AzTrials
AzTrials

Perinatal AsphyxiaNCT06611254

Quantification of Brain and Kidney Perfusion Before, During, and After Hypothermia Treatment in Neonates With Perinatal Asphyxia Using Contrast-enhanced Ultrasound

An observational study of Perinatal Asphyxia and Hypothermia Treatment, run by University of Erlangen-Nürnberg Medical School at 1 site in Germany.

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

In this clinical study vascular dynamics in the neonatal brain and kidney will be monitored by CUES and ULM before, during and after hypothermia treatment in neonates with asphyxia. Read more about this study

Who is it for?
Any age
What is being tested?
Contrast enhanced ultrasound imaging (CEUS) and post processing with ULM
Type of treatment
Medical device
How many people
20 participants
Where
1 siteGermany
Study dates
24 Jun 2024to 1 Dec 2027
Phase
Observational
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 Any age
  • All sexes
  • Child, Adult, Older adult

Study population: One study population. Anticipated approx. n=20 neonateswith above mentioned inclusion criteria with perinatal asphyxia and inclusion criteria for hypothermia treatmentaccording to the AWMF guideline.

Who may be able to join

  • Fulfillment of the inclusion criteria for hypothermia treatment according to the AWMF guideline
  • Severe acidosis (pH ≤7.0 or a base deficit ≥16 mmol/l) in umbilical cord blood or a blood sample from the first hour of life, and
  • clinical signs of moderate or severe encephalopathy (severity grade 2 or 3 according to Sarnat \& Sarnat), and
  • postnatal age ≤6h, and
  • gestational age ≥36 weeks' gestation
  • Consent of the parents/legal guardians
Show all 14Show fewer
  • Time 1 (before the start of hypothermia treatment)
  • Informing the parents/legal guardians present on site despite an emotionally stressful situation with high individual benefit for the patient
  • If only one parent is present and able to provide information, their consent is sufficient - the second parent is informed repeatedly when they regain the ability to provide information
  • Information adapted to the emergency situation, addressing the personal situation and comprehensible presentation of the plan
  • Time 2 (during hypothermia treatment)
  • -->Offer of a further informative discussion/repeated explanation with the parents/legal representatives before the second measurement in order to answer any questions that may have arisen
  • Suitable acoustic window
  • Availability of the qualified examiner

Who cannot join

  • Lack of consent of at least one parent
  • Pre-existing brain malformations
  • Absence of the competent examiner

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Germany1 site, 1 recruiting
  • FAU Erlangen-Nuernberg

    Erlangen, Bavaria, 91054

    Ferdinand Knieling, MD, 0049 9131 85 33118, ferdinand.knieling@uk-erlangen.de

    Ferdinand Knieling, MD

    Recruiting

Other trials in Germany

About this study

In this clinical study vascular dynamics in the neonatal brain and kidney will be monitored by CUES and ULM before, during and after hypothermia treatment in neonates with asphyxia.

Read the detailed description

Perinatal asphyxia (PA) is the reduced supply of oxygen to vital organs during or immediately after birth. PA is one of the most common causes of neonatal mortality in full-term infants worldwide and of hypoxic-ischemic encephalopathy (HIE) with subsequent neurological deficits (spastic cerebral palsy). In addition to brain damage, perinatal asphyxia often leads to dysfunction of other organs. It is not uncommon for this to be accompanied by transient renal failure.

Hypothermia treatment is an established therapeutic measure for neuroprotection in clinical indications of HIE. This involves lowering the core body temperature of affected children to 33.5°C for 72 hours. The therapeutic effect is thought to be due to multifactorial mechanisms, including a reduction in endothelial dysfunction, reduced excretion of free radicals and attenuation of the inflammatory cascade.

In the guidelines for hypothermia treatment in neonatal asphyxia, regular ultrasound examinations are prescribed to clarify damage to the central nervous system (CNS) before, during and after hypothermia treatment.1 In infants, transfontal ultrasound makes it possible to visualize brain structures, vessels and their flow velocities.

The intravenous use of ultrasound contrast enhancers as an aid also opens up the possibility of recording the tissue perfusion of the CNS and kidneys, including the smallest vessels.8 This could provide significantly more information compared to conventional methods and expand our knowledge of the pathophysiology and individual status of tissue perfusion in patients.

For example, two studies at Erlangen University Hospital have successfully used contrast-enhanced ultrasound (CEUS) with the contrast agent known as SonoVue® to visualize postoperative perfusion of the brain after pediatric cardiac surgery.

In this clinical study, the new CEUS measurement and imaging technique will be used before, during and after hypothermia treatment in neonates with asphyxia. A contrast agent (SonoVue®) will be administered during the routine ultrasound examination and improved tissue visualization will be achieved. The aim is to gain new insights into brain and kidney perfusion as part of the treatment and to better assess the extent of organ damage in the individual patient through more specific vascular imaging. Improved visualization and assessment of the end-stream area will provide information on processes that promote the development of HIE and renal failure. Finally, the aim is to compare diagnostic and prognostic methods with the currently recommended measures. The CEUS is to be examined as a possible diagnostic imaging tool and possibly a supplement to existing diagnostic methods.

Being tested
Contrast enhanced ultrasound imaging (CEUS) and post processing with ULM

What participants receive

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

  • Contrast enhanced ultrasound imaging (CEUS) and post processing with ULMDevice

    CEUS is a contrast based ultrasound technique and ULM (Ultrasound Localization Microscopy) is a post-processing bioinformatical method to quantify microvascular architecture and perfusion dynamics.

