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Respiratory Distress SyndromeMASTERNCT05908227

Effects of Flow Magnitude on Cardiorespiratory Stability During Nasal High Flow Therapy in Preterm Infants

A study testing NHF high, NHF low and NCPAP in people with Respiratory Distress Syndrome, run by Insel Gruppe AG, University Hospital Bern at 2 sites in 2 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Premature babies often need help breathing for a longer period of time. Traditionally, this is done with a breathing aid called NCPAP (nasal continuous positive airway pressure). This treatment is safe and effective, but it is very time-consuming and can sometimes have side effects. Read more about this study

Who is it for?
Ages 23 to 31 weeks
Conditions the study is for
Respiratory Distress Syndrome
What is being tested?
NHF high, NHF low and NCPAP
Could I receive a placebo?
No, everyone receives an active treatment
How many people
150 participants
Where
2 sitesin 2 countries
Study dates
1 Jul 2023to Feb 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

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 23 to 31 weeks
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Preterm infants up to 31+6 weeks GA admitted to the Division of Neonatology at Inselspital Bern, Switzerland or Division of Neonatology at the University Medical Center of the Johannes Gutenberg-University Mainz, Germany (inborn or outborn)
  • >2nd day of life (defined as date day)
  • Stable on NCPAP 6 cm H2O for ≥ 24 hours, defined as:
  • ≤ 2 apneas with concomitant bradycardias (<100/min) per hour for the previous 6 hours
  • FiO2 ≤ 0.3 and not increasing
  • No significant chest recessions (Silverman Score < 5)
Show all 10Show fewer
  • Respiratory rate ≤ 60/min
  • No need for intermittent positive pressure ventilation
  • Parents with an age 18+ years
  • Written parental informed consent (or other legal representative)

Who cannot join

  • Significant fetal anomalies
  • Primary palliative care
  • Stable on NCPAP 6 cm H2O according to stability criteria for more than 120 hours

Trial locations and contacts

2 sites in 2 countries. Contact the study team or a site near you to ask about taking part.

André Kidszun, Prof. Dr. med. contact

+41 31 632 14 01

andre.kidszun@insel.ch

2 sites in 2 countries

Germany1 site, 1 recruiting
  • University Medical Center of the Johannes Gutenberg-University Mainz

    Mainz, Rhineland-Palatinate, 55131

    Susanne Tippmann, Dr. med., +49 6131 17 5892, Susanne.Tippmann@unimedizin-mainz.de

    Susanne Tippmann, Dr. med.

    Recruiting

Other trials in Germany

Switzerland1 site, 1 recruiting
  • Department of Pediatrics, Inselspital

    Bern, 3010

    Lisa M Bünte, +41316321923, lisamarie.buente@insel.ch

    André Kidszun, Prof. Dr. med., +41 31 632 14 01, andre.kidszun@insel.ch

    Recruiting

Other trials in Switzerland

About this study

Official title: Effects of Flow Magnitude on Cardiorespiratory Stability During Nasal High Flow Therapy in Preterm Infants (MASTER Trial)

Premature babies often need help breathing for a longer period of time. Traditionally, this is done with a breathing aid called NCPAP (nasal continuous positive airway pressure). This treatment is safe and effective, but it is very time-consuming and can sometimes have side effects. In the present research project, the investigators want to find out whether another type of breathing aid called NHF (nasal high flow therapy) is just as effective for stable premature babies. The investigators suspect that NHF is just as effective, but easier to use and more comfortable.

Read the detailed description

This is a multi center parallel group three arm randomized controlled clinical trial investigating cardiorespiratory stability in stable preterm infants receiving NHF.

Currently, NCPAP remains the gold standard for administration of prolonged non-invasive ventilatory support in very preterm infants. NHF is a promising method for tailored, less invasive long-term ventilatory support for preterm infants. If ventilatory support with NHF is similarly effective to conventional NCPAP in stable preterm infants, clinicians are likely to adopt this method for widespread clinical use because of its improved comfort and potential other benefits. Primary aim of this trial is to examine cardiorespiratory stability in preterm infants treated with two commonly used NHF flowrates (Interventional group 1 and 2) in comparison to NCPAP (Comparator). Secondary aim is to examine potential comfort-related beneficial effects of NHF.

Being tested
NHF high, NHF low, NCPAP
Keywords
Nasal high flow therapy, Continuous positive airway pressure
Medical subject headings
Respiratory Distress Syndrome

What participants receive

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

  • NHF highOther

    Nasal high flow therapy 8L/min.

  • NHF lowOther

    Nasal high flow therapy 6L/min.

