Feeding Intolerance in Premature Infants
Conditions
Keywords
Glycerin Suppositories, Enteral Nutrition, Enterocolitis, Necrotizing, Infant, Premature, Meconium
Brief summary
All premature babies have problems with feeding and nutrition. Some can develop a life-threatening bowel infection necrotizing enterocolitis. This can result in the need for emergency surgery, loss of bowel, lifelong feeding problems, and death. Giving premature babies glycerin suppositories may be one way to stimulate the digestive tract and help prevent these problems. To see if this treatment works, the investigators need to study hundreds of premature babies in a large trial involving multiple hospitals. The purpose of this project is to carry out a small study first and make sure that the larger trial is feasible. The investigators will invite approximately 30 premature babies from the Neonatal Intensive Care Unit at McMaster University Medical Centre to participate in this study over a 6-month period. The investigators will focus on feasibility issues, including cost, safety, and rate of participation. This will allow us to rigorously test our study protocol and lay the groundwork for the larger study involving multiple hospitals.
Interventions
The treatment intervention will be a 250 mg glycerin suppository placed in the rectum once daily starting 48-72 hours after birth.
OTHERSham Suppository
Sham suppositories will be created by placing a 250 mg glycerin suppository in the diaper once daily starting 48-72 hours after birth. This intervention works as a non-invasive placebo to maintain blinding.
Sponsors
McMaster Surgical Associates
Hamilton Health Sciences Corporation
McMaster University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Gestational age 24-32 weeks OR * Birth weight 500-1500 grams
Exclusion criteria
* Congenital gastrointestinal anomalies * Surgery within 48 hours of birth * Culture-proven sepsis\* * Vasopressors within 6 hours of first intervention * Nitric oxide * Duct-dependent congenital heart defect requiring prostaglandins * Suspected coagulopathy (mucosal bleeding from any orifice) * Confirmed coagulopathy (any one of the following): * International Normalized Ratio greater than 1.4 * Partial Thromboplastin Time greater than 39 seconds * Fibrinogen less than 1.00 grams/liter * Thrombocytopenia (platelet count less than 100 x 10\^9/liter)\*\* * Neutropenia (absolute neutrophil count less than 0.5 x 10\^9/liter) * Complete meconium evacuation (2 normal bowel movements) within 48 hours of life * Parent or legal guardian unable to understand English Note: \* C-reactive protein is not an
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Days to full enteral feeding (150 ml/kg/day) | Up to 4 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Compliance with treatment regimen | Up to 4 months | — |
| Days of parenteral nutrition | Up to 4 months | — |
| Necrotizing enterocolitis | Up to 4 months | — |
| Culture-proven line sepsis | Up to 4 months | — |
| Mortality | Up to 4 months | — |
| Feeding volume on day 14 of life (ml/kg/day) | 14 days | — |
| Days to complete meconium evacuation | Up to 4 months | Number of days to complete meconium evacuation (defined as two normal bowel movements free of meconium staining). |
Other
| Measure | Time frame | Description |
|---|---|---|
| Treatment-related adverse events | Up to 4 months | Rectal perforation, rectal bleeding, and/or anal fissure |
| Cost | 6 months | — |
| Recruitment rate | 6 months | Percentage of eligible infants randomized |
| Completion rate | 6 months | Percentage of randomized infants reaching full enteral feeds |
Countries
Canada
Contacts
Primary ContactHenrietta Blinder, BSc
Outcome results
None listed