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Trial registered on ANZCTR
Registration number
ACTRN12623001177640
Ethics application status
Approved
Date submitted
1/10/2023
Date registered
14/11/2023
Date last updated
19/08/2024
Date data sharing statement initially provided
14/11/2023
Type of registration
Prospectively registered
Titles & IDs
Public title
Nasal high-flow during deferred cord clamping in very preterm infants
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Scientific title
Nasal high-flow during deferred cord clamping in very preterm infants: a pilot feasibility study
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Secondary ID [1]
310717
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
prematurity
331652
0
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Condition category
Condition code
Respiratory
328373
328373
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0
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Other respiratory disorders / diseases
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Reproductive Health and Childbirth
328668
328668
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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
Nasal high-flow therapy (nasal high-flow) provides heated, humidified, blended air and oxygen via two small nasal prongs. Nasal high-flow is currently used in preterm infants with respiratory distress soon after birth. Nasal high-flow will be provided to very preterm infants immediately after birth, aiming for a minimum duration of 60 and maximum duration of 120 seconds if good tone and respirations, consistent with local guidelines at the Royal Women's Hospital.
A research team member (neonatal consultant or fellow) will be administering the intervention (applying the high flow).
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Intervention code [1]
327115
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Treatment: Other
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Comparator / control treatment
No control arm.
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Feasibility of providing nasal high-flow during deferred cord clamping
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Assessment method [1]
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Number of successful deliveries of nasal high flow therapy with no breach of sterility at caesarean section (survey questions).
(Composite outcome).
Survey is not named.
Survey designed specifically for this study.
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Timepoint [1]
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At completion of delivery room stabilisation
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Primary outcome [2]
339142
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Acceptability of nasal high-flow during deferred cord clamping
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Assessment method [2]
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Acceptability to obstetric, midwifery, anaesthetic and neonatal clinicians (survey questions)
Survey does not have a name and has been designed for this study.
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Timepoint [2]
339142
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Primary outcome [3]
339143
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Acceptability of nasal high-flow during deferred cord clamping
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Assessment method [3]
339143
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Acceptability to obstetric, midwifery, anaesthetic and neonatal clinicians (survey questions)
Survey does not have a name and has been designed for this study.
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Timepoint [3]
339143
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At completion of delivery room stabilisation.
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Secondary outcome [1]
427357
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Duration of cord clamping (in seconds)
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Assessment method [1]
427357
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Time in seconds, determined by the researcher in real time (present for study) using a digital stopwatch and recorded on the CRF.
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Timepoint [1]
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At time of cord clamping
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Secondary outcome [2]
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Proportion of infants achieving >60 seconds deferred cord clamping
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Assessment method [2]
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Deferred cord clamping achieved: yes/no, determined by the researcher in real time and recorded on the CRF.
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Timepoint [2]
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At conclusion of study.
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Secondary outcome [3]
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Provision of positive pressure ventilation in the delivery room
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Assessment method [3]
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Video review- provision of positive pressure ventilation
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Timepoint [3]
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Delivery room stabilisation
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Secondary outcome [4]
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Duration of positive pressure ventilation in the delivery room (in seconds)
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Assessment method [4]
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Video review
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Timepoint [4]
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Delivery room stabilisation
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Secondary outcome [5]
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Intubation in the delivery room
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Assessment method [5]
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Video review
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Timepoint [5]
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Delivery room stabilisation
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Secondary outcome [6]
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Maximum FiO2 in the delivery room
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Assessment method [6]
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Video review
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Timepoint [6]
427362
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Delivery room stabilisation
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Secondary outcome [7]
427363
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Heart rate 2-5 minutes after birth
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Assessment method [7]
427363
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Video review- median heart rate 2-5 minutes after birth measured at 2-second intervals
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Timepoint [7]
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2-5 minutes after birth
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Secondary outcome [8]
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Oxygen saturation 2-5 minutes after birth
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Assessment method [8]
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Video review- median peripheral oxygen saturations 2-5 minutes after birth measured at 2-second intervals
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Timepoint [8]
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2-5 minutes after birth
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Secondary outcome [9]
427365
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Temperature at 10 minutes after birth
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Assessment method [9]
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Axillary temperature using digital thermometer.
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Timepoint [9]
427365
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10 minutes after birth
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Secondary outcome [10]
427366
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Apgar score at 1 minute
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Assessment method [10]
427366
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Apgar score
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Timepoint [10]
427366
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1 minute after birth
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Secondary outcome [11]
427367
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Apgar score at 5 minutes
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Assessment method [11]
427367
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Apgar score
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Timepoint [11]
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5 minutes after birth
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Secondary outcome [12]
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Mode of respiratory support upon leaving the delivery room
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Assessment method [12]
427368
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Video review
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Timepoint [12]
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Upon leaving the delivery room
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Secondary outcome [13]
427369
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FiO2 upon leaving the delivery room
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Assessment method [13]
427369
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Video review
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Timepoint [13]
427369
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Upon leaving the delivery room
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Secondary outcome [14]
427370
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Pneumothorax requiring drainage
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Assessment method [14]
427370
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Medical record review
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Timepoint [14]
427370
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Within 24 hours after birth
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Secondary outcome [15]
427371
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Hypothermia < 36°C in the delivery room
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Assessment method [15]
427371
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Axillary temperature using digital thermometer.
