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Late Onset Neonatal SepsisPhase 3NEOLACTONCT01525316

Lactoferrin for Prevention of Sepsis in Infants

A Phase 3 study testing Bovine Lactoferrin and Maltodextrin in people with Late Onset Neonatal Sepsis, run by Universidad Peruana Cayetano Heredia at 3 sites in Peru.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The investigators propose a clinical trial in premature infants to determine the effect of orally-administered bovine lactoferrin on occurrence of severe infections and to determine whether as a result of decreased infections, infants' growth and development improve after daily lactoferrin supplementation, due to its… Read more about this study

Who is it for?
Ages 1 hour to 72 hours
Conditions the study is for
Late Onset Neonatal Sepsis
What is being tested?
Bovine Lactoferrin and Maltodextrin
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
414 participants
Where
3 sitesPeru
Study dates
May 2012to Oct 2016
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 hour to 72 hours
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Neonates with a birth weight between 500g and 2000g
  • Neonates born in, or referred to the Neonatal Intermediate and Intensive Care Units of one of the participating hospitals in the first 72 hours of life.

Who cannot join

  • Neonates with underlying gastrointestinal problems that prevent oral intake.
  • Neonates with predisposing conditions that profoundly affect growth and development (chromosomal abnormalities, structural brain anomalies, severe congenital abnormalities).
  • Neonates who have a family history of cow milk allergy.
  • Neonates that, according to the investigator criteria, will not have the chance to complete the subsequent study visits (patients that before one month old would not be living in Lima).
  • Neonates whose parents decline to participate.

Trial locations and contacts

3 sites in 1 country.

Peru3 sites
  • Hospital Nacional Alberto Sabogal Sologuren

    Lima, 0511

  • Hospital Nacional Cayetano Heredia

    Lima, 0511

  • Hospital Nacional Guillermo Almenara Irigoyen

    Lima, 0511

Other trials in Peru

About this study

The investigators propose a clinical trial in premature infants to determine the effect of orally-administered bovine lactoferrin on occurrence of severe infections and to determine whether as a result of decreased infections, infants' growth and development improve after daily lactoferrin supplementation, due to its antimicrobial and anti-inflammatory properties. If successful, the use of lactoferrin as a protective protein could profoundly affect clinical care of neonates both in the developed and developing world.

Read the detailed description

Neonatal mortality is an important global public health challenge. Approximately 4 million neonatal deaths per year occur in developing countries, accounting for 40% all of deaths in children under 5. Infection, birth asphyxia and consequences of premature birth/low birth weight are responsible for the majority of these deaths. Although advances in neonatal intensive care led to improved survival of premature infants, sepsis continues to be an important cause of morbidity and mortality worldwide.

Lactoferrin, an iron-binding protein with multiple physiological functions (anti-microbial, anti-inflammatory, and immunomodulatory), is one of the most important proteins present in mammalian milk. Our hypothesis is that lactoferrin given as a daily oral food supplement to preterm infants will improve their health by mimicking its protective role in milk. There is a vast literature showing in vitro and animal model benefits of lactoferrin. However, there are few clinical studies designed to translate this knowledge into patient care. A recent Italian study showed that lactoferrin given to low-birth weight infants reduces incidence of sepsis (17% vs. 6%) and death. Whether lactoferrin has an effect in higher risk populations and an impact on subsequent neurodevelopment and growth remains to be determined.

Specific aim 1: The investigators will test the hypothesis that bovine lactoferrin supplementation prevents serious infections in preterm infants. The investigators will conduct a randomized placebo-controlled double blind study in 414 premature infants < 2000 g in Neonatal Units in Lima, Peru to determine whether bovine lactoferrin prevents late-onset sepsis or sepsis-associated death.

This hypothesis is based on lactoferrin´s antimicrobial and immunomodulating activities. Lactoferrin protects against pathogens in multiple ways: it sequesters iron essential for bacterial growth; binds to lipopolysaccharide (LPS) on the cell surface of Gram negative bacteria, disrupting the bacterial cell membrane; it has anti-lipoteichoic acid (against Gram positive organisms) and anti-Candida cell wall activities. The investigators have found that lactoferrin not only inhibits growth; it impairs virulence of some of the major pathogens by decreasing their ability to adhere or to invade mammalian cells, and by binding to, or degrading, specific virulence proteins. Lactoferrin may protect infants from sepsis by blocking attachment and invasion of organisms in the gut.

