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Human Milk for Congenital Gastrointestinal Disorders (HM for CGD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02567292
Recruitment Status : Completed
First Posted : October 2, 2015
Last Update Posted : August 31, 2022
Sponsor:
Collaborators:
Chatham Valley Foundation
Prolacta Bioscience
Information provided by (Responsible Party):
Heidi Karpen, Emory University

Study Description
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Brief Summary:
This study aims to identify whether an exclusive human milk diet (EHMD) would improve outcomes in neonates with congenital gastrointestinal disorders (CGD) and by facilitating an earlier transition off of parenteral nutrition (PN).

Condition or disease Intervention/treatment Phase
Congenital Gastrointestinal Disorders Other: Human Milk Not Applicable

Detailed Description:

Infants born with congenital gastrointestinal disorders (CGD) can be very challenging to treat. The CGD require surgery shortly after birth to correct the problems and recovery can take a long time.

During the period of time the infant's intestines are sick or don't work properly, they rely on parenteral nutrition (IV fluids containing carbohydrates, proteins and fats) to meet their nutritional needs. Being on PN for a long time requires special intravenous lines, and increases the risk of blood stream infections and can make the liver sick.

Feeding babies who have these CGD is often very difficult, as the intestine needs to adapt. It needs to make appropriately formed stool to eliminate wastes, but not lose too much water or too many electrolytes. There is often a lot of starting and stopping of feeds. Human milk (HM) is considered the ideal source of nutrition for all infants.

This study aims to identify whether an exclusive human milk diet (EHMD) would improve outcomes in neonates with congenital gastrointestinal disorders (CGD) and by facilitating an earlier transition off of parenteral nutrition (PN).

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 151 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Other
Official Title: Effects of an Exclusive Human Milk Diet on Enteral Feeding Outcomes of Neonates With Congenital Gastrointestinal Disorders
Actual Study Start Date : July 26, 2018
Actual Primary Completion Date : January 18, 2022
Actual Study Completion Date : January 18, 2022

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
No Intervention: Retrospective Control Group
Approximately 150 patients with congenital gastrointestinal disorders who were treated in the neonatal intensive care unit (NICU) at Children's Healthcare of Atlanta-Egleston and other participating institutions from 2012 to 2015, who had non-human milk (HM) diets will be identified as retrospective controls using the electronic medical records system.
Experimental: Exclusive Human Milk Diet Group
A minimum of 150 patients with CGD admitted to participating NICUs who meet inclusion criteria and provide informed consent will be enrolled in the prospective arm of the study. These patients will be fed an EHMD comprised of mother's own milk (MOM) or pasteurized donor human milk (DM). Fortification will be provided with human milk derived human milk fortifier, either a human milk-based fortifier (Prolact+ H2MF®) for infants born at less than 37 weeks GA or <2,200g birth weight or the term-equivalent version (PBCLN-002) formulated for infants >37 weeks and/or >2,200g at birth. Infants will receive this EHMD until they have achieved full enteral feedings for 7 days with bowel in continuity
 Other: Human Milk
Participants will receive an exclusive human milk diet comprised of mother's own milk (MOM, pasteurized donor human milk (DM) fortified with a donor-milk based fortifier (DMBF): Prolact+ for infants <37 weeks PMA and/or or weight <2,200g or PBCLN-002 for infants >37 weeks PMA and/or weight >2,200g)


Outcome Measures
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Primary Outcome Measures :
  1. Time to full enteral feeding [ Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days) ]
    The number of days to achieve full enteral feeding after the initial human milk feeding


Secondary Outcome Measures :
  1. Number of days of parenteral nutrition [ Time Frame: Through study completion, up to 1 year ]
    The total number of days parenteral nutrition is required.

  2. Length of hospital stay [ Time Frame: Through study completion, up to 6 months ]
    The length of hospital stay described as the number of days spent in the hospital

  3. Difference in conjugated bilirubin levels [ Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days) ]
    The difference in average bilirubin level will be compared between the non-human milk diet (retrospective control group) and the breast milk diet group.

  4. Feeding intolerance [ Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days) ]
    Number of days when one or more feedings were held for clinical concerns

  5. Feeding interruptions [ Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days) ]
    NPO for at least 24 hours. NPO due to elective surgeries or procedures will not be defined as feeding interruptions

  6. Episodes of Necrotizing Enterocolitis [ Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days) ]
    Number of episodes of Stage IIb NEC or greater

  7. Number of sepsis episodes [ Time Frame: From birth to day of life full enteral feedings for 7 days is achieved (up to 30 days) ]
    The number of sepsis episodes will be compared between the non-breast milk diet (retrospective control group) and the breast milk diet group.

  8. Death rate [ Time Frame: Through study completion, up to 1 year ]
    The number of deaths between participants who receive breast milk only diets as compared to the non-breast milk diet (retrospective control group while in the neonatal intensive care unit (NICU).


Eligibility Criteria
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Ages Eligible for Study:   1 Minute to 1 Year   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Admission to participating NICU at less than 7 days of age
  2. Birthweight >1250g and/or gestational age at birth >32 weeks
  3. Less than 7 days of enteral feedings
  4. Diagnosis of eligible primary "Congenital Gastointestinal Disorders" defined as: gastroschisis, omphalocele and intestinal atresias
  5. Consent to the use of donor human milk products
  6. Consent to participate in this study

Exclusion Criteria:

  1. Admission to participating NICU at >7 days of age
  2. Birthweight <1250g and/or gestational age <32 weeks
  3. Diagnosis of non-eligible gastrointestinal disorders: congenital diaphragmatic hernia, midgut volvulus, Hirschsprung's disease, esophageal atresia, imperforate anus
  4. Evidence of significant liver dysfunction at time of enrollment (direct bilirubin >4 and transaminases elevated more than 2 SD above upper limit of normal for age)
  5. Liver malformations such as biliary atresia and choledochal cyst
  6. Refusal of consent
Contacts and Locations
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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): NCT02567292


Locations
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United States, Georgia
Children's Healthcare of Atlanta-Egleston
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Chatham Valley Foundation
Prolacta Bioscience
Investigators
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Principal Investigator: Heidi Karpen, MD Emory University
More Information
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Publications of Results:

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Responsible Party: Heidi Karpen, Assistant Professor, Emory University
ClinicalTrials.gov Identifier: NCT02567292    
Other Study ID Numbers: IRB00080481
First Posted: October 2, 2015    Key Record Dates
Last Update Posted: August 31, 2022
Last Verified: August 2022
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: No
Keywords provided by Heidi Karpen, Emory University:
Digestive Disease and Disorders
Neonatal
Pediatric Disorders
Additional relevant MeSH terms:
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Gastrointestinal Diseases
Digestive System Diseases
Disease
Pathologic Processes