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Neuroprotective Effect of Autologous Cord Blood Combined With Therapeutic Hypothermia Following Neonatal Encephalopathy

Primary Purpose

Hypoxic Ischemic Encephalopathy, Cerebral Infarction

Status
Recruiting
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Autologous cord blood
Hypothermia
Sponsored by
Children's Hospital of Fudan University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypoxic Ischemic Encephalopathy

Eligibility Criteria

undefined - 24 Hours (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Gestational age ≥ 34 weeks
  2. Birth weight ≥ 1800 grams
  3. 10-minute Apgar score ≤5 or continued need for ventilation or severe acidosis, defined as pH <7.0
  4. Moderate to severe encephalopathy (Sarnat II to III)
  5. A moderately or severely abnormal background aEEG voltage, or seizures identified by aEEG, if monitored
  6. Up to 24 hours of age
  7. Autologous umbilical cord blood available to infuse 3 doses within 72 hours after birth
  8. Parental informed consent

Exclusion Criteria:

  1. Known major congenital anomalies, such as chromosomal anomalies, heart diseases
  2. Major intracranial hemorrhage identified by brain ultrasonography or computed tomography
  3. Severe intrauterine growth restriction (weight <1800g)
  4. Severe infectious disease, such as sepsis
  5. Inability to enroll by 24 hours of age
  6. Volume of collected cord blood <40 ml
  7. Infants in extremis for whom no additional intensive therapy will be offered by attending neonatologist
  8. Parents refuse consent

Sites / Locations

  • Children Hospital of Fudan UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Cord blood with hypothermia

Hypothermia

Arm Description

Autologous cord blood will be collected after birth and stored in Cord Blood Bank of hospital. All cord blood samples are routinely performed by dedicated, trained UCB collection staff and is restricted to deliveries of mothers who have given prior written informed consent for collection. If the mother delivered a baby with signs of HIE or cerebral infarction, Bank staff collected UCB utilizing standard procedures. Collected UCB was transported at roomtemperature in validated shippers to the NICU. Infusions were started when cells and study staff were available for administration and monitoring. Infants received up to 3 infusions, with the first dose as soon as possible after birth, and at, 48, and 72 postnatal hours. At the same time, babies will referred to neonatal intensive care unit for hypothermia therapy of cooling to 33.5 ℃ body temperature for 72 hours and standard intensive care.

Hypothermia therapy of cooling to 33.5 ℃ body temperature for 72 hours and standard intensive care.

Outcomes

Primary Outcome Measures

Mortality
The relative frequency of deaths in each group.
Disability Rate
Disability, defined as a physical or mental handicap, especially one that prevents a person from living a full, normal life or from holding a gainful job.

Secondary Outcome Measures

Neurodevelopment(Bayley Scores)
Efficacy of levetiracetam by assessment of the change from baseline to 12 months in neurodevelopment via Bayley Scores of Infant Development Mental Development Index (BSID).
Neurodevelopment(Bayley Scores)
Efficacy of levetiracetam by assessment of the change from baseline to 18 months in neurodevelopment via Bayley Scores of Infant Development Mental Development Index (BSID).
Brain Structural Alterations(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Brain Structural Alterations(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 28.
Brain Structural Alterations(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on 12 months old.
Brain Parenchyma Alterations(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Brain Parenchyma Alterations(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 28.
Brain Parenchyma Alterations(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on 12 months old.
Intracranial Hemorrhage(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Intracranial Hemorrhage(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Intracranial Hemorrhage(MRI)
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on 12 months.
Number of Adverse Events
This is a composition of general appearance includes abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Number of Adverse Events(Blood Pressure)
This is a composition of general appearance, blood pressure, pulse, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Number of Adverse Events(Pulse)
This is a composition of general appearance, blood pressure, pulse, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Number of Adverse Events(Respiratory)
This is a composition of general appearance, blood pressure, pulse, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Incidence of Complication
To gain the incidence of Polycythemia, neutropenia, thrombocytopenia, hypertension, sepsis, intraventricular hemorrhage(IVH), periventricular leukomalacia(PVL), seizure, necrotizing enterocolitis (NEC), persistent ductus arterious (PDA), apnea of prematurity, pulmonary haemorrhage, pulmonary hypertension, Prolonged blood coagulation time, retinopathy of prematurity(ROP), cardiac arrhythmia, major venous thrombosis, Renal failure treated with dialysis, pneumonia, pulmonary airleak and chronic lung disease.
SDF-1 in Serum
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
SDF-1 in Serum
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
TNF-alpha in Serum
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
TNF-alpha in Serum
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
IL-1 in Serum
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
IL-1 in Serum
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.