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Timepoint [15]
427371
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In the delivery room
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Secondary outcome [16]
427372
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Grade III/IV intraventricular haemorrhage (IVH)
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Assessment method [16]
427372
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Medical record review
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Timepoint [16]
427372
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Within 72 hours after birth
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Secondary outcome [17]
427373
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Death within 72 hours after birth
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Assessment method [17]
427373
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Medical record review
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Timepoint [17]
427373
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Within 72 hours after birth
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Eligibility
Key inclusion criteria
Very preterm infants born 26-31+6 weeks’ gestation born at the Royal Women’s Hospital, where prospective, written consent has been obtained from the parent/legal guardian.
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Minimum age
No limit
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Maximum age
1
Hours
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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
• Contraindication to deferred cord clamping, including monochorionic twin pregnancy, large antepartum haemorrhage, vasa praevia or placental abruption, general anaesthetic, cord prolapse
• Contraindication to nasal high-flow (congenital diaphragmatic hernia, abdominal wall defect, nasal abnormality, craniofacial abnormality involving nose/mouth, cyanotic congenital heart disease)
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Non-randomised.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
19/08/2024
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Actual
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Date of last participant enrolment
Anticipated
7/07/2025
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Actual
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Date of last data collection
Anticipated
10/10/2025
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
25608
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The Royal Women's Hospital - Parkville
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Recruitment postcode(s) [1]
41433
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3052 - Parkville
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Funding & Sponsors
Funding source category [1]
314932
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Hospital
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Name [1]
314932
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Royal Women's Hospital
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Address [1]
314932
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20 Flemington Road, Parkville VIC 3052
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Country [1]
314932
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Australia
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Funding source category [2]
315148
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Charities/Societies/Foundations
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Name [2]
315148
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Royal Australasian College of Physicians
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Address [2]
315148
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145 Macquarie St Sydney NSW 2000
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Country [2]
315148
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Australia
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Primary sponsor type
Hospital
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Name
Royal Women's Hospital
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Address
20 Flemington Road, Parkville VIC 3052
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Country
Australia
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Secondary sponsor category [1]
316938
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None
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Name [1]
316938
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Address [1]
316938
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Country [1]
316938
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
313923
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Royal Women's Hospital Human Research Ethics Committee
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Ethics committee address [1]
313923
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Royal Women's Hospital, 20 Flemington Road, Parkville VIC 3052
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Ethics committee country [1]
313923
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Australia
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Date submitted for ethics approval [1]
313923
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06/09/2023
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Approval date [1]
313923
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22/07/2024
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Ethics approval number [1]
313923
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Summary
Brief summary
Deferred (delayed) cord clamping for at least 60 seconds improves survival in very preterm infants. However, some infants require positive pressure ventilation to establish breathing in the first minutes after birth. For these infants, the cord is often clamped early, therefore they miss out on the benefits of deferred cord clamping. Furthermore, positive pressure ventilation may injure the fragile preterm lung. Nasal high-flow therapy (nasal high-flow) provides heated, humidified, blended air and oxygen via two small nasal prongs. We hypothesise that the provision of nasal high-flow prior to cord clamping may support and stimulate breathing, therefore allowing deferred cord clamping to occur and limiting positive pressure ventilation, improving outcomes. In this single-centre pilot feasibility trial, preterm infants born 26-31+6 weeks’ gestation will receive nasal high-flow during deferred cord clamping. We aim to study the feasibility of providing nasal high-flow prior to cord clamping in 20 infants with respect to 1) acceptability to clinicians and 2) practical application. We will also study clinical and physiological outcomes in infants receiving nasal high-flow during deferred cord clamping. These pilot data will help establish feasibility for a larger randomised controlled trial, and inform the primary outcome and sample size for this definitive trial.
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Trial website
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Trial related presentations / publications
N/A
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Public notes
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Contacts
Principal investigator
Name
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Dr Kate Hodgson
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Address
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Royal Women's Hospital, 20 Flemington Road, Parkville VIC 3052
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Country
129806
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Australia
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Phone
129806
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+61 407567360
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Fax
129806
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Email
129806
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[email protected]
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Contact person for public queries
Name
129807
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Kate Hodgson
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Address
129807
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Royal Women's Hospital, 20 Flemington Road, Parkville VIC 3052
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Country
129807
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Australia
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Phone
129807
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+61 407567360
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Fax
129807
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Email
129807
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[email protected]
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Contact person for scientific queries
Name
129808
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Kate Hodgson
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Address
129808
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Royal Women's Hospital, 20 Flemington Road, Parkville VIC 3052
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Country
129808
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Australia
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Phone
129808
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+61 407567360
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Fax
129808
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Email
129808
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Outcome data
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When will data be available (start and end dates)?
For 5 years after publication
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Available to whom?
Requests will be evaluated by the Trial Steering Committee
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Available for what types of analyses?
To be evaluated by Trial Steering Committee
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How or where can data be obtained?
By request emailed to PI- Kate Hodgson (
[email protected]
)
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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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