  • NCPAPOther

    Nasal continuous positive airway pressure 6 cm H20

Study groups in NCT05908227
Study groupRoleWhat they receive
NHF highExperimentalNasal high flow therapy 8L/min
Receives: Other: NHF high
NHF lowExperimentalNasal high flow therapy 6L/min
Receives: Other: NHF low
NCPAPActive comparatorNasal continuous positive airway pressure 6 cm H20
Receives: Other: NCPAP

What is being measured

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

  1. Treatment failure

    Treatment failure is a composite outcome defined as meeting one of the following treatment failure criteria within 24 hours of starting of intervention:

    1. >2 apneas with concomitant bradycardias (<100/min) per hour for > 1 hour or
    2. FiO2 > 0.3 consistently for > 1 hour or
    3. Significant chest recessions (Silverman Score ≥ 5) for > 1 hour or
    4. Respiratory rate > 60/min consistently for > 1 hour or
    5. Any need for intermittent positive pressure ventilation

    The presence of "Treatment failure" within 24 hours of starting of intervention will be documented (dichotomous outcome; yes/no).

    Measured: 24 hours

Secondary outcomes (30)
  1. Apneas and bradycardias

    The total frequency of apneas and bradycardias (<100/min) within 24 hours of starting of intervention will be documented.

    Measured: 24 hours

  2. Respiratory rate (RR)

    The mean RR within 24 hours of starting of intervention will be documented.

    Measured: 24 hours

  3. Heart rate (HR)

    The mean HR within 24 hours of starting of intervention will be documented.

    Measured: 24 hours

  4. Oxygen saturation (SpO2) and fraction of inspired oxygen (FiO2)

    The mean SpO2/FiO2 ratio within 24 hours of starting of intervention will be documented.

    Measured: 24 hours

  5. Frequency of any treatment failure

    Treatment failure is a composite outcome (see "Outcome 1"). The frequency of any treatment failure during the duration of the study will be documented.

    Measured: Individual study duration: estimated to be between a minimum of 7 days to an (estimated) maximum of 10 weeks.

  6. Rescue NCPAP

    Rescue NCPAP is defined as NCPAP >6 cm H2O. The frequency of need for Rescue NCPAP during the duration of the study will be collected.

    Measured: Individual study duration: estimated to be between 7 days to 10 weeks.

  7. Postmenstrual age (PMA) off positive pressure support

    The investigators will document the PMA when the infant is off positive pressure support.

    Measured: Estimated to be at a PMA of approximately 29 to 34 weeks.

  8. Postmenstrual age (PMA) off FiO2 > 0.21

    The investigators will document the PMA when the infant is off FiO2 > 0.21

    Measured: Estimated to be at a PMA between approximately 28 to 34 weeks.

  9. Postmenstrual age (PMA) at discharge

    The investigators will document the PMA when the infant is being discharged from the hospital.

    Measured: Estimated to be at a PMA of approximately 38-40 weeks.

  10. Cerebral oxygen saturation (cRSO2) 1 hour before until 3 hours after start of the intervention

    The cerebral oxygen saturation (cRSO2) in [%] 1 hour before until 3 hours after start of the intervention will be measured by using Near-infrared spectroscopy (NIRS).

    Measured: 4 hours

  11. Time spent <55% cRSO2 1 hour before until 3 hours after start of the intervention

    The time spent <55% cRSO2 in [min] 1 hour before until 3 hours after start of the intervention will be measured by using Near-infrared spectroscopy (NIRS).

    Measured: 4 hours

  12. Cerebral oxygen saturation (cRSO2) 1 hour before until 3 hours after cessation of the intervention

    The cerebral oxygen saturation (cRSO2) in [%] 1 hour before until 3 hours after cessation of the intervention will be measured by using Near-infrared spectroscopy (NIRS).

    Measured: 4 hours

  13. Time spent <55% cRSO2 1 hour before until 3 hours after cessation of the intervention

    The time spent <55% cRSO2 in [min] 1 hour before until 3 hours after cessation of the intervention will be measured by using Near-infrared spectroscopy (NIRS).

    Measured: 4 hours

  14. Change in end-expiratory lung impedance (ΔEELI)

    The change Δ in end-expiratory lung impedance (ΔEELI) will be measured using electrical impedance tomography (EIT) at 9 different timepoints during the first 48 hours after starting of intervention. One measurement will last 6 minutes.

    The measurements will take place:

    • within 30 minutes before starting of intervention (baseline measurement)
    • 3 minutes before until 3 minutes after starting of intervention
    • within 30 minutes after starting of intervention
    • 2, 6, 12, 24, 36, and 48 hours after starting of intervention

    Measured: 48 hours

  15. Change in global inhomogeneity (ΔGI) index

    The change Δ in global inhomogeneity (ΔGI) index will be measured using electrical impedance tomography (EIT) at 9 different timepoints during the first 48 hours after starting of intervention. One measurement will last 6 minutes.

    The measurements will take place:

    • within 30 minutes before starting of intervention (baseline measurement)
    • 3 minutes before until 3 minutes after starting of intervention
    • within 30 minutes after starting of intervention
    • 2, 6, 12, 24, 36, and 48 hours after starting of intervention

    Measured: 48 hours

  16. Change in variability of tidal volume (ΔTV)

    The change Δ in variability of tidal volume (ΔTV) will be measured using electrical impedance tomography (EIT) at 9 different timepoints during the first 48 hours after starting of intervention. One measurement will last 6 minutes.

