Cerebral Regional Tissue Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates During Immediate Transition (COSGOD)

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ClinicalTrials.gov Identifier: NCT03166722

Recruitment Status : Recruiting

First Posted : May 25, 2017

Last Update Posted : July 1, 2020

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Sponsor:

Collaborator:

Royal Alexandra Hospital

Information provided by (Responsible Party):

Medical University of Graz

Study Description

Brief Summary:

The aim of the COSGOD Phase III trial is to examine, if it is possible to increase survival without cerebral injury in preterm neonates <32 weeks of gestation by monitoring the cerebral tissue oxygen saturation in addition to routine monitoring of arterial oxygen saturation and heart rate and specified clinical treatment guidelines during immediate transition period after birth (the first 15 minutes).

Condition or disease	Intervention/treatment	Phase
Preterm Infant Brain Injuries Birth Hypoxia	Other: Control group Device: Study group	Not Applicable

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Detailed Description:

Background

The transition to life after birth is a complex physiological process where the neonate has to establish sufficient ventilation and changes from intra-uterine circulation to extra-uterine circulation take place. During these processes the neonate has to provide the brain with adequate perfusion and oxygen delivery to maintain normal cerebral tissue oxygenation and activity. If hypoxia and bradycardia both common events during immediate transition in preterm neonates occur, cerebral hypoxia-ischaemia may cause perinatal brain injury that is the major causes of mortality and long term neurodevelopmental impairment.

Objectives

The primary objective of the COSGOD Phase III trial is to examine, if it is possible to increase survival without cerebral injury in preterm neonates <32 weeks of gestation by monitoring the cerebral tissue oxygen saturation in addition to routine monitoring of arterial oxygen saturation (SpO2) and heart rate (HR) and specified clinical treatment guidelines during immediate transition period after birth (the first 15 minutes).

Hypothesis

The investigators hypothesise that using cerebral tissue oxygen saturation in addition to SpO2 and HR monitoring and specified treatment guidelines during immediate transition and resuscitation would increase survival without cerebral injury in preterm neonates.

Trial design

An investigator-initiated randomised, multi-centre, multinational, phase III clinical trial involving preterm infants from European countries and North America.

Inclusion and exclusion criteria

The inclusion criteria are: neonates born more than 8 weeks preterm (gestational age up to 31 weeks and 6 days); decision to conduct full life support; parental informed consent; and cerebral NIRS oximeter placed within three minutes after birth.

Sample size

According to actual data of two European centres (Graz and Rotterdam) and one Canadian centre (Edmonton) the percentage of neonates not affected by mortality and cerebral injury is 65%. Assuming an increase of not affected neonates from 65% to 75% and a dropout rate of 10% a total of 724 neonates are required to detect this difference with a two group χ² test (alpha: 0.05, power: 80%).

Intervention

The premature infants will be randomised into experimental or control group. Both groups will have a near infrared spectroscopy (NIRS) device (left frontal), pulse-oximeter (right wrist) and electrocardiogram placed within three minutes after birth. In the study group, the cerebral tissue saturation, SpO2 and HR readings are visible, and the infant will be treated accordingly using a defined treatment guideline. In the control group, only SpO2 and HR will be visible, and the infant will be treated according routine treatment.

Duration of intervention Monitoring will be started within 3 minutes after birth and the intervention will last during immediate transition period and resuscitation up to 15 minutes after birth.

Follow up

Thereafter, each neonate will be followed up for primary outcome to term date or discharge.

Outcome measures

The primary outcome is mortality and/or cerebral injury defined as any intraventricular bleeding and/or cystic periventricular leucomalacia.

The secondary outcomes are neonatal morbidities.

