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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT02139800
Registration number
NCT02139800
Ethics application status
Date submitted
8/05/2014
Date registered
15/05/2014
Titles & IDs
Public title
Sustained Aeration of Infant Lungs Trial
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Scientific title
Sustained Aeration of Infant Lungs Trial
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Secondary ID [1]
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1U01HD072906-01A1
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Secondary ID [2]
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819208
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Universal Trial Number (UTN)
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Trial acronym
SAIL
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Preterm Birth
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Extreme Prematurity
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Condition category
Condition code
Reproductive Health and Childbirth
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Complications of newborn
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Reproductive Health and Childbirth
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Childbirth and postnatal care
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Reproductive Health and Childbirth
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Fetal medicine and complications of pregnancy
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Surgery - Sustained Inflation
Treatment: Surgery - Standard of Care
Active comparator: Control Arm-Standard of care - Control Arm-Respiratory support using Standard of Care positive-end expiratory pressure/continuous positive airway pressure (PEEP/CPAP) of 5-7 cm H2O compared to Sustained Inflation intervention
Experimental: Sustained Intervention - Administer delivery room respiratory support using a Sustained Inflation (SI) intervention and expiratory pressure/continuous positive airway pressure (PEEP/CPAP) of 5-7 cm H2O
Treatment: Surgery: Sustained Inflation
The first sustained inflation will use inflation pressure of 20 cm H20 for 15 seconds
Treatment: Surgery: Standard of Care
Newborn Resuscitation Program (NRP) Guidelines using a standard PEEP/CPAP of 5-7 cm H2O as compared to the Sustained Inflation intervention
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Intervention code [1]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Combined Outcome of Death or Bronchopulmonary Dysplasia
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Assessment method [1]
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To determine in infants born at 23-26 weeks gestational age requiring respiratory support at birth, which of two treatment strategies when compared, results in a lower rate of the combined endpoint of death or bronchopulmonary dysplasia.
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Timepoint [1]
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36 weeks
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Secondary outcome [1]
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Oxygen Profile Over First 24 Hours
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Assessment method [1]
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Oxygen profile over first 24 hours post delivery room using hourly FiO2 records
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Timepoint [1]
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First 24 hours post delivery
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Secondary outcome [2]
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Oxygen Profile With Highest FiO2 Level up to 48 Hours
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Assessment method [2]
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Highest FiO2 level recorded during the first 48 hours post DR
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Timepoint [2]
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48 hours of life
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Secondary outcome [3]
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Heart Rate in the Delivery Room (DR)
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Assessment method [3]
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Categorical variable with 3 levels: \<60, 60-100, \>100
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Timepoint [3]
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First 30 seconds of life in DR
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Secondary outcome [4]
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Detailed Status on Departure From the Delivery Room (DR)
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Assessment method [4]
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Type of respiratory support (CPAP, PPV) and Fraction of Inspired Oxygen (FiO2) on departure from DR
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Timepoint [4]
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Resuscitation time will vary - 1 to 30 minutes
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Secondary outcome [5]
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Use of Inotropes on Arrival in NICU
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Assessment method [5]
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Circulatory support post-delivery room
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Timepoint [5]
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First 48 hours of life
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Secondary outcome [6]
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Need for Intubation in Delivery Room
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Assessment method [6]
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Need for intubation in delivery room during the first 30 seconds to 24 hours of age
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Timepoint [6]
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First 30 seconds to 24 hours of life
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Secondary outcome [7]
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Pressure-volume Characteristics in the Delivery Room (DR)
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Assessment method [7]
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Pressure-volume characteristics in the Delivery room (DR) expected within 30 minutes
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Timepoint [7]
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Expected average 30 minutes
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Secondary outcome [8]
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Pneumothorax or New Chest Drains in the First 48 Hours of Life
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Assessment method [8]
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Chest x-ray reports showing pneumothorax or new chest drains in the first 48 hours of life
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Timepoint [8]
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First 48 hours of life
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Secondary outcome [9]
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Duration of Any Chest Drain In-situ Post-DR
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Assessment method [9]
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Duration of any chest drain in-situ post-DR during hospitalization - up to 36 weeks Post Menstrual Age (PMA)
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Timepoint [9]
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During hospitalization - up to 36 weeks Post Menstrual Age (PMA)
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Secondary outcome [10]
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Intraventricular Hemorrhage by All Grades
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Assessment method [10]
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Head ultrasound and/or MRI findings of intraventricular hemorrhage by all grades focusing on grades 3 and 4 by 48 hour and by day 10
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Timepoint [10]
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48 hours to 10 days
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Secondary outcome [11]
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Chest X-ray Between Days 7-10
