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Trial record 17 of 68 for:    tpn

Targeted Breast Milk Fortification for Very Low Birth Weight Infants in the NICU

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ClinicalTrials.gov Identifier: NCT04025021
Recruitment Status : Enrolling by invitation
First Posted : July 18, 2019
Last Update Posted : September 17, 2019
Sponsor:
Information provided by (Responsible Party):
Sharon Groh-Wargo, MetroHealth Medical Center

Brief Summary:
This study evaluates the effectiveness of individualized human milk fortification for very low birth weight (<1500 g) babies in the NICU (Neonatal Intensive Care Unit) to optimize their growth. Breast milk analysis will occur on a weekly basis using the Miris Human Milk Analyzer. In the Control group, participants will receive standard TPN (total parenteral nutrition) and lipids and breast milk fortification according to MetroHealth's NICU guidelines. The Intervention group will receive TPN and lipids optimized depending on the results of breast milk analysis, followed by additional individualized fortification using additional microlipids and/or liquid protein to achieve the goal of 4g protein/kg/day and 100-130 kcal/kg/day.

Condition or disease Intervention/treatment Phase
Human Milk Neonate Breast Milk Dietary Supplement: Targeted Fortification Device: The Miris Human Milk Analyzer Not Applicable

Detailed Description:
Human milk has a variety of benefits for neonates, especially premature neonates, including a decreased risk of for necrotizing enterocolitis, sudden infant death syndrome (SIDS), respiratory syncytial virus (RSV) bronchiolitis, respiratory infections, and many other childhood conditions. There is variability in macronutrient and caloric content of breast milk between mothers, making it difficult to accurately quantify the nutritional content the breast milk is providing. The protein content varies by postnatal age, and the fat content varies temporally during a feed. Currently calculations use a standard value for caloric density and macronutrient content of breast milk, which is a reported average, but not necessarily specific to each individual mother. Human milk analysis has been used to address this variability. The Miris Human Milk Analyzer (HMA) is a mid-infrared analyzer and has been evaluated in many studies. It measures the macronutrient content of breast milk, providing values for protein, fat, carbohydrates, and calculated calories. By having this information available, the fortification added to breast milk can be tailored specifically to each mother's breast milk composition to meet each neonate's nutritional needs, and optimize growth.This will be a prospective randomized control study of preterm infants less than 1500 grams [very low birth weight (VLBW)] receiving human milk (maternal or donor) will be included. The control group will receive adjustment of total parenteral nutrition (TPN) per NICU guidelines as enteral feedings are advanced followed by standard fortification of human milk. The intervention group will have TPN (protein and lipids) adjusted based on analysis of human milk as feedings are advanced to provide goal 4g/kg/day of protein and 100-130 kcal/kg/day followed by targeted fortification of breast milk based on human milk analysis to continue to provide 4 g/kg/day of protein and 100-130 kcal/kg/day for once full feeds are achieved. The primary aim of this study is to evaluate the growth, anthropometric measurements, and body composition, to see if targeted fortification improves neonatal growth. By optimizing neonatal growth and nutrition there is potential to also have an impact on other morbidities and long term neurodevelopmental outcomes.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: This study will be a randomized control trial with 2 arms: control group (standard fortification) or intervention group (targeted fortification) in a 1:1 allocation ratio. Allocation group will be stratified to four groups according to birth weight: <750g, 751-1000g, 1001-1250g, 1251-1500g. This stratification is based upon our NICU feeding guideline, and will ensure that enrolled infants will receive comparable nutrition progression (e.g. NPO (nil per os) days, days of trophic feeds) throughout the study period. The allocation will be concealed in a sequentially numbered, opaque, sealed envelope, that will be opened after consent is obtained.
Masking: None (Open Label)
Masking Description: After randomization, the groups will not be blinded to the investigators or caregivers.
Primary Purpose: Treatment
Official Title: Targeted Fortification of Human Breast Milk and Adjustment of TPN for Very Low Birth Weight Infants to Optimize Growth and Nutrition Using the Miris Mid-infrared Human Milk Analyzer
Estimated Study Start Date : September 2019
Estimated Primary Completion Date : March 2021
Estimated Study Completion Date : March 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
No Intervention: Control group (standard fortification)

Breast milk will be fortified standard with Similac Human Milk Fortifier 1 packet:

50 ml breast milk at 50ml/kg/day enteral feeds, then 1 packet:25 ml breast milk at 75 ml/kg/day. As feedings are advanced to goal of 150 ml/kg/day, the TPN and SMOF lipids (Fat Emulsion Comprised of Soy Oil, Medium Chain Triglycerides, Olive Oil, and Fish Oil) will be decreased per standard management and NICU guidelines.

