Craniosynostosis
Conditions
Keywords
Craniosynostosis, hemoglobin, iron peros, iron intravenous
Brief summary
Oral iron is commonly used in conjunction with EPO preoperatively for hemorrhagic surgeries in children and especially in the surgery of craniosynostosis. The bioavailability of oral iron is low and compliance with treatment is inconsistent. The aim of this study is to evaluate whether the use of ferric carboxymaltose by injection, which has a much better bioavailability, would make it possible to increase the preoperative hemoglobin level more effectively and thus reduce the risk of perioperative blood transfusion .
Detailed description
Prospective study, randomized in two parallel groups (martial treatment versus venous injection) and stratified by center (Montpellier, Nice, Angers). The number of subjects required is 100 patients, or 50 per group.
Interventions
DRUGFerrous fumarate or ferrostrane
Young children operated with craniosynostosis and treated with EPO and ferrous fumarate or ferostrane per os or intravenous ferric carboxymaltose.
Sponsors
University Hospital, Montpellier
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Caregiver)
Eligibility
Sex/Gender
ALL
Age
4 Months to 24 Months
Healthy volunteers
No
Inclusion criteria
* Craniosynostosis Surgery * Age: between 4 and 24 months inclusive * Weight: less than 12kg * Hemoglobin: 10 g / dl ≤ Hb 14 ≤ g / dl * Affiliated patients or beneficiaries of a Social Security scheme * Signature of the consent of the patient's parents
Exclusion criteria
* Generalized infection * Time for consultation of anesthesia with respect to the date of surgery greater than 5 weeks or less than 22 days. * Initial biological assessment dating more than 3 months before the consultation of anesthesia * Parents do not understand French * BMI greater than 20 kg.m-2 * Contraindications to EPO * Contraindications to ferric carboxymaltose and to ferrous fumarate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Variation from reference in hemoglobin rate at the day before surgery | Hemoglobin rate change from reference day (right before treatment) to one day before surgery (from 22 days to 5 weeks maximum) | Variation of hemoglobin rate between reference value (collected right before the implementation of treatment) and preoperative hemoglobin rate (collected one day before surgery) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Variation from reference in hemoglobin rate at the day before surgery depending on the inflammatory state of patient evaluated by CRP rate before treatment | Reference day (right before treatment) and one day before surgery (from 22 days to 5 weeks maximum) | Variation of hemoglobin rate between reference value (collected right before the implementation of treatment) and preoperative hemoglobin rate (collected one day before surgery) depending on the CRP rate before treatment |
| Frequency of EPO treatment discontinuation at the end of 2nd injection | 15 days before surgery | Number of patient stopping EPO injections at the end of 2nd injection |
| Variation from reference in iron status at the day before surgery | Reference day (right before treatment) and one day before surgery (from 22 days to 5 weeks maximum) | Changes in iron status between reference day (right before the implementation of treatment) and preoperative iron status (one day before surgery) |
| Occurrence of adverse events due to experimental treatments | from treatment administration to end of patient follow-up | Comparision of adverse event du to experimental treatments (ferric carboxymaltose versus ferrous fumarate) |
| Compliance of oral iron treatment | At the end of oral iron treatment | Evaluated by visual analogic scale (0 the minimum to 10 the maximum) |
| Variation from reference in hemoglobin rate at the day before surgery depending on the reference iron status | Reference day (right before treatment) and one day before surgery (from 22 days to 5 weeks maximum) | Variation of hemoglobin rate between reference value (collected right before the implementation of treatment) and preoperative hemoglobin rate (collected one day before surgery) depending on the reference iron status |
| Number of packed red blood cells transfused in perioperative phase and during 3 days following | Perioperative phase and during 3 days following surgery | — |
| Volume of packed red blood cells transfused | Perioperative phase and during 3 days following surgery | Volume in mL/kg |
| Total perioperative blood loss | Perioperative phase and during 3 days following surgery | Expressed in red blood cell mass |
| Cost of oral ferrous fumarate treatment compared to ferric carboxymaltose treatment | At the end of patient folllow-up (6 months after surgery) | — |
| Rate of blood transfusion in perioperative phase and during 3 days following surgery | Perioperative phase and during 3 days following surgery | Number of transfused patients among all patients |
Countries
France
Outcome results
None listed