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Assessment method [11]
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Chest x-ray between the first 7-10 days of life
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Timepoint [11]
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First 7-10 days of life
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Secondary outcome [12]
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Death or Need for Positive Pressure Ventilation
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Assessment method [12]
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Death or need for positive pressure ventilation during the first 7 days of life
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Timepoint [12]
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First 7 days of life
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Secondary outcome [13]
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Highest FiO2 and Area Under the FiO2 Curve for the First Week of Life
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Assessment method [13]
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Highest FiO2 and Area under the FiO2 curve during the first 7 days of life
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Timepoint [13]
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First 7 days of life
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Secondary outcome [14]
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Pneumothorax and Pulmonary Interstitial Emphysema (PIE)
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Assessment method [14]
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Pneumothorax and pulmonary interstitial emphysema (PIE) during the first 10 days of life
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Timepoint [14]
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First 10 days of life
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Secondary outcome [15]
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Survival to Discharge Home Without BPD, Retinopathy of Prematurity (Grades 3 & 4), or Significant Brain Abnormalities on Head Ultrasound
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Assessment method [15]
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Survival to discharge home without BPD, retinopathy of prematurity (grades 3 \& 4), or significant brain abnormalities on head ultrasound with an expected discharge between 36-40 weeks PMA
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Timepoint [15]
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Expected discharge between 36 - 40 weeks PMA
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Secondary outcome [16]
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Duration of Respiratory Support (Ventilation, CPAP, Supplemental Oxygen)
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Assessment method [16]
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Duration of respiratory support (ventilation, CPAP, supplemental oxygen) during hospitalization upto 36 weeks Post Menstrual Age (PMA)
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Timepoint [16]
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During hospitalization - up to 36 weeks Post Menstrual Age (PMA)
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Secondary outcome [17]
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Death in Hospital
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Assessment method [17]
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Death in hospital during expected hospitalization of 23-40 weeks PMA
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Timepoint [17]
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During expected hospitalization 23 - 40 weeks PMA
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Secondary outcome [18]
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Retinopathy of Prematurity (ROP) Stage 3 or Greater Requiring Treatment
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Assessment method [18]
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Retinopathy of prematurity (ROP) stage 3 or greater requiring treatment at 36 weeks
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Timepoint [18]
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36 weeks
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Secondary outcome [19]
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Use of Postnatal Steroids for Treatment of BPD
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Assessment method [19]
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Use of postnatal steroids for treatment of BPD during hospitalization up to 36 weeks Post Menstrual Age (PMA)
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Timepoint [19]
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During hospitalization - up to 36 weeks Post Menstrual Age (PMA)
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Secondary outcome [20]
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Length of Hospital Stay
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Assessment method [20]
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Length of hospital stay with average discharge between 36-40 weeks PMA
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Timepoint [20]
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Average discharge between 36 - 40 weeks PMA
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Secondary outcome [21]
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Neurodevelopmental and Respiratory Outcome at 22-26 Months Corrected Gestational Age
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Assessment method [21]
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Neurodevelopmental and respiratory outcome at 22-26 months corrected gestational age
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Timepoint [21]
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22-26 months corrected gestational age
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Eligibility
Key inclusion criteria
* Gestational age (GA) at least 23 weeks but less than 27 completed weeks by best obstetrical estimate
* Requiring resuscitation/respiratory intervention at birth -"apneic, labored breathing, gasping" (as defined in NRP 2011 AAP 6th Edition p.45)
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Minimum age
23
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Maximum age
26
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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
* Considered non-viable by the attending neonatologist
* Refusal of antenatal informed consent
* Known major anomalies, pulmonary hypoplasia
* Mothers who are unable to consent for their medical care and who do not have a surrogate guardian will not be approached for consent
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Study design
Purpose of the study
Treatment
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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)
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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
Parallel
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
27/08/2014
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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
23/03/2020
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Sample size
Target
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Accrual to date
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Final
460
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
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Mater Mother's Hospital - Brisbane
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Recruitment hospital [2]
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Royal Women's Hospital - Melbourne
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Recruitment postcode(s) [1]
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QLD 4101 - Brisbane
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Recruitment postcode(s) [2]
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- Melbourne
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Recruitment outside Australia
Country [1]
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United States of America
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State/province [1]
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California