Full Information

First Posted
September 4, 2015
Last Updated
March 16, 2023
Sponsor
Children's Hospital of Fudan University
Collaborators
Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Guangzhou Women and Children's Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT02551003
Brief Title
Neuroprotective Effect of Autologous Cord Blood Combined With Therapeutic Hypothermia Following Neonatal Encephalopathy
Official Title
A Multi-Centre Safety and Efficacy Study of Autologous Cord Blood Combined With Therapeutic Hypothermia Following Neonates Encephalopathy in China
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 8, 2015 (Actual)
Primary Completion Date
December 30, 2025 (Anticipated)
Study Completion Date
December 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Children's Hospital of Fudan University
Collaborators
Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Guangzhou Women and Children's Medical Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study examines the effect of cord blood in the treatment of newborn infants with neonatal encephalopathy in combination with hypothermia, which is the standard treatment for this condition. The hypothesis is that the cord blood + hypothermia combination will produce better neuroprotection than the standard treatment of hypothermia alone.
Detailed Description
The primary aim of this study is to determine the neuroprotective effect of intravenous administration of autologous cord blood in neonates with severe encephalopathy (hypoxic ischemic encephalopathy or cerebral infarction). It is hypothesized that the administration of autologous cord blood will be safe and well tolerated in neonates with severe encephalopathy. If a neonate is born with signs of moderate to severe encephalopathy and cooled for the encephalopathy, the neonate will receive their own cord blood. The cord blood cells are divided into 3 doses and infused at 24, 48, and 72 hours after the birth. Infants will be randomised to treatment with autologous cord blood and hypothermia or hypothermia only and followed for safety and neurodevelopmental outcome up to 18 months. All infants in both groups will be treated with hypothermia for 72 hours started within 6 hours of delivery and infants who allocated to hypothermia and xenon will also receive autologous cord blood in 24 hours from birth through a purpose designed delivery system. Additionally, postnatal neuro-developmental outcomes in neonates with encephalopathy after autologous cord blood therapy will be measured; HIE injury to the neonate/infant brain post autologous cord blood therapy by imaging will be characterized; MRI's will be obtained per clinical routine; serum levels of selected cytokine and neurotrophic factors in neonates with HIE before and after autologous cord blood therapy will be compared and immune cell phenotype and function in neonates with HIE before and after autologous cord blood therapy will be compared.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypoxic Ischemic Encephalopathy, Cerebral Infarction

