Early Protein Supplementation on Prevention of Hyperkalemia
Primary Purpose
Hyperkalemia
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Protein supplementation
Sponsored by
About this trial
This is an interventional prevention trial for Hyperkalemia focused on measuring Hyperkalemia, Protein, Hyperglycemia, ELBW
Eligibility Criteria
Inclusion Criteria: ELBW infants with birth weight <1000 grams . Enrollment within the first 12 hr of life. Exclusion Criteria: major congenital anomalies; gestational age less than 24 weeks, infants not resuscitated, death.
Sites / Locations
- University Health System
Outcomes
Primary Outcome Measures
Incidence of hyperkalemia in between groups
Secondary Outcome Measures
Incidence of hyperglycemia, post-natal growth, neurodevelopmental outcome at 18 months
Full Information
NCT ID
NCT00290160
First Posted
February 8, 2006
Last Updated
October 2, 2023
Sponsor
The University of Texas Health Science Center at San Antonio
1. Study Identification
Unique Protocol Identification Number
NCT00290160
Brief Title
Early Protein Supplementation on Prevention of Hyperkalemia
Official Title
The Effect of Early Protein Supplementation on Prevention of Hyperkalemia in Extremely Low Birth Weight Infants
Study Type
Interventional
2. Study Status
Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
December 2002 (undefined)
Primary Completion Date
September 2005 (Actual)
Study Completion Date
July 2007 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
The University of Texas Health Science Center at San Antonio
4. Oversight
5. Study Description
Brief Summary
Evaluate if early protein supplementation decreases the incidence of hyperkalemia in Extremely Low Birth Weight Infants (babies less than 1,000 grams birth weight).
Detailed Description
Randomized double blind prospective clinical trial. All infants admitted to University Hospital neonatal intensive care unit with birth weight of < 1000 grams, mmore than 24 weeks gestation and with no congenital anomalies will be enrolled in the study. This will include inborn infants and those that are transported from outlying hospitals and admitted at <12 hours of life. After informed consent, infants will be randomized to receive either standard of care nutritional management or nutritional management per study protocol with the addition of protein supplementation. Randomization will take place in the pharmacy.
Control Group: Infants enrolled in the control group will be started on intravenous fluids (IVF) on admission to the NICU with 5% Dextrose and 1500 mg calcium gluconate per 500 cc for a total fluid intake of either 120 or 150 cc/kg/day. The attending neonatologist in accordance with the infant's gestational age and maturity will make the decision regarding total fluid intake. The control group will be started at 0.5 gram/kg/d of protein ( Amynosin PF) on DOL 1 and increase by 0.5 gram/kg/day every day to a maximum of 3 grams/kg/day.
Study group: The study group will receive the same total fluid intake (120 cc/kg/day or 150 cc/kg/day) and 5% dextrose infusion with calcium gluconate and the addition of 2 grams/kg/day of protein (Aminosyn PF). The study group will receive 2 grams/kg/day of protein for 24 hours to 36 hours and will increase by 1 gram/kg/day up to a maximum of 4 grams/kg/day.
In both groups, caloric intake will start at 29-34 kcal/kg day (i.e., approximately 20-25 calories per kilogram from glucose and 9 calories per kilogram from lipids). Caloric intake will be progressively increased depending on the infant's tolerance to glucose. Protein to glucose ratio in the control group will be 250-312 and nitrogen balance ratio (including all calories) will be approximately 362-425. In the study group, protein to glucose ratio will be 64-80 and nitrogen balance ratio (including all calories) will be 93-109. The control group corresponds to the current standard of care. The study group nitrogen balance is within the limits of recent studies which show that a nitrogen balance ratio of 46-78 is appropriate for ELBW infants.
Glucose infusion rate (GIR) will be increased by attending neonatologist depending on infant's glucose tolerance. Usually GIR is started at 6 mg/kg/min and increased by 1 milligram per kilo per minute every 24 hrs. in ELBW infants. For fluctuations in glucose, adjustments in glucose infusion rate (GIR) will be via piggyback dextrose to the IVF if necessary.
