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Apnea in Hospitalized Preterm Infants Following the Administration of Routine Childhood Vaccines

Primary Purpose

Apnea, Apnea Neonatal, Prematurity

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
PCV13
DTaP
HBV
IPV
Hib
Sponsored by
Duke University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Apnea focused on measuring apnea following vaccination

Eligibility Criteria

6 Weeks - undefined (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. <33 and 0 days weeks gestational age at birth
  2. ≥6 weeks and 0 days and ≤12 weeks and 0 days postnatal age at randomization
  3. Remains hospitalized after birth (has never been discharged home)
  4. Treating clinician deems infant eligible to receive 2-month vaccines
  5. English- or Spanish-speaking parent(s)/legally authorized representative(s) (LAR(s))
  6. Not planned for discharge within 60 hours of study entry
  7. The parent/guardian must be willing and capable of providing permission for their child to participate through the written informed consent process

Exclusion Criteria:

  1. Receipt of DTaP, IPV, PCV13, or Hib prior to enrollment. Previous administration of the first dose of HBV is permitted
  2. Anticipated receipt of any vaccine other than DTaP, IPV, HBV, PCV13, or Hib during the first 60 hours after randomization
  3. History of a severe allergic reaction (e.g. anaphylaxis) to a previous dose of any hepatitis B vaccine
  4. History of a severe allergic reaction (e.g. anaphylaxis) to any component of the vaccines used in the study including neomycin, yeast and polymyxin B
  5. History of latex allergy
  6. Fever ≥38°C within 48 hours prior to randomization*

    *This may result in a temporary delay of randomization

  7. Active known respiratory infection within 48 hours prior to randomization*

    *This may result in a temporary delay of randomization

  8. Active infection being treated with systemic antimicrobials*

    *This may result in a temporary delay of randomization

  9. Requiring mechanical ventilation or support with nasal intermittent positive pressure ventilation (NIPPV)*

    *This may result in a temporary delay of randomization

  10. History of unstable progressive neurologic disorder of unknown cause
  11. Known cause of apnea other than apnea of prematurity
  12. Cyanotic heart disease (congenital or acquired)
  13. Major invasive medical or surgical procedure (including circumcision) within 48 hours prior to randomization or anticipated to have major invasive medical or surgical procedure during the first 60 hours after randomization*

    *This may result in a temporary delay of randomization

  14. Child or parent/LAR is an immediate relative of study staff or an employee who is supervised by study staff.
  15. Any condition that would, in the opinion of the site investigator, place the participant at an unacceptable risk of injury or render the participant unable to meet the requirements of the protocol

Sites / Locations

  • Centers for Disease Control and Prevention
  • University of North Carolina
  • Duke University
  • Cincinnati Children's Hospital Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

No Intervention

Arm Label

Vaccinated

Unvaccinated

Arm Description

In the study arm, infants will receive PCV13, DTaP, HBV, IPV, and Hib vaccines within 12 hours of randomization. Infants will be monitored from time of vaccination to 48 hours post-vaccination for the occurrence of apnea, bradycardia and desaturation.

In the study arm, infants will not receive PCV13, DTaP, HBV, IPV, and Hib vaccines during the study. Infants will be monitored from randomization to 48 hours post-randomization for the occurrence of apnea, bradycardia and desaturation.

Outcomes

Primary Outcome Measures

Occurrence of Apnea
Number of infants with ≥ 1 apneic event in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group, mITT Population Apnea was defined as a pause in respirations of >20 seconds, or a pause in respirations of >15 seconds with associated bradycardia (heart rate <80 beats per minute for any duration occurring within 1 minute of the apnea event). Potential apnea events triggered by the cardiorespiratory monitors were manually reviewed by 2 neonatologists to verify the event. In uncommon situations in which manual review of a triggered event was not possible due to missing data, the triggered event was considered to be apnea.

Secondary Outcome Measures

Number of Apneic Episodes
Average number of apneic episodes in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Duration of Apneic Episodes
Average duration of apneic episodes in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Increase in Respiratory Support
Proportion of infants requiring any increase in respiratory support in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Severe Cardiorespiratory Events
Proportion of infants with severe ≥1 severe cardiorespiratory event in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group. Only severe apnea events in the mITT analysis window and only the severe bradycardia events in the mITT analysis window from Duke University. The monitor data were not viable at UNC and Cincinnati Children's Hospital. Duke data were adjudicated by neonatologists.
Positive Pressure Ventilation
Proportion of Infants Requiring Positive Pressure Ventilation in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.