    The measurements will take place:

    • within 30 minutes before starting of intervention (baseline measurement)
    • 3 minutes before until 3 minutes after starting of intervention
    • within 30 minutes after starting of intervention
    • 2, 6, 12, 24, 36, and 48 hours after starting of intervention

    Measured: 48 hours

  17. Change in ratio of tidal volume anterior/posterior (ΔRatio TV ap)

    The change Δ in ratio of tidal volume anterior/posterior (ΔRatio TV ap) will be measured using electrical impedance tomography (EIT) at 9 different timepoints during the first 48 hours after starting of intervention. One measurement will last 6 minutes.

    The measurements will take place:

    • within 30 minutes before starting of intervention (baseline measurement)
    • 3 minutes before until 3 minutes after starting of intervention
    • within 30 minutes after starting of intervention
    • 2, 6, 12, 24, 36, and 48 hours after starting of intervention

    Measured: 48 hours

  18. Incidence of Bronchopulmonary dysplasia (BPD)

    The incidence with specification of severity of BPD at 36 weeks PMA will be documented. BPD is a form of chronic lung disease (CLD).

    BPD is classified into 3 levels of severity according to the internationally used definition of Jobe and Bancalari (1).

    FiO2 >0.21 for ≥ 28 days and

    1. Breathing room air (mild)
    2. FiO2 <0.3 (moderate)
    3. FiO2 ≥ 0.3 and/or positive pressure support (severe) (1) Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163(7):1723-9.

    Measured: At 36 weeks PMA

  19. Urinary cortisol

    A 24-hour-urine-sample will be collected on the third study day. The urinary production rates of cortisol and the most important metabolites will be documented as an indicator for infant stress.

    Measured: 24 hours

  20. COMFORTneo score

    The COMFORTneo score will be documented on the third, fourth and fifth study day. The score measures comfort and chronic pain by observation.

    Measured: 72 hours

  21. Revised Bernese Pain Scale for Neonates (BSN-R) score

    The BSN-R score will be documented on the third, fourth and fifth study day. The score measures pain.

    Measured: 72 hours

  22. Parental assessment of comfort

    The parents will be asked 3 predefined questions concerning their infants' comfort on the on the third, fourth and fifth study day.

    Measured: 72 hours

  23. NASA Task Load Index (NASA-TLX)

    The NASA-TLX will be filled out by the participants' nurses on the third, fourth and fifth study day. The NASA-TLX is a questionnaire that measures workload.

    Measured: 72 hours

  24. Nasal trauma score

    The nasal trauma score is assessed according to internal standard guidelines in case of a present nasal trauma. The highest respective score and time of assessment will be documented on the participant CRF at 36 weeks PMA. Measuring nasal trauma using the Nasal trauma score takes approximately 20 seconds.

    Measured: Individual study duration: estimated to be between 7 days to 10 weeks.

  25. Behavioral Sleep stage classification for Preterm Infants (BeSSPI)

    Sleep-wake cycles as determined by the BeSSPI on the fourth study day will be documented. The BeSSPI identifies sleep stages by observation and takes approximately 2.5 hours.

    Measured: 24 hours

  26. Parental Bonding Questionnaire (PBQ)

    The score of the PBQ will be documented at 36 weeks PMA. The PBQ investigates infant-parental bonding.

    Measured: At 36 weeks PMA

  27. Age at initiating breastfeeds

    The postmenstrual age (PMA) at initiating breastfeeds will be documented. This refers to the PMA at which the first successful breastfeeding attempt takes place.

    Measured: Estimated to be between 30-34 weeks PMA.

  28. Age at reaching full breastfeeds

    The postmenstrual age (PMA) at reaching full breastfeeds will be documented. This corresponds to 100% nutrition per breastfeeds for 24 consecutive hours.

    Measured: Estimated to be between 34-40 weeks PMA.

  29. Weight

    The weight in [g] at 36 weeks postmenstrual age (PMA) will be documented.

    Measured: At 36 weeks PMA

  30. Head circumference

    The head circumference in [cm] at 36 weeks postmenstrual age (PMA) will be documented.

    Measured: At 36 weeks PMA

Timeline

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

  1. First posted18 Jun 2023
  2. Study start1 Jul 2023
  3. Primary completionDec 2025 (estimated)
  4. Study completionFeb 2026 (estimated)

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 N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
150 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05908227
Sponsor's protocol ID
2022-02287
Acronym
MASTER
Status last verified
Feb 2025
First submitted
30 May 2023
Last updated
21 Feb 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001 Jun;163(7):1723-9. doi: 10.1164/ajrccm.163.7.2011060. No abstract available.

    PubMed 11401896

Questions about this trial

What is this clinical trial studying?

A study testing NHF high, NHF low and NCPAP in people with Respiratory Distress Syndrome, run by Insel Gruppe AG, University Hospital Bern at 2 sites in 2 countries.

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 10 inclusion and 3 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: looking for participants now, as of the sponsor's last update on 21 Feb 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Germany, Switzerland. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

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

Contact Lisa Marie Bünte (+41 31 632 19 23, lisamarie.buente@insel.ch), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Treatment failure (time frame: 24 hours). 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 NCT05908227, which also lists 1 linked publication.

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 21 Feb 2025.

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