Lipids will be supplied as a 20% solution and will be started by attending neonatologist according to standard of care (0.5-1 gr/kg first day of life, then increases of 0.5-1 gr/kg per day up to a maximum of 3 gr/kg day).
All infants will be started on Total Parenteral Nutrition (TPN) on DOL 1. The amino acid solution (Aminosyn PF) will be supplemented with 40 mg cysteine hydrochloride/kg/day in both groups since it is considered to be one of the essential amino acids for premature infants. Stable isotope studies have suggested improved protein retention with cysteine supplementation. 3 The amino acid solution will be added via pharmacy per study protocol. Subjects will continue to receive supplementation for the first week of life.
Initiation of feedings, TPN, fluid, and electrolyte intake will be determined by the attending neonatologist.
If the infant develops hyperkalemia (>6.5 mmol/lt), treatment will be determined by attending neonatologist based on standard of care incluiding: an increase in intravenous fluid delivery, diuretic therapy (lasix), correction of acidosis, close monitoring of ionized and total calcium levels and correction with calcium gluconate if needed, glucose and insulin infusion , kayexalate, and if refractory, exchange transfusion might be considered.
Following completion of the study, we will continue to monitor standard laboratory data, including serum and urine electrolytes. We will also monitor growth until hospital discharge. Following discharge, infants will be followed in PREMIEre clinic for neurodevelopmental outcome with Bayley testing at 6, 12, and 18 months CGA. In addition to the primary outcome reduction in incidence of hyperkalemia, our secondary outcomes of interest include the incidence of hyperglycemia, the incidence of periventricular-intraventricular hemorrhage (PIVH), renal function, growth, and neurodevelopmental outcome at 18 months corrected gestational age.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hyperkalemia
Keywords
Hyperkalemia, Protein, Hyperglycemia, ELBW
7. Study Design
Primary Purpose
Prevention
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
Double
Allocation
Randomized
Enrollment
62 (false)
8. Arms, Groups, and Interventions
Intervention Type
Behavioral
Intervention Name(s)
Protein supplementation
Primary Outcome Measure Information:
Title
Incidence of hyperkalemia in between groups
Secondary Outcome Measure Information:
Title
Incidence of hyperglycemia, post-natal growth, neurodevelopmental outcome at 18 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
1 Minute
Maximum Age & Unit of Time
12 Hours
Eligibility Criteria
Inclusion Criteria: ELBW infants with birth weight <1000 grams . Enrollment within the first 12 hr of life.
Exclusion Criteria: major congenital anomalies; gestational age less than 24 weeks, infants not resuscitated, death.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Cynthia L Blanco, MD
Organizational Affiliation
University of Texas
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Health System
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
22228000
Citation
Blanco CL, Gong AK, Schoolfield J, Green BK, Daniels W, Liechty EA, Ramamurthy R. Impact of early and high amino acid supplementation on ELBW infants at 2 years. J Pediatr Gastroenterol Nutr. 2012 May;54(5):601-7. doi: 10.1097/MPG.0b013e31824887a0.
Results Reference
derived
PubMed Identifier
21129755
Citation
Blanco CL, Gong AK, Green BK, Falck A, Schoolfield J, Liechty EA. Early changes in plasma amino acid concentrations during aggressive nutritional therapy in extremely low birth weight infants. J Pediatr. 2011 Apr;158(4):543-548.e1. doi: 10.1016/j.jpeds.2010.09.082. Epub 2010 Dec 3.
Results Reference
derived
PubMed Identifier
18589451
Citation
Blanco CL, Falck A, Green BK, Cornell JE, Gong AK. Metabolic responses to early and high protein supplementation in a randomized trial evaluating the prevention of hyperkalemia in extremely low birth weight infants. J Pediatr. 2008 Oct;153(4):535-40. doi: 10.1016/j.jpeds.2008.04.059. Epub 2008 Jun 27.
Results Reference
derived
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Early Protein Supplementation on Prevention of Hyperkalemia
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