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Country [2]
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United States of America
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State/province [2]
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Delaware
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Country [3]
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United States of America
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State/province [3]
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Michigan
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Country [4]
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United States of America
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State/province [4]
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North Carolina
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Country [5]
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United States of America
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State/province [5]
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Pennsylvania
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Country [6]
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United States of America
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State/province [6]
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Rhode Island
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Country [7]
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Austria
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State/province [7]
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Feldkirch
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Country [8]
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Canada
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State/province [8]
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Edmonton
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Country [9]
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Germany
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State/province [9]
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Freiburg
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Country [10]
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Germany
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State/province [10]
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Ulm
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Country [11]
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Italy
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State/province [11]
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Milan
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Country [12]
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Korea, Republic of
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State/province [12]
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Seoul
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Country [13]
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Netherlands
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State/province [13]
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Amsterdam
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Country [14]
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Netherlands
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State/province [14]
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Leiden
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Country [15]
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Singapore
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State/province [15]
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Singapore
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Funding & Sponsors
Primary sponsor type
Other
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Name
University of Pennsylvania
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Address
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Country
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Other collaborator category [1]
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Government body
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Name [1]
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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
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Summary
Brief summary
This study is a 2-arm randomized, controlled, multi-center clinical trial to determine which of two strategies at birth are best to optimally aerate the lung of preterm infants. Specifically we will determine in 600 infants of 23-26 weeks gestational age (GA) requiring respiratory support at birth which of two lung opening strategies - either a standard PEEP/CPAP of 5-7 cm H2O in the delivery room (DR), as compared to early lung recruitment using Sustained Inflation (SI) in the DR, will result in a lower rate of the combined endpoint of death or bronchopulmonary dysplasia (BPD) at 36 weeks gestational age. Hypotheses: 1. Early lung recruitment with SI superimposed upon standard PEEP/CPAP in the DR will reduce the need for mechanical ventilation in the first seven days of life, and reduce need for surfactant use; and 2. A policy of DR SI on standard PEEP/CPAP recruitment will confer better outcomes at 36 weeks post-menstrual age (PMA) than standard PEEP/CPAP
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Trial website
https://clinicaltrials.gov/study/NCT02139800
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Trial related presentations / publications
Foglia EE, Kirpalani H, Ratcliffe SJ, Davis PG, Thio M, Hummler H, Lista G, Cavigioli F, Schmolzer GM, Keszler M, Te Pas AB. Sustained Inflation Versus Intermittent Positive Pressure Ventilation for Preterm Infants at Birth: Respiratory Function and Vital Sign Measurements. J Pediatr. 2021 Dec;239:150-154.e1. doi: 10.1016/j.jpeds.2021.08.038. Epub 2021 Aug 25. Kirpalani H, Keszler M, Foglia EE, Davis P, Ratcliffe S. Considering the Validity of the SAIL Trial-A Navel Gazers Guide to the SAIL Trial. Front Pediatr. 2019 Nov 27;7:495. doi: 10.3389/fped.2019.00495. eCollection 2019. Kirpalani H, Ratcliffe SJ, Keszler M, Davis PG, Foglia EE, Te Pas A, Fernando M, Chaudhary A, Localio R, van Kaam AH, Onland W, Owen LS, Schmolzer GM, Katheria A, Hummler H, Lista G, Abbasi S, Klotz D, Simma B, Nadkarni V, Poulain FR, Donn SM, Kim HS, Park WS, Cadet C, Kong JY, Smith A, Guillen U, Liley HG, Hopper AO, Tamura M; SAIL Site Investigators. Effect of Sustained Inflations vs Intermittent Positive Pressure Ventilation on Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants: The SAIL Randomized Clinical Trial. JAMA. 2019 Mar 26;321(12):1165-1175. doi: 10.1001/jama.2019.1660. Foglia EE, Te Pas AB. Sustained Lung Inflation: Physiology and Practice. Clin Perinatol. 2016 Dec;43(4):633-646. doi: 10.1016/j.clp.2016.07.002. Foglia EE, Owen LS, Thio M, Ratcliffe SJ, Lista G, Te Pas A, Hummler H, Nadkarni V, Ades A, Posencheg M, Keszler M, Davis P, Kirpalani H. Sustained Aeration of Infant Lungs (SAIL) trial: study protocol for a randomized controlled trial. Trials. 2015 Mar 15;16:95. doi: 10.1186/s13063-015-0601-9.
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Public notes
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Contacts
Principal investigator
Name
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Haresh Kirpalani, BM, MSc
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Address
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Children's Hospital of Philadelphia
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Address
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Country
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Phone
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Fax
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Email
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Undecided
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No/undecided IPD sharing reason/comment
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What supporting documents are/will be available?
No Supporting Document Provided
Type
Other Details
Attachment
Study protocol
https://cdn.clinicaltrials.gov/large-docs/00/NCT02139800/Prot_000.pdf
Statistical analysis plan
https://cdn.clinicaltrials.gov/large-docs/00/NCT02139800/SAP_001.pdf
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results are available at
https://clinicaltrials.gov/study/NCT02139800