Experimental: Intervention group (targeted fortification)

Breast milk will be fortified standard with Similac Human Milk Fortifier 1 packet:

50 ml breast milk at 50ml/kg/day enteral feeds, then 1 packet:25 ml breast milk at 75 ml/kg/day. During this time, as the volume decreases, the TPN and SMOF lipids will be optimized to provide a goal of 4 g/kg/day of protein, and 100-130kcal/kg/day. At 100 ml/kg/day of enteral feeds additional liquid protein and/or microlipids will be added to the breast milk to provide goal of 4 g/kg/day of protein and 100-130 kcal/kg/day. This will be determined by analysis of the milk and reported composition. They will continue targeted fortification for 4 weeks after achieving full feeds of 150 ml/kg/day. Breast milk analysis will occur on a weekly basis immediately after birth for all infants enrolled in the study.

Dietary Supplement: Targeted Fortification
The TPN and SMOF lipids will be optimized to provide a goal of 4 g/kg/day of protein, and 100-130kcal/kg/day. At 100 ml/kg/day of enteral feeds additional liquid protein and/or microlipids will be added to the breast milk to provide goal of 4 g/kg/day of protein and 100-130 kcal/kg/day. This will be determined by analysis of the milk and reported composition. They will continue targeted fortification for 4 weeks after achieving full feeds of 150 ml/kg/day.

Device: The Miris Human Milk Analyzer
The Miris human milk analyzer is a mid infrared that reports the amount of energy absorbed at each wavelength. The amount of fat (grams), lactose (grams), total protein (grams), true protein (grams), and energy (kcal) per 100 ml will be reported.




Primary Outcome Measures :
  1. Body composition [ Time Frame: 4 weeks after baby reaches full feeds (150 mL/kg/day) or at NICU discharge ]
    Body composition will be measured by air displacement plethysmography (PEAPod). As standardized assessment of body composition is relatively new in the preterm infant population, we are using clinical judgment to determine that a difference in fat free mass z-score (from data from Norris T, 2019) of 0.5 is clinically significant.


Secondary Outcome Measures :
  1. Weight gain velocity [ Time Frame: From enrollment in study to 4 weeks after full feeds (150 mL/kg/day) or at NICU discharge. ]
    Weight gain velocity, measured in grams/kg/day

  2. Weight gain [ Time Frame: From enrollment in study to 4 weeks at full feeds (150 mL/kg/day) or at NICU discharge. ]
    Daily weight will be obtained, measured in grams

  3. Linear growth [ Time Frame: From enrollment in study to 4 weeks at full feeds (150 mL/kg/day) or at NICU discharge. ]
    Weekly measurements of length will be obtained throughout the study, measured in centimeters

  4. Head circumference growth [ Time Frame: From enrollment in study to 4 weeks at full feeds (150 mL/kg/day) or at NICU discharge. ]
    Weekly measurements of head circumference will be obtained throughout the study, measured in centimeters

  5. Body composition [ Time Frame: From enrollment in study to 4 weeks at full feeds (150 mL/kg/day) or at NICU discharge. ]
    Mid upper arm circumference (cm) or skinfold thickness (mm) will be measured weekly throughout the study and combined with length to calculate the body composition



Information from the National Library of Medicine

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Ages Eligible for Study:   up to 6 Months   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Premature infants <1500 g
  • Mother consenting to provide breast milk or use of donor breast milk

Exclusion Criteria:

  • Infants with major congenital malformations
  • Infants with medical conditions precluding them from having breast milk
  • Mothers with medical conditions that preclude them form providing breast milk
  • Insufficient breast milk supply
  • Refusal of donor breast milk
  • Mother is non-English speaking

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): NCT04025021


Locations
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United States, Ohio
MetroHealth Medical Center
Cleveland, Ohio, United States, 44109
Sponsors and Collaborators
MetroHealth Medical Center
Investigators
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Principal Investigator: Sharon Groh-Wargo, PhD, RDN MetroHealth Medical Center

Additional Information:
Publications:
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Responsible Party: Sharon Groh-Wargo, Principal Investigator, Neonatal Nutritionist, Clinical Professor, MetroHealth Medical Center
ClinicalTrials.gov Identifier: NCT04025021     History of Changes
Other Study ID Numbers: 19-00200
First Posted: July 18, 2019    Key Record Dates
Last Update Posted: September 17, 2019
Last Verified: September 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: No
Pediatric Postmarket Surveillance of a Device Product: No
Product Manufactured in and Exported from the U.S.: No
Keywords provided by Sharon Groh-Wargo, MetroHealth Medical Center:
Targeted Fortification
Human Milk Analysis
Neonatal Nutrition
Additional relevant MeSH terms:
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Birth Weight
Body Weight
Signs and Symptoms