Study Design

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Study Type :	Interventional (Clinical Trial)
Estimated Enrollment :	726 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Intervention Model Description:	investigator-initiated randomised multi-centre multinational clinical trial
Masking:	Single (Outcomes Assessor)
Primary Purpose:	Diagnostic
Official Title:	Cerebral Regional Tissue Oxygen Saturation to Guide Oxygen Delivery in Preterm Neonates During Immediate Transition After Birth: An Investigator-initiated Randomised Multi-centre Multinational Clinical Trial
Actual Study Start Date :	September 20, 2017
Estimated Primary Completion Date :	May 31, 2021
Estimated Study Completion Date :	September 30, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Oxygen Therapy

U.S. FDA Resources

Arms and Interventions

Arm	Intervention/treatment
Experimental: Study group: Invos 5100 Supplemental oxygen support and respiratory/circulatory support is guided by cerebral regional tissue oxygenation (crSO2) measured with near-infrared spectroscopy ("INVOS 5100" ), in addition to the SpO2/HR (oxygen saturation/heart rate) monitoring according to routine.	Device: Study group Cerebral NIRS measurement with INVOS 5100 during immediate transition in addition to SpO2 and HR monitoring
Active Comparator: Control group: Routine care Supplemental oxygen support and respiratory/circulatory support is guided by SpO2/HR monitoring according to routine - The resuscitation team is blinded to the crSO2 monitoring.	Other: Control group SpO2 and HR monitoring and routine treatment during immediate transition

Outcome Measures

Primary Outcome Measures :

Mortality and/or occurrence of cerebral injury [ Time Frame: up to 19 weeks ]
Number of patients, who die or have intraventricular hemorrhage or have periventricular leucomalacia

Secondary Outcome Measures :

Frequency of neonatal morbidities [ Time Frame: up to 19 weeks ]
Number of patients, who have infection and/or sepsis and/or necrotizing enterocolitis and/or bronchoplumonary dysplasia and /or retinopathia prematurorum

Eligibility Criteria

Information from the National Library of Medicine

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Ages Eligible for Study:	up to 15 Minutes (Child)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Preterm neonates less than completed 32 weeks,
Decision to conduct full life support,
Written informed consent.

Exclusion Criteria:

No decision to conduct full life support,
No written informed consent,
Congenital malformation.

Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03166722

Contacts

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Contact: Gerhard Pichler, MD	+43 316 385 80520	gerhard.pichler@medunigraz.at

Locations

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Austria
Department of Pediatrics, Medical University of Graz	Recruiting
Graz, Styria, Austria, 8036
Contact: Gerhard Pichler, MD 0043 316 385 80520 gerhard.pichler@medunigraz.at
Principal Investigator: Gerhard Pichler, MD
Canada, Alberta
Royal Alexandra Hospital	Recruiting
Edmonton, Alberta, Canada, T5H 3V9
Contact: Georg M Schmölzer, MD, PhD georg.schmoelzer@me.com

Sponsors and Collaborators

Medical University of Graz

Royal Alexandra Hospital

Investigators

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Principal Investigator:	Gerhard Pichler, MD	Medical University of Graz, Austria
Principal Investigator:	Georg M Schmölzer, MD, PhD	Royal Alexandra Hospital, Edmonton, Canada

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Pichler G, Baumgartner S, Biermayr M, Dempsey E, Fuchs H, Goos TG, Lista G, Lorenz L, Karpinski L, Mitra S, Kornhauser-Cerar L, Avian A, Urlesberger B, Schmölzer GM. Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth (COSGOD III): an investigator-initiated, randomized, multi-center, multi-national, clinical trial on additional cerebral tissue oxygen saturation monitoring combined with defined treatment guidelines versus standard monitoring and treatment as usual in premature infants during immediate transition: study protocol for a randomized controlled trial. Trials. 2019 Mar 20;20(1):178. doi: 10.1186/s13063-019-3258-y.

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Responsible Party:	Medical University of Graz
ClinicalTrials.gov Identifier:	NCT03166722
Other Study ID Numbers:	COSGOD Phase III
First Posted:	May 25, 2017 Key Record Dates
Last Update Posted:	July 1, 2020
Last Verified:	June 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	Undecided

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Studies a U.S. FDA-regulated Drug Product:	No
Studies a U.S. FDA-regulated Device Product:	No

Additional relevant MeSH terms:

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Brain Injuries Premature Birth Hypoxia Obstetric Labor, Premature Obstetric Labor Complications Pregnancy Complications Brain Diseases	Central Nervous System Diseases Nervous System Diseases Craniocerebral Trauma Trauma, Nervous System Wounds and Injuries Signs and Symptoms, Respiratory

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