Role of Montelukast in Modulation of Response to Sepsis in Preterm Infants
キーワード
概要
説明
Since inflammatory mediators play a crucial role in the pathophysiology of sepsis so anti-inflammatory treatment, Montelukast, could be a beneficial therapy. The investigators will conduct this pilot, open-labeled, randomized controlled intervention trial on 40 newborns admitted to NICU. The study will include late preterm infants with gestational age (34 weeks to less than 37 weeks) with clinical evidence of sepsis. The study included an intervention group (n=20) that will receive oral Montelukast for 10 days with antibiotics in addition to the conventional antibiotic therapy regimen according to NICU policy while the control group (n=20) will receive antibiotics in addition to the conventional antibiotic therapy regimen according to NICU policy. After obtaining a fully informed written consent from the neonate's parents or guardians, patients will be recruited and group allocated in the study by random pick up of closed opaque sealed envelopes. Patients will be observed clinically and by laboratory investigations along the duration of hospital admission through a structured collection sheet. Demographic data, cause of admission, clinical data (vital signs, activity, feeding intolerance, respiratory symptoms, duration of oxygen support, use of inotropes) will be recorded. Blood sampling will be performed twice in both groups, on admission, and 10 days after treatment. The following investigations will be carried out: complete blood picture, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF alpha), blood culture, Serum creatinine, Liver enzymes, and INR. A lumbar puncture will be performed when the treating physicians suspect meningitis. Patients in both groups will be observed along the duration of hospital admission to detect the outcome.
Patients in the intervention group, receiving Montelukast sodium (Singulair), will be given at a dose according to body weight (1.5 kg to 2 kg, will be given 1.5 mg; greater than 2 kg, will be given 2 mg). This dose was previously prescribed and given to preterm neonates suffered from bronchopulmonary dysplasia by Kim et al. (2015). Four mg of the drug will be dissolved in four ml milk and 1.5 - 2 ml milk only will be given once daily at 9 pm via an orogastric tube or by oral administration for 10 days. Along the period of NICU admission, patients receiving Montelukast will be closely observed for the development of any of its side effects that including "diarrhea, colic, vomiting, fever or cough" (Adelsberg et al., 2005).
日付
最終確認済み: | 06/30/2020 |
最初に提出された: | 07/12/2020 |
提出された推定登録数: | 07/14/2020 |
最初の投稿: | 07/15/2020 |
最終更新が送信されました: | 07/23/2020 |
最終更新日: | 07/26/2020 |
実際の研究開始日: | 07/23/2020 |
一次完了予定日: | 12/31/2020 |
研究完了予定日: | 01/31/2021 |
状態または病気
介入/治療
Drug: Intervention group
段階
アームグループ
腕 | 介入/治療 |
---|---|
Experimental: Intervention group The intervention group will receive Montelukast Sodium for 10 days in addition to the conventional antibiotic therapy regimen and other supportive measures according to the policy of neonatal units and patients' needs. Montelukast sodium will be given at a dose according to body weight (1.5 kg to 2 kg, will be given 1.5 mg; greater than 2 kg, 2 mg will be given) this dose was calculated according to ( Kim et al. (2015). Four mg of the drug will be dissolved in four ml milk and 1.5 - 2 ml milk only will be given once daily at 9 pm via an orogastric tube or by oral administration for 10 days and patients of this group will be closely observed for development of Montelukast side effects as "diarrhea, colic, vomiting, fever and cough" (Adelsberg et al. 2005). | Drug: Intervention group Montelukast sodium (Singulair) will be given at a dose according to body weight. Four mg of the drug will be dissolved in four ml milk and the dose will be given once daily at 9 pm for 10 days. |
No Intervention: Control group The control group will receive antibiotics and other supportive measures according to the policy of neonatal units and patients' needs. |
適格基準
研究に適格な性別 | All |
健康なボランティアを受け入れる | はい |
基準 | Inclusion Criteria: - 1. Infants with gestational age from 34 weeks to less than 37 weeks (late preterm) and weighted more than 1.5 Kg with clinical evidence of neonatal sepsis (Wynn 2016). Exclusion Criteria: - 1. Infants presented initially with septic shock, multi-organ dysfunction syndrome (MODS), disseminated intravascular coagulopathy. 2. Infants with major congenital malformations 3. Infants with chromosomal aberrations 4. Postoperative patients. |
結果
主な結果の測定
1. Change in serum tumor necrosis factor (TNF) Alpha level [Measured twice: on admission and 10 days after receiving therapy]
二次的な結果の測定
1. The duration of NICU admission [Counting the total duration of NICU admission]
2. Change in serum C-reactive protein (CRP) level [Measured twice: on admission and 10 days after receiving therapy]
3. Patients improvement, deterioration (Clinically and laboratory) or death [determined at 10 days after receiving therapy]
4. use of positive pressure ventilation and its duration [determined at 10 days after receiving therapy]
5. Duration of use of inotropes [determined at 10 days after receiving therapy]