Specific aim 2: The investigators will test the hypothesis that bovine lactoferrin supplementation promotes better neurodevelopment and growth outcomes in preterm infants assessed by the Mullen Scales of Early Learning, a standardized neurologic exam and growth measurements at 12, 18 and 24 months corrected age.

It is postulated that exposure of the preterm brain to inflammatory mediators during infectious episodes contribute to brain (white matter) injury and poor developmental outcome. It has been demonstrated that breast milk has a beneficial effect on neurodevelopment outcomes in preterm infants. The investigators hypothesize that lactoferrin is the major factor in milk responsible for this effect due to its antimicrobial and immunomodulatory properties: it reduces inflammation by decreasing production of tumor necrosis factor α and other pro-inflammatory molecules, and by regulating the immune response, protecting against severe inflammation related to infection and septic shock. In addition, the investigators hypothesize that lactoferrin will improve growth by decreasing the frequency of growth-impairing infections and by lactoferrin effect on intestinal cell proliferation, differentiation and maturation.

The use of lactoferrin as a broad-spectrum non-pathogen specific antimicrobial protective protein is an innovative approach. If successful this study will profoundly affect clinical care of neonates both in the developed and developing world.

Being tested
Bovine Lactoferrin, Maltodextrin
Keywords
Late Onset Neonatal Sepsis, Neonates, Lactoferrin, Infections, Prevention, Neurodevelopment
Medical subject headings
Neonatal Sepsis, Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Bovine LactoferrinDietary supplement

    Also called Lactoferrin

    Infants will receive oral bovine lactoferrin (200 mg/Kg/day divided in three dosis) for 8 weeks. Lactoferrin will be dissolved in human milk or infant formula or in a 5% glucose solution. Each dose will be dissolved in a small volume so the maximum lactoferrin concentration will be 25mg/mL.

  • MaltodextrinDietary supplement

    Infants will receive oral maltodextrin (200mg/Kg/day in three divided dosis) for 8 weeks. Maltodextrin will be dissolved in human milk or infant formula or in a 5% glucose solution. Each dose will be dissolved in a small volume so the maximum maltodextrin concentration will be 25mg/mL.

Study groups in NCT01525316
Study groupRoleWhat they receive
Bovine LactoferrinExperimentalLactoferrin is a freeze-dried protein purified directly from fresh bovine milk.
Receives: Dietary Supplement: Bovine Lactoferrin
MaltodextrinPlacebo comparatorMaltodextrin is an inert sugar.
Receives: Dietary Supplement: Maltodextrin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. First episode of late-onset sepsis or sepsis-associated death

    The primary study outcome will be a composite outcome of the first episode of late-onset sepsis or sepsis-associated death.

    Measured: 72hrs to 8 weeks of age

Secondary outcomes (1)
  1. Neurodevelopment

    Neurodevelopment at 24 months of corrected age, assessed by the Mullen Scale for Early Learning.

    Measured: 12 to 24 months of corrected age

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Feb 2012 (estimated)
  2. Study startMay 2012
  3. Primary completionOct 2016
  4. Study completionOct 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
414 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01525316
Sponsor's protocol ID
SIDISI 57710
Other IDs
1R01HD067694-01A1
Acronym
NEOLACTO
Status last verified
Dec 2021
First submitted
30 Jan 2012
Last updated
6 Dec 2021
Results posted
No
Data monitoring committee
Yes

Publications

  • Manzoni P, Rinaldi M, Cattani S, Pugni L, Romeo MG, Messner H, Stolfi I, Decembrino L, Laforgia N, Vagnarelli F, Memo L, Bordignon L, Saia OS, Maule M, Gallo E, Mostert M, Magnani C, Quercia M, Bollani L, Pedicino R, Renzullo L, Betta P, Mosca F, Ferrari F, Magaldi R, Stronati M, Farina D; Italian Task Force for the Study and Prevention of Neonatal Fungal Infections, Italian Society of Neonatology. Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low-birth-weight neonates: a randomized trial. JAMA. 2009 Oct 7;302(13):1421-8. doi: 10.1001/jama.2009.1403.