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Cord blood with hypothermia
Arm Type
Experimental
Arm Description
Autologous cord blood will be collected after birth and stored in Cord Blood Bank of hospital. All cord blood samples are routinely performed by dedicated, trained UCB collection staff and is restricted to deliveries of mothers who have given prior written informed consent for collection. If the mother delivered a baby with signs of HIE or cerebral infarction, Bank staff collected UCB utilizing standard procedures. Collected UCB was transported at roomtemperature in validated shippers to the NICU. Infusions were started when cells and study staff were available for administration and monitoring. Infants received up to 3 infusions, with the first dose as soon as possible after birth, and at, 48, and 72 postnatal hours. At the same time, babies will referred to neonatal intensive care unit for hypothermia therapy of cooling to 33.5 ℃ body temperature for 72 hours and standard intensive care.
Arm Title
Hypothermia
Arm Type
Active Comparator
Arm Description
Hypothermia therapy of cooling to 33.5 ℃ body temperature for 72 hours and standard intensive care.
Intervention Type
Drug
Intervention Name(s)
Autologous cord blood
Intervention Description
Autologous cord blood will be collected after birth and administered in divided aliquots during the first 3 days of life. At the same time, babies will referred to neonatal intensive care unit for hypothermia therapy of cooling to 33.5 ℃ body temperature for 72 hours and standard intensive care.
Intervention Type
Device
Intervention Name(s)
Hypothermia
Intervention Description
Hypothermia therapy of cooling to 33.5 ℃ body temperature for 72 hours and standard intensive care.
Primary Outcome Measure Information:
Title
Mortality
Description
The relative frequency of deaths in each group.
Time Frame
From birth to the age of 18 months
Title
Disability Rate
Description
Disability, defined as a physical or mental handicap, especially one that prevents a person from living a full, normal life or from holding a gainful job.
Time Frame
From birth to the age of 18 months
Secondary Outcome Measure Information:
Title
Neurodevelopment(Bayley Scores)
Description
Efficacy of levetiracetam by assessment of the change from baseline to 12 months in neurodevelopment via Bayley Scores of Infant Development Mental Development Index (BSID).
Time Frame
At the age of 12 months
Title
Neurodevelopment(Bayley Scores)
Description
Efficacy of levetiracetam by assessment of the change from baseline to 18 months in neurodevelopment via Bayley Scores of Infant Development Mental Development Index (BSID).
Time Frame
At the age of 18 months
Title
Brain Structural Alterations(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Time Frame
At the age of 7 days
Title
Brain Structural Alterations(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 28.
Time Frame
At the age of 28 days
Title
Brain Structural Alterations(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on 12 months old.
Time Frame
At the age of 12 months
Title
Brain Parenchyma Alterations(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Time Frame
At the age of 7 Days
Title
Brain Parenchyma Alterations(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 28.
Time Frame
At the age of 28 days
Title
Brain Parenchyma Alterations(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on 12 months old.
Time Frame
At the age of 12 months
Title
Intracranial Hemorrhage(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Time Frame
At the age of 7 days
Title
Intracranial Hemorrhage(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on Day 7.
Time Frame
At the age of Day 28
Title
Intracranial Hemorrhage(MRI)
Description
Efficacy of cord blood by assessment of the changes in brain from baseline in MRI on 12 months.
Time Frame
At the age of 12 months
Title
Number of Adverse Events
Description
This is a composition of general appearance includes abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Time Frame
In 72 hours
Title
Number of Adverse Events(Blood Pressure)
Description
This is a composition of general appearance, blood pressure, pulse, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Time Frame
In 72 hours
Title
Number of Adverse Events(Pulse)
Description
This is a composition of general appearance, blood pressure, pulse, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Time Frame
In 72 hours
Title
Number of Adverse Events(Respiratory)
Description
This is a composition of general appearance, blood pressure, pulse, respiratory, cardiovascular, abdomen, skin, head and neck (including ears, eyes, nose, and throat), lymph nodes, thyroid, musculoskeletal and neurological systems.
Time Frame
In 72 hours
Title
Incidence of Complication
Description
To gain the incidence of Polycythemia, neutropenia, thrombocytopenia, hypertension, sepsis, intraventricular hemorrhage(IVH), periventricular leukomalacia(PVL), seizure, necrotizing enterocolitis (NEC), persistent ductus arterious (PDA), apnea of prematurity, pulmonary haemorrhage, pulmonary hypertension, Prolonged blood coagulation time, retinopathy of prematurity(ROP), cardiac arrhythmia, major venous thrombosis, Renal failure treated with dialysis, pneumonia, pulmonary airleak and chronic lung disease.
Time Frame
From birth to the age of 28 days in each treatment period
Title
SDF-1 in Serum
Description
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
Time Frame
At the age of 4 days
Title
SDF-1 in Serum
Description
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
Time Frame
At the age of 14 days
Title
TNF-alpha in Serum
Description
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
Time Frame
At the age of 4 days
Title
TNF-alpha in Serum
Description
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
Time Frame
At the age of 14 days
Title
IL-1 in Serum
Description
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
Time Frame
At the age of 4 days
Title
IL-1 in Serum
Description
Biomarkers for Oxidative Stress, Inflammation and immune response as a measure of efficacy for hypoxic ischemic encephalopathy or cerebral infarction.
Time Frame
At the age of 14 days

