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Antenatal Late Preterm Steroids (ALPS): A Randomized Placebo-Controlled Trial (ALPS)

This study has been completed.
Sponsor:
Collaborators:
National Heart, Lung, and Blood Institute (NHLBI)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Information provided by (Responsible Party):
The George Washington University Biostatistics Center
ClinicalTrials.gov Identifier:
NCT01222247
First received: October 14, 2010
Last updated: November 4, 2015
Last verified: November 2015
  Purpose

Infants born between 34 and 36 weeks of gestation, known as 'late preterm', are more likely to be admitted to a special care nursery, and more likely to suffer respiratory complications than infants born at term. The use of antenatal corticosteroids has been shown to improve lung function in very premature infants, but has not been evaluated in those likely to deliver in the late preterm period.

This research study will attempt to answer the following primary research question: Do steroids, compared to no steroids, decrease babies' need for oxygen support when given to pregnant women at least 12 to 24 hours before they deliver at 34 weeks to 36 weeks gestation? The research study will also collect information on whether steroids improve the chances that the baby will not get sick from other causes.


Condition Intervention Phase
Pregnancy
Respiratory Distress
Pregnancy Outcome
Drug: Corticosteroid
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Prevention
Official Title: Antenatal Late Preterm Steroids (ALPS): A Randomized Placebo-Controlled Trial

Resource links provided by NLM:


Further study details as provided by The George Washington University Biostatistics Center:

Primary Outcome Measures:
  • Composite Outcome [ Time Frame: 72 hours of life ] [ Designated as safety issue: No ]
    Need for respiratory support: Continuous positive airway pressure (CPAP) or humidified high-flow nasal cannula (HHFNC) for greater than or equal to 2 hours or more in the first 72 hours, or fraction of inspired oxygen (FiO2) greater than or equal to 0.30 for 4 hours or more in the first 72 hours, or mechanical ventilation in the first 72 hours, or Extracorporeal membrane oxygenation (ECMO) Stillbirth, or neonatal death less than 72 hours of age


Secondary Outcome Measures:
  • Maternal outcomes [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Chorioamnionitis, Postpartum endomyometritis, delivery prior to steroids completion, time in hours from initial dose to delivery, length of labor, mode of delivery, indication for delivery, length of stay

  • Neonatal morbidity / mortality [ Time Frame: 72 hours of life ] [ Designated as safety issue: No ]
    Major respiratory morbidity: Continuous positive airway pressure (CPAP) or humidified high-flow nasal cannula (HHFNC) for greater than or equal to 12 hours or more in the first 72 hours, or FiO2 greater than or equal to 0.30 for 24 hours or more in the first 72 hours, or mechanical ventilation in the first 72 hours, or Extracorporeal membrane oxygenation (ECMO) Stillbirth or neonatal death less than 72 hours of age

  • Respiratory Distress Syndrome [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Respiratory distress with an oxygen requirement and a chest x-ray that shows hypoaeration and reticulogranular infiltrates

  • Neonatal composite [ Time Frame: 72 hours of life ] [ Designated as safety issue: No ]
    Transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and apnea

  • Need for immediate resuscitation after birth [ Time Frame: Delivery ] [ Designated as safety issue: No ]
  • Surfactant use [ Time Frame: Delivery ] [ Designated as safety issue: No ]
  • Chronic lung disease (BPD) [ Time Frame: 28 days of life ] [ Designated as safety issue: No ]
    Infants requiring oxygen at 28 days of life

  • Necrotizing enterocolitis (NEC) [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Defined as modified Bell Stage 2 or 3. Stage 2: Clinical signs and symptoms with pneumatosis intestinalis on radiographs. Stage 3: Advanced clinical signs and symptoms, pneumatosis, impending or proven intestinal perforation.

  • Morbidity composite [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    A composite endpoint of morbidities known to be affected by steroid administration will also be evaluated. Specifically, this composite will include RDS, intraventricular hemorrhage (IVH), and NEC

  • Birth weight [ Time Frame: Delivery ] [ Designated as safety issue: No ]
  • Hypoglycemia [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Glucose < 40 mg%

  • Hyperbilirubinemia [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Peak total bilirubin of at least 15 mg% or the use of phototherapy.

  • Feeding difficulty [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Inability to take all feeds (po), i.e. requiring gavage feeds or IV supplementation. In addition, time to first feed (po) will be recorded.

  • Hypothermia [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    Rectal temperature < 36 C

  • Neonatal infectious morbidity [ Time Frame: Delivery ] [ Designated as safety issue: No ]
    • Sepsis (within 72hrs and > 72 hrs after birth) OR
    • Suspected sepsis OR
    • Pneumonia

  • Seizures / encephalopathy [ Time Frame: Delivery ] [ Designated as safety issue: No ]
  • Length of hospital stay [ Time Frame: Discharge from hospital ] [ Designated as safety issue: No ]
    Includes need for NICU or intermediate care admission and length of stay if admitted

  • Number of and reason for infant re-hospitalizations, ER visits or unanticipated visits to the primary care pediatrician / specialist [ Time Frame: 3 and 6 months of age ] [ Designated as safety issue: No ]

Enrollment: 2831
Study Start Date: October 2010
Study Completion Date: October 2015
Primary Completion Date: March 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Corticosteroid Drug: Corticosteroid

The active study drug, betamethasone, trade name Celestone Soluspan® manufactured by Schering Plough.

