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Trial registered on ANZCTR
Registration number
ACTRN12610000382077
Ethics application status
Approved
Date submitted
1/04/2010
Date registered
12/05/2010
Date last updated
10/05/2011
Type of registration
Prospectively registered
Titles & IDs
Public title
Determining the docosahexaenoic acid dose to obtain plasma and erythrocyte phospholipid fatty acid profiles in preterm infants comparable to term infant profiles: a dose response pilot study.
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Scientific title
In preterm infants born less than 33 weeks gestation will a tuna oil emulsion containing 121 mg/ml or 76 mg/ml of docosahexaenoic acid (DHA) compared with 37 mg/ml of DHA achieve an erythrocyte phospholipid fatty acid profile comparable to a term infant profile?
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Secondary ID [1]
1595
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None
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Universal Trial Number (UTN)
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Trial acronym
DINO-II pilot study
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Preterm infants
257083
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Condition category
Condition code
Diet and Nutrition
257236
257236
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0
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Other diet and nutrition disorders
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Reproductive Health and Childbirth
257293
257293
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0
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Complications of newborn
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Infants are randomised to receive one of three solutions:
Aqueous emulsion of 19.5% DHA oil:
1) Containing 11.4 mg DHA. This will carry 121 mg of DHA for each ml of emulsion.
2) 66:33 blend of DHA and soy oil to give an emulsion that will carry 76 mg of DHA for each ml of emulsion.
3) Control (details in control field)
Administration for all three solutions: 1 ml/kg/day (given via feeding tube in 3 divided doses, 8 hourly) for 28 days.
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Intervention code [1]
256250
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Treatment: Other
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Comparator / control treatment
Aqueous emulsion of 19.5% DHA oil:
33:66 blend of DHA and soy oil to give an emulsion that will carry 37 mg of DHA for each ml of emulsion.
Administration for all three solutions: 1 ml/kg/day (given via feeding tube in 3 divided doses, 8 hourly) for 28 days.
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Control group
Dose comparison
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Outcomes
Primary outcome [1]
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Blood (erythrocyte and plasma) phospholipid DHA levels analysed using gas chromotography.
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Assessment method [1]
258133
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Timepoint [1]
258133
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Day 0, 7, 14, 21, 28
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Secondary outcome [1]
263776
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Tolerance of the enteral emulsions will be determined by comparing the number of days to reach full enteral feeds (>=150 mls/kg/day) and number of days in which one or more feeds were stopped.
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Assessment method [1]
263776
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Timepoint [1]
263776
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Daily from study start to end (28 days)
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Eligibility
Key inclusion criteria
Infants born less than 33 weeks gestation after one but before five days of commencing any enteral feeds and with parental/guardian consent. Multiple births will be eligible and will be randomised individually. Women providing breast milk for their infant not taking DHA supplements or willing to stop taking supplements for duration study.
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Minimum age
2
Days
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Maximum age
14
Days
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Infants with major congenital or chromosomal abnormalities. Infants likely to be transferred to remote locations where weekly blood tests can’t be done.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
The parent/s of eligible infants will be approached to enter the trial by the study neonatologist, or nominee; follow-up for consent will be by the study nurse. This will occur when the infant is nearing readiness to commence feeds. Upon consent, infants will be randomised to one of the three study emulsions and assigned a unique study ID. The Clinical Trials Pharmacist (who is not involved in study recruitment or conduct) holds the allocation schedule and assigns the study group.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A computer generated randomisation schedule using variable block design was generated by statistician independent of study conduct. Stratification occurrred for sex, gestational age <28 weeks and 28 to 32 weeks.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Bio-availability
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
20/05/2010
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Actual
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
30
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
256752
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Other
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Name [1]
256752
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Women's and Children's Health Research Institute
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Address [1]
256752
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72 King William Road
North Adelaide SA 5006
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Country [1]
256752
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Australia
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Primary sponsor type
Other
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Name
Women's and Children's Health Research Institute
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Address
72 King William Road
North Adelaide SA 5006
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Country
Australia
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Secondary sponsor category [1]
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University
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Name [1]
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The University of Adelaide
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Address [1]
256066
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Adelaide SA 5005
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Country [1]
256066
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
258764
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Children, Youth and Women's Health Service
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Ethics committee address [1]
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72 King William Road North Adelaide SA 5006
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Ethics committee country [1]
258764
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Australia
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Date submitted for ethics approval [1]
258764
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Approval date [1]
258764
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10/03/2010
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Ethics approval number [1]
258764
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REC2169/5/12
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Summary
Brief summary
Infants born before 33 weeks are at high risk of developmental disorders and learning disabilities. We confirmed the importance of dietary docosahexaenoic acid (DHA) in preterm infants born <33 weeks gestation in a large, National Health and Medical Research Council funded (ID 250322), multi-centre randomised controlled trial (the DINO trial; ACTRN 12606000327583; JAMA. 2009;301:175-82). We demonstrated that DHA given at a dose designed to approximate the in utero accumulation rate (3 times the standard dietary dose) resulted in fewer preterm children with significant mental delay at 18 months corrected age compared with control. The effect of DHA-supplementation was most pronounced in girls born <33 weeks gestation and in infants born weighing <1250g. Despite this some children (boys, infants born >1250g) failed to respond leading us to suspect that higher doses of DHA may be required. This was confirmed when we observed that the DHA level of preterm infants did not achieve levels seen in term infants. This was most likely caused by a number of factors: biological variability and compliance variation influenced the amount of DHA that appeared in breast milk, delay in reaching target infant milk volumes and losses due to oxidation for energy. A randomised controlled trial of higher-dose is warranted. Before undertaking such a trial a pilot study is needed to determine the effect of a higher DHA dose on plasma and erythrocyte phospholipid levels, and to assess the feasibility of giving DHA directly to the infant rather than as an addition to milk or formula.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Address
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Country
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Phone
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Fax
31006
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Email
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Contact person for public queries
Name
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Carmel Collins
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Address
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Child Nutrition Research Centre
Flinders Medical Centre
Bedford Park SA 5042
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Country
14253
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Australia
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Phone
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+61 8 8204 5755
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Fax
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+61 8 8204 6296
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Email
14253
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[email protected]
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Contact person for scientific queries
Name
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Carmel Collins
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Address
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Child Nutrition Research Centre
Flinders Medical Centre
Bedford Park SA 5042
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Country
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Australia
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Phone
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+61 8 8204 5755
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Fax
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+61 8 8204 6296
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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