Exclusive Human Milk Feeding in Infants With Single Ventricle Physiology



Status:Recruiting
Conditions:Cardiology
Therapuetic Areas:Cardiology / Vascular Diseases
Healthy:No
Age Range:Any
Updated:10/19/2018
Start Date:July 2016
End Date:December 2022
Contact:Amy Piacentino, BScN CRAII
Email:APiacentino@prolacta.com
Phone:310-748-7237

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A Randomized Controlled Trial to Evaluate Growth Velocity and Clinical Outcomes of Infants With Single Ventricle Physiology Fed an Exclusive Human Milk Diet With Early Nutritional Fortification Following Surgical Repair

A randomized, blinded, controlled trial to evaluate growth velocity and clinical outcomes in
infants with single ventricle physiology fed an exclusive human milk diet prior to, and
throughout the post-operative period following, surgical repair. Human milk is defined as
expressed human milk or donor milk and its derivatives, human milk-based fortifier and human
milk caloric fortifier.

The study hypothesis is that infants fed an exclusive human milk diet will have short and
long term benefits, with improved wound healing, growth, and neurodevelopmental outcomes
while reducing episodes of feeding intolerance and necrotizing enterocolitis (NEC).

This is a single blinded (physician investigator), randomized, controlled trial to evaluate
growth velocity and clinical outcomes in infants with single ventricle physiology fed an
exclusive human milk diet during their initial hospitalization after birth and through the 30
days post-surgical repair feeding period or hospital discharge, whichever comes first.

Subjects will be randomized to one of two groups at birth or immediately following diagnosis
if prenatal care was not obtained prior to birth. Parents who decline participation by their
infants in the study will be asked to consent to data gathering on their infants who will be
treated and fed per institutional practice. The data on these individuals will be summarized
and evaluated descriptively in comparison with the actual trial results.

All patients will receive exclusive maternal human milk or donor human milk prior to
randomization. Once randomized, patients in Group One will receive an exclusive human milk
diet prior to the surgery and throughout the 30-day feeding period following surgical repair
or until hospital discharge, whichever comes first. Day 1 is defined as the day of the first
enteral feed post-surgery. Patients in Group Two (Control Group) will receive maternal human
milk or formula or donor human milk (per standard of care at each hospital) in the
pre-surgical period. In the post-surgical period the control group will receive human milk or
formula, as per feeding algorithm The primary objective of this study is to evaluate growth
velocity (weight velocity [g/kg/day] and weight z-score from World Health Organization (WHO)
growth charts) at 30 days after the initiation of feed post-surgery for infants with single
ventricle physiology who are fed an exclusive human milk diet from birth through the 30 day
feeding period following surgical repair or until hospital discharge, whichever comes first.

Inclusion Criteria:

1. Term infants (≥37 and 0/7 weeks gestational age) ≤ 7 days old with a diagnosis of
single ventricle physiology who are thought to require a single ventricle repair at
the time of enrollment.

2. Infant feeding was NPO or consisted of 100% human milk diet prior to enrollment

3. Parent(s) willing to sign informed consent.

4. Parent(s) willing to comply with study follow-up procedures.

5. Require surgical palliation within the first 1 month of life.

Exclusion Criteria:

1. Term infants >7 days old at the time of diagnosis.

2. <37 weeks gestation

3. Infants requiring cardio-pulmonary resuscitation prior to surgical repair.

4. Outborn infants who received enteral nutrition at the other institution prior to
surgical repair. If it is uncertain if infant received even 1 bottle or a small amount
of formula, infants will be excluded.

5. Major congenital abnormalities that could significantly affect survival such as:

1. Confirmed or suspected major genetic abnormalities (lethal or with extremely low
probability for survival).

2. Chromosomal abnormalities: Trisomies (13, 18, 21 etc.) deletions or
translocations (Turner/Williams Syndrome, DiGeorge, to name a few)

3. Major organ system abnormalities not related to a genetic syndrome that are
lethal or have extremely low probability for survival (i.e, bilateral kidney
intrinsic disease, pulmonary hypoplasia, Central Nervous System (CNS)
malformations: Arnold Chiari, myelomeningoceles, hydranencephaly, schizencephaly,
holoprosencephaly))

4. Heterotaxia

5. Metabolic disorders affecting growth: homocystinuria, methylmalonic acidemias,
propionic acidemias, urea cycle defects

6. Evidence of intracerebral hemorrhage (IVH) ≥ Grade 3

7. Any comorbidity or significant clinical event prior to enrollment, deemed by the
Investigator as likely to affect survival.

8. Requires Extracorporeal Membrane Oxygenation (ECMO) pre-operatively

9. Legally Authorized Representative(s) unwilling to comply with an exclusive human milk
diet either in the form of mother's milk, human milk-based human milk fortifier, human
milk based caloric fortifier or donor human milk during the initial hospitalization
period and through the 30 day feeding period after surgical repair or hospital
discharge, whichever comes first.
We found this trial at
12
sites
Chicago, Illinois 60611
Principal Investigator: Bradley Marino, MD
Phone: 800-543-7362
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116th St and Broadway
New York, New York 10027
(212) 854-1754
Principal Investigator: Sudha Kashyap, MD
Phone: 212-305-9034
Columbia University In 1897, the university moved from Forty-ninth Street and Madison Avenue, where it...
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1201 W La Veta Ave
Orange, California 92868
(714) 997-3000
Phone: 714-509-4373
Children's Hospital of Orange County For more than 45 years, CHOC Children’s has been steadfastly...
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3333 Burnet Avenue
Cincinnati, Ohio 45229
Principal Investigator: David Cooper, MD
Phone: 513-803-2995
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1801 Inwood Rd
Dallas, Texas 75390
(214) 645-3300
Principal Investigator: Erin Gordon, MD
University of Texas Southwestern Medical Center UT Southwestern is an academic medical center, world-renowned for...
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801 7th Ave
Fort Worth, Texas 76104
Principal Investigator: Victor Levy, MD
Phone: 682-885-6837
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1600 Southwest Archer Road
Gainesville, Florida 32608
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6621 Fannin St
Houston, Texas 77030
(832) 824-1000
Principal Investigator: Amy Hair, MD
Phone: 832-826-7991
Texas Children's Hospital Texas Children's Hospital, located in Houston, Texas, is a not-for-profit organization whose...
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Loma Linda University
Loma Linda, California 92354
(909) 558-4000
Phone: 909-558-7448
Loma Linda University Loma Linda University (LLU) is a Seventh-day Adventist educational health-sciences institution with...
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Los Angeles, California 90027
Phone: 323-361-1871
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1200 Children's Avenue
Oklahoma City, Oklahoma 73104
Principal Investigator: Patricia Williams, MD
Phone: 405-271-5215
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Oklahoma City, OK
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San Antonio, Texas 78229
Principal Investigator: Cynthia L Blanco, MD
Phone: 210-567-5262
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San Antonio, TX
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