3 mg per ml betamethasone sodium phosphate 3 mg per milliliter betamethasone acetate The first dose of study drug medication will be administered at randomization as 2 ml injection; the next dose of 2 ml will be administered 24 hours later.

Other Name: Celestone Soluspan
Placebo Comparator: Placebo Drug: Corticosteroid

The active study drug, betamethasone, trade name Celestone Soluspan® manufactured by Schering Plough.

3 mg per ml betamethasone sodium phosphate 3 mg per milliliter betamethasone acetate The first dose of study drug medication will be administered at randomization as 2 ml injection; the next dose of 2 ml will be administered 24 hours later.

Other Name: Celestone Soluspan

Detailed Description:

Antenatal Late Preterm Steroids (ALPS): A Randomized Placebo-Controlled Trial:

The rate of preterm birth has steadily increased in the United States over the past 10 years. This increase is driven in part by the rising rate of late preterm birth, defined as those births occurring between 34 and 36 weeks. Late preterm infants experience a higher rate of readmission than their term counterparts, and these infants are more likely to suffer complications such as respiratory distress, kernicterus, feeding difficulties, and hypoglycemia. Late preterm infants also have a higher mortality for all causes when compared to term infants. The use of antenatal corticosteroids has been shown to be beneficial in women at risk for preterm delivery prior to 34 weeks but has not been evaluated in those likely to deliver in the late preterm period. If shown to reduce the need for respiratory support and thus to decrease the rate of special care nursery admissions and improve short-term outcomes, the public health and economic impact will be considerate.

This protocol describes a randomized placebo controlled trial to evaluate whether antenatal corticosteroids can decrease the rate of neonatal respiratory support, thus decreasing the rate of neonatal intensive care unit (NICU) admissions and improving short-term outcomes in the late preterm infant.

  Eligibility

Ages Eligible for Study:   Child, Adult, Senior
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

Singleton Pregnancy. A twin pregnancy reduced to singleton (either spontaneously or therapeutically) before 14,0 weeks by project gestational age is acceptable

Gestational age at randomization between 34,0weeks and 36,5 weeks confirmed by study criteria

High probability of delivery in the late preterm period (any one of the following):

  • Membrane rupture as defined by the study criteria.

or

  • Preterm labor with intact membranes. Preterm labor is defined as at least 6 regular uterine contractions in an observation period of no more than 60 minutes and at least one of the following: cervix greater than or equal to 3cm dilated or 80% effaced

or

  • Planned delivery by induction of labor or cesarean section in no less than 24 hours and no more than 7 days, as deemed necessary by the provider. An induction must be scheduled to start by 36,5 weeks at the latest, whereas a cesarean delivery must be scheduled by 36,6 weeks at the latest. Therefore the latest gestational age for randomization is 36,4 weeks for a planned induction. The planned delivery may be for any indication, such as the following: prior myomectomy, prior classical cesarean, intrauterine growth restriction (IUGR), oligohydramnios, preeclampsia, nonreassuring fetal heart rate tracing warranting delivery, abruption, placenta previa

Exclusion Criteria:

