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Complete Shielding of Multivitamins to Reduce Toxic Peroxides in the Parenteral Nutrition: A Pilot Study (C-SMART-PN)

S

St. Justine's Hospital

Status

Completed

Conditions

Infant, Premature, Diseases
Lung Diseases
Infant, Newborn, Disease
Bronchopulmonary Dysplasia
Parenteral Nutrition
Respiratory Tract Disease
Pathologic Processes

Treatments

Other: Photo-protection
Other: Standard Care

Study type

Interventional

Funder types

Other

Identifiers

NCT04234152
2020-2713

Details and patient eligibility

About

The purpose of this study is to examine if a new and simple method involving complete photo-protection of multivitamins only (since sampling through infusion) will result in a significant reduction of peroxide contamination of parenteral nutrition compared to standard method of parenteral nutrition preparation and infusion in extremely preterm infants.

Full description

Hypothesis and Objectives:

The investigators propose, in this pilot study, a new and simple method involving complete photo-protection of multivitamins (MV) only (since sampling through infusion) and they hypothesize that this method will be readily applicable and will result in a significant reduction of peroxide contamination of parenteral nutrition (PN) compared to standard care of PN preparation and infusion method.

In Vitro Results Using This Proposed Photo-Protection Method:

This method has reduced the quantity of infused peroxides (as equivalent H2O2). When adding the generated peroxides over 5 hours (5 samples: at times 0, 30 minutes, 1, 3 and 5 hours), the total peroxides were 1270± 47 micromolar (μM) without photo-protection vs. 710±16 μM with this method, leading to 45% reduction of peroxides (data presented as a poster presentation in the Pediatric academic societies meeting , 2018, Poster number 2874.625). This reduction is comparable to the previously reported in vitro data for the whole PN complete photo-protection that reported 50% reduction of peroxides.

Specific objective of this pilot study:

To examine if this new and simple method will be feasible in clinical practice and will result in a significant reduction of urinary peroxide concentration when compared to standard PN compounding and infusion technique.

Innovation:

The investigators' team's long experience in this field permitted the identification of the interaction between light and MV (specifically riboflavin) that leads to doubling the amount of peroxides contaminating the PN. The complexity of complete photo-protection encountered by the team to conduct small uni-center studies and the incapacity to introduce the complete photo-protection in daily clinical practice led the team to create this simple intervention that will address the problem at its origin in a practical way. All trials, including complete PN photo-protection, faced the complexity of keeping MV away from light while needing to prepare the PN admixture under the light of a sterile hood. Added to this was the complexity of completely covering the PN bag while compounding the admixture. Light exposure may also occur during the transportation of the PN from the hospital pharmacy to the neonatal unit (even with special attention to the bottom of the bag and the area around the tubing being well covered).

The proposed intervention will eliminate all these complex procedures by directly sampling the MV in a photo-protected syringe, transporting it in this syringe, and directly infusing the MV into the photo-protected intravenous lines through its infusion into the patient.

Enrollment

35 patients

Sex

All

Ages

1 minute to 2 days old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Infants < 28 weeks of gestational age
  • Obtaining parental consent before the start of the first PN prescribed by the attending physician

Exclusion criteria

  • Significant congenital malformations
  • Infant is currently enrolled in another trial -unless approval of trial research team-
  • Parent inability to comprehend and consent

Trial design

Primary purpose

Prevention

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Single Blind

35 participants in 2 patient groups, including a placebo group

MV Photo-protection
Experimental group
Description:
Includes infants in whom the new procedure of MV separation and photo-protection will be applied. This arm will be stratified to male and female 1:1
Treatment:
Other: Photo-protection
Standard of care
Placebo Comparator group
Description:
Includes infants in whom the standard method of preparation and infusion of PN will be applied. This arm will be stratified to male and female 1:1
Treatment:
Other: Standard Care

Trial contacts and locations

2

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Data sourced from clinicaltrials.gov

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