10. Eligibility

Sex
All
Maximum Age & Unit of Time
24 Hours
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Gestational age ≥ 34 weeks Birth weight ≥ 1800 grams 10-minute Apgar score ≤5 or continued need for ventilation or severe acidosis, defined as pH <7.0 Moderate to severe encephalopathy (Sarnat II to III) A moderately or severely abnormal background aEEG voltage, or seizures identified by aEEG, if monitored Up to 24 hours of age Autologous umbilical cord blood available to infuse 3 doses within 72 hours after birth Parental informed consent Exclusion Criteria: Known major congenital anomalies, such as chromosomal anomalies, heart diseases Major intracranial hemorrhage identified by brain ultrasonography or computed tomography Severe intrauterine growth restriction (weight <1800g) Severe infectious disease, such as sepsis Inability to enroll by 24 hours of age Volume of collected cord blood <40 ml Infants in extremis for whom no additional intensive therapy will be offered by attending neonatologist Parents refuse consent
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Wenhao Zhou, Doctor
Email
zwhchfu@126.com
First Name & Middle Initial & Last Name or Official Title & Degree
Guoqiang Cheng, Doctor
Email
gqchengcm@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wenhao Zhou, Doctor
Organizational Affiliation
Children's Hospital of Fudan University
Official's Role
Study Chair
Facility Information:
Facility Name
Children Hospital of Fudan University
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
201102
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Wenhao Zhou, Doctor
Phone
(+86)021-64931003
Email
zwhchfu@126.com

12. IPD Sharing Statement

Citations:
PubMed Identifier
24388332
Citation
Cotten CM, Murtha AP, Goldberg RN, Grotegut CA, Smith PB, Goldstein RF, Fisher KA, Gustafson KE, Waters-Pick B, Swamy GK, Rattray B, Tan S, Kurtzberg J. Feasibility of autologous cord blood cells for infants with hypoxic-ischemic encephalopathy. J Pediatr. 2014 May;164(5):973-979.e1. doi: 10.1016/j.jpeds.2013.11.036. Epub 2013 Dec 31.
Results Reference
background
PubMed Identifier
23823198
Citation
Walsh BH, Boylan GB, Livingstone V, Kenny LC, Dempsey EM, Murray DM. Cord blood proteins and multichannel-electroencephalography in hypoxic-ischemic encephalopathy. Pediatr Crit Care Med. 2013 Jul;14(6):621-30. doi: 10.1097/PCC.0b013e318291793f.
Results Reference
background
PubMed Identifier
23227182
Citation
Walsh BH, Broadhurst DI, Mandal R, Wishart DS, Boylan GB, Kenny LC, Murray DM. The metabolomic profile of umbilical cord blood in neonatal hypoxic ischaemic encephalopathy. PLoS One. 2012;7(12):e50520. doi: 10.1371/journal.pone.0050520. Epub 2012 Dec 5.
Results Reference
background
PubMed Identifier
22964590
Citation
Liao Y, Cotten M, Tan S, Kurtzberg J, Cairo MS. Rescuing the neonatal brain from hypoxic injury with autologous cord blood. Bone Marrow Transplant. 2013 Jul;48(7):890-900. doi: 10.1038/bmt.2012.169. Epub 2012 Sep 10.
Results Reference
background
PubMed Identifier
22430382
Citation
Pimentel-Coelho PM, Rosado-de-Castro PH, da Fonseca LM, Mendez-Otero R. Umbilical cord blood mononuclear cell transplantation for neonatal hypoxic-ischemic encephalopathy. Pediatr Res. 2012 Apr;71(4 Pt 2):464-73. doi: 10.1038/pr.2011.59. Epub 2012 Feb 8.
Results Reference
background
PubMed Identifier
20846059
Citation
Wiberg N, Kallen K, Herbst A, Olofsson P. Relation between umbilical cord blood pH, base deficit, lactate, 5-minute Apgar score and development of hypoxic ischemic encephalopathy. Acta Obstet Gynecol Scand. 2010 Oct;89(10):1263-9. doi: 10.3109/00016349.2010.513426.
Results Reference
background

Learn more about this trial

Neuroprotective Effect of Autologous Cord Blood Combined With Therapeutic Hypothermia Following Neonatal Encephalopathy

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