic bacteria species) and | Day 0, Day 28, Day 56 |
| Bifidobacteria colonization | Bifidobacteria colonization using a newly developed rapid diagnostic kit | Day 0, Day 28, Day 56 |
| Fecal microbiome: Continuation of bifidobacteria colonization | Continuation of bifidobacteria colonization 4 weeks after intervention stop using NGS technology and DNAFoil® technology | Day 84 |
| Fecal metabolic profile: Fecal pH | Fecal pH | Day 0, Day 28, Day 56 |
| Fecal metabolic profile: Fecal organic acids | Fecal organic acids (such as, but not restricted to lactate, propionate, butyrate, acetate, valerate, and total fecal organic acids) | Day 0, Day 28, Day 56 |
| Fecal metabolic profile: gut microbiota-derived metabolites | Concentration of gut microbiota-derived metabolites using mass spectrometry and/or nuclear magnetic resonance | Day 0, Day 28, Day 56 |
| Biological response of selected fecal metabolites | Biological response using cultured cell lines or combinations of cell lines (Cell-based functional assays) | Day 0, Day 28, Day 56 |
| Fecal markers of immune health and gut barrier | Total secretory IgA, calprotectin, and α-1-antitrypsin assessed by ELISA and Fecal cytokine levels (such as, but not restricted to: IL-1ra, IL-1α, IL-1β, IL-6, IFN- γ, and TNF-α) will be measured by multiplex assays | Day 0, Day 28, Day 56 |
| GI tolerance | Infant Gastrointestinal Symptom Questionnaire (IGSQ-13) Index Score for overall GI tolerance calculated from the IGSQ-13 | Day 0, Day 28, Day 56 |
| GI-related behaviors: Stool frequency | GI endpoints will be recorded via the 1-day and 3-day GI Symptom and Behavior Diary | Day 0, Day 25-27, Day 53-55 |
| GI-related behaviors: Stool consistency | Stool consistency using a validated 5-point scale in the 1-day and 3-day GI Symptom and Behavior Diary | Day 0, Day 25-27, Day 53-55 |
| GI-related behaviors: Incidence of spitting-up | Incidence of spitting-up using a Likert scale via the 1-day and 3-day GI Symptom and Behavior Diary | Day 0, Day 25-27, Day 53-55 |
| GI-related behaviors: Incidence of flatulance | Flatulence of spitting-up using a Likert scale via the 1-day and 3-day GI Symptom and Behavior Diary | Day 0, Day 25-27, Day 53-55 |
| GI-related behaviors: Crying time | Crying time (hours/min) via the 1-day and 3-day GI Symptom and Behavior Diary | Day 0, Day 25-27, Day 53-55 |
| GI-related behaviors: Sleep time | Sleep time (hours/min) using a Likert scale via the 1-day and 3-day GI Symptom and Behavior Diary | Day 0, Day 25-27, Day 53-55 |