Full Information

First Posted
May 8, 2018
Last Updated
October 18, 2023
Sponsor
Duke University
Collaborators
Centers for Disease Control and Prevention, Children's Hospital Medical Center, Cincinnati, University of North Carolina
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1. Study Identification

Unique Protocol Identification Number
NCT03530124
Brief Title
Apnea in Hospitalized Preterm Infants Following the Administration of Routine Childhood Vaccines
Official Title
A Prospective, Randomized, Open-label Clinical Trial to Assess Apnea Following Administration of 13-valent Conjugate Pneumococcal Vaccine, Diphtheria Toxoid, Tetanus Toxoid, and Acellular Pertussis Vaccine, Inactivated Polio Vaccine, Hepatitis B Vaccine, and Haemophilus Influenzae Type B Vaccine in Preterm Infants
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Completed
Study Start Date
July 17, 2018 (Actual)
Primary Completion Date
November 1, 2021 (Actual)
Study Completion Date
November 1, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Duke University
Collaborators
Centers for Disease Control and Prevention, Children's Hospital Medical Center, Cincinnati, University of North Carolina

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
A prospective, randomized open-label clinical trial will be conducted from July 2018 to October 2020. Approximately 300 preterm infants will be enrolled across three sites: Duke University Medical Center, the University of North Carolina, and Cincinnati Children's Hospital Medical Center. Eligible infants will be randomized 1:1 to receive either 2-month US licensed childhood vaccines (PCV13, DTaP, HBV, IPV an Hib) or no vaccines. After their participation in the study, healthcare providers of the infants in the unvaccinated group will make decision abut receipt of their 2-month childhood vaccines. The study will collect data from the continuous cardiorespiratory and pulse oximetry monitors from randomization to 48 hours after randomization for infants in the unvaccinated group, and from randomization to 48 hours after vaccination for infants in the vaccinated group. Infants in both groups will be monitored for up to 60 hours for the occurrence of apnea, bradycardia, and oxygen desaturation. For infants in the "vaccinated" group, the study will also collect adverse events of clinical interest and serious adverse events occurring between the end of the 48-hour monitoring period and 14 days after vaccination. This information will be collected through parental report and review of medical records.
Detailed Description
Modified Intent-to-Treat (mITT) Analysis Population: Defined as any infant that was enrolled and randomized in the study For the mITT analysis, infants will be analyzed in their assigned treatment arms irrespective of receipt of vaccine. Study outcomes will be included in the analysis as follows: i) Vaccinated group: study outcomes in the 48-hour monitoring after vaccination. If vaccination does not occur by 12 hours after randomization, then study outcomes will be assessed between 12 and 60 hours after randomization. ii) Unvaccinated group: study outcomes in the 48-hour monitoring period after randomization.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Apnea, Apnea Neonatal, Prematurity
Keywords
apnea following vaccination