    PubMed 19809023
  • Ochoa TJ, Zegarra J, Cam L, Llanos R, Pezo A, Cruz K, Zea-Vera A, Carcamo C, Campos M, Bellomo S; NEOLACTO Research Group. Randomized controlled trial of lactoferrin for prevention of sepsis in peruvian neonates less than 2500 g. Pediatr Infect Dis J. 2015 Jun;34(6):571-6. doi: 10.1097/INF.0000000000000593.

    PubMed 25973934
  • Akin IM, Atasay B, Dogu F, Okulu E, Arsan S, Karatas HD, Ikinciogullari A, Turmen T. Oral lactoferrin to prevent nosocomial sepsis and necrotizing enterocolitis of premature neonates and effect on T-regulatory cells. Am J Perinatol. 2014 Dec;31(12):1111-20. doi: 10.1055/s-0034-1371704. Epub 2014 May 16.

    PubMed 24839144
  • Torres Roldan VD, Urtecho S M, Gupta J, Yonemitsu C, Carcamo CP, Bode L, Ochoa TJ. Human milk oligosaccharides and their association with late-onset neonatal sepsis in Peruvian very-low-birth-weight infants. Am J Clin Nutr. 2020 Jul 1;112(1):106-112. doi: 10.1093/ajcn/nqaa102.

    PubMed 32401307
  • Ochoa TJ, Zegarra J, Bellomo S, Carcamo CP, Cam L, Castaneda A, Villavicencio A, Gonzales J, Rueda MS, Turin CG, Zea-Vera A, Guillen D, Campos M, Ewing-Cobbs L; NEOLACTO Research Group. Randomized Controlled Trial of Bovine Lactoferrin for Prevention of Sepsis and Neurodevelopment Impairment in Infants Weighing Less Than 2000 Grams. J Pediatr. 2020 Apr;219:118-125.e5. doi: 10.1016/j.jpeds.2019.12.038. Epub 2020 Feb 6.

    PubMed 32037149
  • Medina-Alva P, Duque KR, Zea-Vera A, Bellomo S, Carcamo C, Guillen-Pinto D, Rivas M, Tori A, Zegarra J, Cam L, Castaneda A, Villavicencio A, Ochoa TJ. Combined predictors of neurodevelopment in very low birth weight preterm infants. Early Hum Dev. 2019 Mar;130:109-115. doi: 10.1016/j.earlhumdev.2019.01.019. Epub 2019 Feb 8.

    PubMed 30743197
  • Rueda MS, Calderon-Anyosa R, Gonzales J, Turin CG, Zea-Vera A, Zegarra J, Bellomo S, Cam L, Castaneda A, Ochoa TJ; NEOLACTO Research Group. Antibiotic Overuse in Premature Low Birth Weight Infants in a Developing Country. Pediatr Infect Dis J. 2019 Mar;38(3):302-307. doi: 10.1097/INF.0000000000002055.

    PubMed 29613975
  • Turin CG, Zea-Vera A, Rueda MS, Mercado E, Carcamo CP, Zegarra J, Bellomo S, Cam L, Castaneda A, Ochoa TJ; NEOLACTO Research Group. Lactoferrin concentration in breast milk of mothers of low-birth-weight newborns. J Perinatol. 2017 May;37(5):507-512. doi: 10.1038/jp.2016.265. Epub 2017 Jan 26.

    PubMed 28125095

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Bovine Lactoferrin and Maltodextrin in people with Late Onset Neonatal Sepsis, run by Universidad Peruana Cayetano Heredia at 3 sites in Peru.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Dec 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Peru. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

First episode of late-onset sepsis or sepsis-associated death (time frame: 72hrs to 8 weeks of age). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01525316, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Dec 2021.

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