  • Rupture of Membranes (ROM) does not satisfy protocol criteria - exclude if the patient being evaluated for Preterm Premature Rupture of Membranes (pPROM) does not have preterm labor or planned delivery and does not satisfy the spontaneous membrane rupture criteria (any 2 of: positive Nitrazine test, pooling of fluid in the vaginal vault test or ferning of vaginal fluid; or indigo carmine pooling in the vagina after amnioinfusion; or visible leakage of amniotic fluid from the cervix)
  • Preterm labor does not satisfy protocol criteria - exclude if patient has intact membranes with no delivery planned and contractions are more than 10 minutes apart or if the cervix is both less than 3cm dilated and less than 80% effaced
  • Fetal death / major fetal anomaly / fetus non-viable - exclude if the patient has a major fetal anomaly or the fetus is not viable
  • Delivery expected < 12 hours after randomization - this includes 1) ruptured membranes with cervical dilation ≥ 3cm or more than 6 contractions per hour unless pitocin is deferred for at least 12 hours 2) evidence of non-reassuring fetal status requiring immediate delivery 3) chorio-amnionitis 4) Cervical dilation ≥ 8 cm
  • Prior corticosteroids for fetal lung maturity - exclude if patient was given corticosteroids for fetal lung maturity before 34 weeks
  • Systemic corticosteroids for other indications - exclude if patient was given systemic corticosteroids for indication other than fetal lung maturity
  • No ultrasound < 20 weeks for unsure last menstrual period (LMP). If the patient has an unsure LMP but she had no dating ultrasound before 20 weeks by ultrasound parameters, she is excluded.
  • No ultrasound < 24 weeks for sure LMP. If the patient has an sure LMP but she had no dating ultrasound before 24 weeks by ultrasound parameters, she is excluded
  • Cervical dilation ≥ 8 cm
  • Project gestational age < 34,0 weeks or ≥ 36,6 weeks
  • Delivery planned at project gestational age ≥ 36,6 weeks
  • Known congenital malformation
  • Fetal reduction/loss ≥ 14 weeks - exclude if the singleton pregnancy is due to reduction or fetal loss from a twin pregnancy at greater or equal to 14 weeks
  • Gestational diabetes
  • Pre-gestational diabetes - exclude if the patient was on medication (insulin, glyburide) prior to pregnancy
  • Maternal contraindication to betamethasone - exclude if the patient has a known contraindication to betamethasone
  • Chorioamnionitis - exclude if patient is diagnosed with chorioamnionitis
  • Physician planning to give steroids - exclude if patient's physician is planning to give her steroids
  • Physician refusal for other reasons - exclude if patient's physician refuses to allow the patient to participate in the study
  • Refusal to sign medical record release
  • Participation in conflicting study / this study before - exclude if the patient is participating in an antenatal study in which the clinical status or intervention may influence neonatal respiratory outcome, or if she was previously enrolled in this study
  • Multifetal gestation. Exclude if current multifetal gestation or a single gestation resulting from a reduction of a multiple of higher order than twins
  • Delivery at a non-participating hospital
  • Gestational age 36,0 or more and quota already reached.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01222247

Locations
United States, Alabama
University of Alabama - Birmingham
Birmingham, Alabama, United States, 35233
United States, California
Stanford University
Stanford, California, United States, 94305
United States, Colorado
University of Colorado
Denver, Colorado, United States, 80045
United States, Illinois
Northwestern University
Chicago, Illinois, United States, 60611
United States, Michigan
Wayne State University
Detroit, Michigan, United States, 48201
United States, New York
Columbia University
New York, New York, United States, 10032
United States, North Carolina
University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, United States, 27599
Duke University
Durham, North Carolina, United States, 27710
United States, Ohio
Case Western Reserve University
Cleveland, Ohio, United States, 44109
Ohio State University
Columbus, Ohio, United States, 43210
United States, Oregon
Oregon Health & Science University
Portland, Oregon, United States, 97239
United States, Pennsylvania
University of Pittsburgh Magee Womens Hospital
Pittsburgh, Pennsylvania, United States, 15213
United States, Rhode Island
Brown University
Providence, Rhode Island, United States, 02905
United States, Texas
University of Texas - Southwest
Dallas, Texas, United States, 75235
University of Texas - Galveston
Galveston, Texas, United States, 77555
University of Texas - Houston
Houston, Texas, United States, 77030
United States, Utah
University of Utah Medical Center
Salt Lake City, Utah, United States, 84132
Sponsors and Collaborators
The George Washington University Biostatistics Center
National Heart, Lung, and Blood Institute (NHLBI)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Investigators
Study Director: Uma Reddy, MD, MPH Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Principal Investigator: Elizabeth Thom, PhD George Washington University
Study Chair: Cynthia Gyamfi Bannerman, MD Columbia University
  More Information

Additional Information:
Publications:
Hamilton BE, Ventura SJ, Martin JA, and Sutton PD. Preliminary births for 2004. Health E-stats. Hyattsville, MD: National Center for Health Statistics. Released October 28, 2005.

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: The George Washington University Biostatistics Center
ClinicalTrials.gov Identifier: NCT01222247     History of Changes
Other Study ID Numbers: HL98354-HD36801-ALPS  U10HD021410  U10HD027869  U10HD027917  U10HD053118  U10HD027915  U10HD034116  U10HD034208  U10HD053097  U10HD040500  U10HD040485  U10HD040544  U10HD040545  U10HD040560  U10HD040512  U01HD036801  U01HL098354  U01HL098554 
Study First Received: October 14, 2010
Last Updated: November 4, 2015
Health Authority: United States: Federal Government

Keywords provided by The George Washington University Biostatistics Center:
Betamethasone
Celestone
Steroids
Perinatology

Additional relevant MeSH terms:
Betamethasone benzoate
Betamethasone-17,21-dipropionate
Betamethasone
Betamethasone Valerate
Betamethasone sodium phosphate
Betamethasone acetate phosphate
Anti-Inflammatory Agents
Glucocorticoids
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Anti-Asthmatic Agents
Respiratory System Agents
Bronchodilator Agents
Autonomic Agents
Peripheral Nervous System Agents

ClinicalTrials.gov processed this record on September 28, 2016