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
223 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Vaccinated
Arm Type
Other
Arm Description
In the study arm, infants will receive PCV13, DTaP, HBV, IPV, and Hib vaccines within 12 hours of randomization. Infants will be monitored from time of vaccination to 48 hours post-vaccination for the occurrence of apnea, bradycardia and desaturation.
Arm Title
Unvaccinated
Arm Type
No Intervention
Arm Description
In the study arm, infants will not receive PCV13, DTaP, HBV, IPV, and Hib vaccines during the study. Infants will be monitored from randomization to 48 hours post-randomization for the occurrence of apnea, bradycardia and desaturation.
Intervention Type
Biological
Intervention Name(s)
PCV13
Other Intervention Name(s)
13-valent Conjugate Pneumococcal Vaccine
Intervention Description
Advisory Committee on Immunization Practices (ACIP) Recommended vaccine
Intervention Type
Biological
Intervention Name(s)
DTaP
Other Intervention Name(s)
Diphtheria, Tetanus, and Acellular Pertussis Vaccine
Intervention Description
ACIP Recommended vaccine
Intervention Type
Biological
Intervention Name(s)
HBV
Other Intervention Name(s)
Hepatitis B Vaccine
Intervention Description
ACIP Recommended vaccine
Intervention Type
Biological
Intervention Name(s)
IPV
Other Intervention Name(s)
Inactivated Polio Vaccine
Intervention Description
ACIP Recommended vaccine
Intervention Type
Biological
Intervention Name(s)
Hib
Other Intervention Name(s)
Haemophilus influenzae Type B Vaccine
Intervention Description
ACIP Recommended vaccine
Primary Outcome Measure Information:
Title
Occurrence of Apnea
Description
Number of infants with ≥ 1 apneic event in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group, mITT Population Apnea was defined as a pause in respirations of >20 seconds, or a pause in respirations of >15 seconds with associated bradycardia (heart rate <80 beats per minute for any duration occurring within 1 minute of the apnea event). Potential apnea events triggered by the cardiorespiratory monitors were manually reviewed by 2 neonatologists to verify the event. In uncommon situations in which manual review of a triggered event was not possible due to missing data, the triggered event was considered to be apnea.
Time Frame
48 hours
Secondary Outcome Measure Information:
Title
Number of Apneic Episodes
Description
Average number of apneic episodes in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Time Frame
48 hours
Title
Duration of Apneic Episodes
Description
Average duration of apneic episodes in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Time Frame
48 hours
Title
Increase in Respiratory Support
Description
Proportion of infants requiring any increase in respiratory support in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Time Frame
48 hours
Title
Severe Cardiorespiratory Events
Description
Proportion of infants with severe ≥1 severe cardiorespiratory event in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group. Only severe apnea events in the mITT analysis window and only the severe bradycardia events in the mITT analysis window from Duke University. The monitor data were not viable at UNC and Cincinnati Children's Hospital. Duke data were adjudicated by neonatologists.
Time Frame
48 hours
Title
Positive Pressure Ventilation
Description
Proportion of Infants Requiring Positive Pressure Ventilation in a 48-hour monitoring period after vaccination in the "vaccinated" group and a 48-hour monitoring period after randomization in the "unvaccinated" group.
Time Frame
48 hours

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Weeks
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: <33 and 0 days weeks gestational age at birth ≥6 weeks and 0 days and ≤12 weeks and 0 days postnatal age at randomization Remains hospitalized after birth (has never been discharged home) Treating clinician deems infant eligible to receive 2-month vaccines English- or Spanish-speaking parent(s)/legally authorized representative(s) (LAR(s)) Not planned for discharge within 60 hours of study entry The parent/guardian must be willing and capable of providing permission for their child to participate through the written informed consent process Exclusion Criteria: Receipt of DTaP, IPV, PCV13, or Hib prior to enrollment. Previous administration of the first dose of HBV is permitted Anticipated receipt of any vaccine other than DTaP, IPV, HBV, PCV13, or Hib during the first 60 hours after randomization History of a severe allergic reaction (e.g. anaphylaxis) to a previous dose of any hepatitis B vaccine History of a severe allergic reaction (e.g. anaphylaxis) to any component of the vaccines used in the study including neomycin, yeast and polymyxin B History of latex allergy Fever ≥38°C within 48 hours prior to randomization* *This may result in a temporary delay of randomization Active known respiratory infection within 48 hours prior to randomization* *This may result in a temporary delay of randomization Active infection being treated with systemic antimicrobials* *This may result in a temporary delay of randomization Requiring mechanical ventilation or support with nasal intermittent positive pressure ventilation (NIPPV)* *This may result in a temporary delay of randomization History of unstable progressive neurologic disorder of unknown cause Known cause of apnea other than apnea of prematurity Cyanotic heart disease (congenital or acquired) Major invasive medical or surgical procedure (including circumcision) within 48 hours prior to randomization or anticipated to have major invasive medical or surgical procedure during the first 60 hours after randomization* *This may result in a temporary delay of randomization Child or parent/LAR is an immediate relative of study staff or an employee who is supervised by study staff. Any condition that would, in the opinion of the site investigator, place the participant at an unacceptable risk of injury or render the participant unable to meet the requirements of the protocol
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rachel G Greenberg, MD
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Andrea Trembath, MD
Organizational Affiliation
University of North Carolina
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mary A Staat, MD
Organizational Affiliation
Children's Hospital Medical Center, Cincinnati
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Karen Broder, MD
Organizational Affiliation
Centers for Disease Control and Prevention
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centers for Disease Control and Prevention
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30329
Country
United States
Facility Name
University of North Carolina
City
Chapel Hill
State/Province
North Carolina
ZIP/Postal Code
27599
Country
United States
Facility Name
Duke University
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27705
Country
United States
Facility Name
Cincinnati Children's Hospital Medical Center
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Apnea in Hospitalized Preterm Infants Following the Administration of Routine Childhood Vaccines

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