Birth, Preterm, Infant, Premature, Diseases
Conditions
Keywords
Preterm infant, Tactile stimulation, Resuscitation
Brief summary
The aim of this study is to determine the effect of repetitive tactile stimulation compared to selective stimulation on oxygenation of the infant at 5 minutes after birth. Infants born before 32 weeks of gestation will be included in this trial. This is a stepped-wedge cluster randomised controlled trial. The participating centre, rather than the individual infant, will be the unit of randomisation. This design is appropriate to test the effect of an intervention that encompasses a behavioral aspect - in this case the performance of tactile stimulation.
Detailed description
Rationale: A randomised study demonstrated that preterm infants who received repetitive stimulation at birth (10 second episodes of stroking of the soles of the feet and/or back, followed by 10 seconds rest) showed an increase in respiratory effort. This may in turn improve clinical outcomes as improved breathing effort may reduce the need for invasive respiratory support. Tactile stimulation can be immediately and easily performed at birth at no extra cost. It therefore has great potential to be implemented in delivery rooms (DRs) worldwide. Objective: To determine the effect of repetitive tactile stimulation compared to selective stimulation on oxygenation of the infant at 5 minutes after birth. Study design: This is a stepped-wedge cluster randomised controlled trial. The participating centre, rather than the individual infant, will be the unit of randomisation. This design is appropriate to test the effect of an intervention that encompasses a behavioral aspect - in this case the performance of tactile stimulation. Study population: Infants born before 32 weeks of gestation will be included in this trial. Intervention: At the start of the study, each participating centre will perform selective tactile stimulation in accordance with international guidelines, as is their usual practice. Clinicians will gently rub the back, chest, extremities or soles of the feet if they consider the breathing of the infant to be insufficient or absent. In the second stage of the study, centres will be randomised to switch their stimulation approach to repetitive stimulation. Clinicians will then gently rub the back, chest, extremities or soles of the feet for 10 seconds. To avoid extinction of the stimulatory effect (reflex), every 10 second period of stimulation will be followed by 10 seconds of rest (no stimulation). Repetitive stimulation will be performed for the first 5 minutes of life, or longer if the breathing is still considered insufficient or absent. Main study parameter: The proportion of infants with pre-ductal oxygen saturation (SpO2) ≥ 80%.
Interventions
PROCEDURERepeated tactile stimulation
See arm
PROCEDURESelective tactile stimulation
See arm
Sponsors
European Society for Paediatric Research
Leiden University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Centres will be randomised for the fortnight at which they will switch their tactile stimulation practice from selective stimulation to repetitive stimulation. The analysing researcher will be blinded for the allocation of treatment switch.
Intervention model description
This is a stepped-wedge cluster randomised controlled trial. The participating centre, rather than the individual infant, will be the unit of randomisation.
Eligibility
Sex/Gender
ALL
Age
No minimum to 32 Weeks
Healthy volunteers
No
Inclusion criteria
* Infants born before 32 weeks of gestation can be included in this trial after parental consent.
Exclusion criteria
* Infants will be excluded if they are found to have a congenital abnormality or condition that has an adverse effect on breathing/ventilation or oxygenation, including: congenital diaphragmatic hernia, trachea-oesophageal fistula, cyanotic heart disease and surfactant protein deficiency. Many of the infants enrolled in the study will later be diagnosed with respiratory distress syndrome (RDS); this will not render them ineligible for inclusion.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| SpO2>80 | At 5 minutes of life | Proportion of infants with pre-ductal SpO2 \>80% |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of infants who received chest compressions <10min | Within 10 minutes after birth | Number of infants who received chest compressions \<10min |
| Death <10min | Within 10 minutes after birth | Death \<10min |
| Number of infants who were supported by CPAP in first week | In the first week after birth | CPAP use in the NICU |
| Number of infants who received surfactant in first week | In the first week after birth | Surfactant administration via INSURE, LISA or ET tube |
| Surfactant doses | In the first week after birth | Number of surfactant doses administered |
| Number of infants who were mechanically ventilated | In the first week after birth | Mechanical ventilation |
| Number of infants with abnormalities on the first cranial ultrasound | In first week after birth | Abnormalities on first cranial ultrasound (IVH/PVL) |
| Death | In the first week after birth | Mortality |
| Cord clamping time | During resuscitation at birth | The time after birth at which the cord is clamped |
| Heart rate | At 5 minutes after birth | Heart rate |
| Number of infants who received CPAP <10min | Within 10 minutes after birth | Number of infants who received continuous positive airway pressure |
| Number of infants who received PPV <10min | Within 10 minutes after birth | Number of infants who received positive pressure ventilation |
| Number of infants who were intubated <10min | Within 10 minutes after birth | Number of infants who were endotracheally intubated |
| Number of infants who were administered adrenaline <10min | Within 10 minutes after birth | Adrenaline use |
| Number of infants who were administered volume expansion <10min | Within 10 minutes after birth | Number of infants who were administered volume expansion \<10minv |
| Max FiO2 | In the first 10 minutes after birth | Maximum FiO2 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Gender | At birth | Gender of the infant |
| Mode of delivery | At birth | Mode of delivery |
| Doses of antenatal steroids | Before birth | Number of doses of antenatal steroids administered |
| Maternal magnesium sulphate | Before birth | Whether maternal magnesium sulphate was administered |
| Maternal general anaesthesia | Before birth | Whether maternal general anaesthesia was administered |
| Complications during pregnancy | Before birth | Whether there were any complications during pregnancy, e.g. premature prolonged rupture of membranes, chorioamnionitis, pre-eclampsia, placental abruption, twin-to-twin transfusion syndrome, hydrops fetalis, feto-maternal haemorrhage |
| Congenital anomalies | At birth | Whether the infant has congenital anomalies, e.g. diaphragmatic hernia, oesophageal atresia, cyanotic heart disease |
| Gestational age | At birth | gestational age in weeks and days |
Countries
Austria, Belgium, Croatia, Czechia, Denmark, Germany, Greece, Hungary, Iceland, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Romania, Spain, Turkey (Türkiye), Ukraine
Contacts
Primary ContactJanneke Dekker, PhD
Backup ContactColm O'Donnell, MD PhD
Outcome results
None listed