Study groups in NCT06611254
Study groupRoleWhat they receive
Neonates with perinatal asphyxia and indication for hypothermia treatmentIncluded will be neonates with perinatal asphyxia that get an indication for hypothermia treatment (severe azidosis and signs of encephalopathy and under 6h of age and >36 gest. weeks). They will be monitored with CEUS/ULM at three different time points (T1: within first 6h of life/before hypothermia treatment, T2 = during hypothermia treatment/6-78h of life, T3 = after hypothermia treatment/within first week of life.
Receives: Device: Contrast enhanced ultrasound imaging (CEUS) and post processing with ULM

What is being measured

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

  1. CEUS Time intensity curves

    All CEUS outcomes will be generated in order to achieve time intensity curves in contrast enhanced ultrasound analysis

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  2. CEUS Measurement1

    PE (Peak-Enhancement)

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  3. CEUS Measurement2

    WiAUC (Wash-in Area Under the Curve (AUC(TI: TTP)))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  4. CEUS Measurement3

    WiAUC (Wash-in Area Under the Curve (AUC(TI: TTP)))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  5. CEUS Measurement4

    RT (Rise Time)

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  6. CEUS Measurement5

    mTT (mean Transit Time local) (mTT-TI))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  7. CEUS Measurement6

    TTP (Time to Peak)

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  8. CEUS Measurement7

    WiR (Wash-in-Rate )

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  9. CEUS Measurement8

    WiPI (Wash-in Perfusion Index (WiAUC/RT))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  10. CEUS Measurement9

    WoAUC (Wash-out AUC (AUC(TTP:TO)))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  11. CEUS Measurement10

    WiWoAUC (Wash-in- und Wash-out-AUC (WiAUC+WoAUC))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  12. CEUS Measurement11

    FT (Fall Time - (TO-TTP))

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  13. CEUS Measurement12

    WOR (Wash-out-Rate) QOF (Quality Of Fit between the echo-power signal and f(t)

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  14. CEUS Measurement13

    QOF (Quality Of Fit between the echo-power signal and f(t)

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  15. Near-infrared spectroscopy

    Near-infrared spectroscopy Non-invasive measurement of oxygen saturation in tissue using a probe that is attached to the head.62 This procedure is already firmly established in the field of pediatric surgery and pediatric cardiology interventions at the University Hospital Erlangen. The probe is attached before the start of the first measurement time point and removed after the end of the third measurement time point. There is no risk of side effects.

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  16. Visualization and quantification of cerebral perfusion with CEUS

    CEUS imaging for cerebral perfusion in asphyxia

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

  17. Visualization and quantification of of renal perfusion with CEUS

    CEUS imaging for renal perfusion in asphyxia

    Measured: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)

Secondary outcomes (12)
  1. CEUS and NIRS

    Correlation coefficient (R) between CEUS curve and NIRS

    Measured: T1,T2,T3

  2. Neurological status assessment (Bayley Score)

    Neurological status of the patients will be assessed by the score "Bayley Scales of Infant and Toddler Development"

    Measured: Month of life: 3-4 and 6-24

  3. MRI imaging in asphyxia

    MRI Weeke Score

    Measured: once within first two years of life

  4. Comparison of the CEUS time-intensity curve between three timepoints

    CEUS curve at T1,T2, T3

    Measured: T1,T2, T3

  5. Assessment of blood Lactate

    Lactate (mmol/l)

    Measured: T1, T2, T3

  6. EEG signs of seizures

    Number (n) of ETPs in EEG

    Measured: T1 -T3 and through study completion

  7. EEG activity

    frequency EEG (Hz)

    Measured: T1 -T3 and through study completion

  8. Assessment of renal function GFR

    GFR (ml/min/1,73 m2)

    Measured: T1 -T3 and through study completion, an average of 3 years

  9. Assessment of renal function urea

    urea (mg/dl)

    Measured: T1 -T3 and through study completion, an average of 3 years

  10. Assessment of renal function urinary status

    standardized urinary status

    Measured: T1 -T3 and through study completion

  11. Assesment of renal function kreatininekinase

    kreatininekinase (U/l)

    Measured: T1, T2, T3

  12. Assessment of metabolic LDH

    LDH (U/l)

    Measured: T1, T2, T3

Timeline

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

  1. First posted24 Sep 2024
  2. Study start24 Jun 2024
  3. Primary completion1 Jul 2027 (estimated)
  4. Study completion1 Dec 2027 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
20 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06611254
Sponsor's protocol ID
Neo_CEUS_ULM
Status last verified
Sep 2024
First submitted
21 Jun 2024
Last updated
24 Sep 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

An observational study of Perinatal Asphyxia and Hypothermia Treatment, run by University of Erlangen-Nürnberg Medical School at 1 site in Germany.

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 14 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 24 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Germany. 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 Ferdinand Knieling, MD (0049 9131 85 33118, ferdinand.knieling@uk-erlangen.de), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

CEUS Time intensity curves (time frame: before(T1, within the first 6hours of life), during hypothermia treatment(T2, 6-78hours of life), after treatment (T3, within first week of life)). The study lists 17 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 24 Sep 2024.

Free account

Keep searching with a free account

You’ve used your 3 free searches for this session. Log in or create a free AzTrials account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in