N-acetylcysteine in Intra-amniotic Infection/Inflammation
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Purpose
The aim of the study is to determine if N-acetylcysteine (a potent free radical scavenger) prevents the occurrence of adverse neonatal outcomes in preterm deliveries complicated by infection associated with preterm labor or preterm premature rupture of membranes (PPROM). The working hypothesis is that in pregnancies complicated by intra-amniotic infection or inflammation, N-acetylcysteine protects the fetus by preventing the development, or decreasing the intensity and/or progression of the fetal inflammatory syndrome.
| Condition | Intervention | Phase |
|---|---|---|
|
Labor, Premature Preterm Premature Rupture of the Membranes Infection Inflammation Chorioamnionitis |
Procedure: amniocentesis Drug: N-acetylcysteine or placebo |
Phase 1 Phase 2 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor) Primary Purpose: Treatment |
| Official Title: | Effect of N-acetylcysteine in Preventing Adverse Neonatal Outcomes in Women With Intra-amniotic Infection/Inflammation |
- early onset neonatal sepsis [ Time Frame: within 3 days of postnatal life ] [ Designated as safety issue: Yes ]
- maternal and umbilical cord plasma N-acetylcysteine levels [ Time Frame: within peripartum period ] [ Designated as safety issue: No ]
- maternal and umbilical cord plasma antioxidant capacity [ Time Frame: within peripartum period ] [ Designated as safety issue: No ]
- maternal and umbilical cord blood glutathione concentration [ Time Frame: within peripartum period ] [ Designated as safety issue: No ]
- umbilical cord levels of inflammatory cytokine concentrations [ Time Frame: at birth ] [ Designated as safety issue: No ]
- funisitis grades [ Time Frame: at birth ] [ Designated as safety issue: No ]
- other neonatal outcomes (respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, late-onset sepsis, bronchopulmonary dysplasia) [ Time Frame: within the period of admission in neonatal intensive care ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 140 |
| Study Start Date: | October 2006 |
| Estimated Study Completion Date: | April 2015 |
| Estimated Primary Completion Date: | November 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: N-Acetylcysteine
The subjects enrolled in our research protocol must have evidence of infection/inflammation at amniocentesis in order to receive N-acetylcysteine. Women with positive amniocentesis results The dose of N-acetylcysteine is the one recommended to be used in humans to prevent acetaminophen toxicity: 150 mg/kg loading dose (60 min), followed by 50mg/kg IV continuous infusion rate for 4 hours, and followed by 100 mg/kg IV continuous infusion rate for the following 16 hours. Acetadote (Cumberland Pharmaceuticals) is the only FDA-approved intravenous N-acetylcysteine formulation and will be used in our study.
|
Procedure: amniocentesis
Amniotic fluid will be retrieved for routine amniocentesis to rule-out or confirm intra-amniotic infection and /or inflammation. The amniocentesis procedure will be clinically indicated and the patient will undergo the procedure independent of our study.
Other Name: transabdominal amniocentesis
Drug: N-acetylcysteine or placebo
Only women with amniocentesis results consistent with infection/inflammation will be randomized
Other Names:
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Placebo Comparator: Placebo
The subjects enrolled in our research protocol must have infection/inflammation in order to be randomized to receive N-acetylcysteine or placebo. Placebo-assigned patients will receive sodium chloride solution without N-acetylcysteine
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Procedure: amniocentesis
Amniotic fluid will be retrieved for routine amniocentesis to rule-out or confirm intra-amniotic infection and /or inflammation. The amniocentesis procedure will be clinically indicated and the patient will undergo the procedure independent of our study.
Other Name: transabdominal amniocentesis
Drug: N-acetylcysteine or placebo
Only women with amniocentesis results consistent with infection/inflammation will be randomized
Other Names:
|
Detailed Description:
Despite extensive research, the etiology of most preterm births remains unknown. There are significant fetal consequences associated with preterm birth, which include necrotizing enterocolitis, fetal respiratory distress and intra-ventricular hemorrhage. Perinatal mortality is about 44%, 11% and 5% when deliveries occur between 25-28 weeks, 29-32 weeks and 33-34 weeks, respectively. While for many years, it was assumed that the cause of the high morbidity associated with prematurity was the birth of a neonate with a restricted adaptive capacity, it has also been suggested that part of the high perinatal morbidity was the consequence of adverse processes affecting the fetus in utero, rather than of prematurity per se. Intra-amniotic inflammation present in utero early in gestation may trigger the cascade of events leading to preterm birth (i.e. rupture of membranes, cervical ripening, uterine contractions) and provide an intrauterine milieu which is unfavorable or even harmful to the fetus.
Most living organisms have developed well-integrated, antioxidant defenses to scavenge free radicals and control their intracellular concentration. A loss of balance between free radicals and antioxidants (the redox balance) is one mechanism of cell injury in diseases associated with inflammation. N-acetylcysteine is an approved anti-oxidant medication drug used during pregnancy for treatment of mothers with acetaminophen (Tylenol) toxicity. N-acetylcysteine has been safely administered during pregnancy in over 100 women who overdosed with Tylenol and to preterm and healthy term newborns for other purposes. It is a goal of our trial to prevent free radical formation by administering N-acetylcysteine and to further study whether the outcome of preterm deliveries will improve compared to a control group which will not receive placebo infusion
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Women admitted onto the Labor and Birth Ward or Maternal Special Care Units of the Yale New Haven Hospital who have a clinically indicated amniocentesis which demonstrates presence of intra-amniotic infection and/or inflammation.
Exclusion Criteria:
- Patients that require immediate intervention or close medical supervision (cardiac and renal disease, congestive heart failure, history of asthma), maternal infection (HIV, hepatitis B or C), cord prolapse, known fetal malformation, allergic reactions to N-acetylcysteine, preeclampsia
Contacts and Locations| Contact: Catalin S Buhimschi, MD | 203-785-4536 | catalin.buhimschi@yale.edu |
| Contact: Irina A Buhimschi, MD | 203-785-6164 | irina.buhimschi@yale.edu |
| United States, Connecticut | |
| Yale New Haven Hospital | Recruiting |
| New Haven, Connecticut, United States, 06510 | |
| Principal Investigator: | Catalin S Buhimschi, MD | Yale University |
More Information
Additional Information:
No publications provided
| Responsible Party: | Catalin Buhimschi, Associate Professor, Director Perinatal Reserach, Yale University |
| ClinicalTrials.gov Identifier: | NCT00397735 History of Changes |
| Other Study ID Numbers: | 0603001228 |
| Study First Received: | November 7, 2006 |
| Last Updated: | July 18, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Yale University:
|
pregnancy chorioamnionitis preterm labor |
preterm premature rupture of the membranes Intra-amniotic infection Intra-amniotic inflammation |
Additional relevant MeSH terms:
|
Fetal Diseases Chorioamnionitis Inflammation Obstetric Labor, Premature Rupture Pregnancy Complications Fetal Membranes, Premature Rupture Obstetric Labor Complications Placenta Diseases Pathologic Processes Wounds and Injuries Acetylcysteine N-monoacetylcystine |
Antiviral Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions Expectorants Respiratory System Agents Free Radical Scavengers Antioxidants Molecular Mechanisms of Pharmacological Action Protective Agents Physiological Effects of Drugs Antidotes |
ClinicalTrials.gov processed this record on May 23, 2013