Current Studies
NEOLEV3
A Phase IIb Dose Escalation Study of Levetiracetam in the Treatment of Neonatal Seizures
Recruitment Status: Recruiting
Brief Summary
The main purpose of this study is to determine the maximum safe tolerated dose of LEV in the treatment of neonatal seizures. Our hypothesis is that optimal dosing of Levetiracetam (LEV) to treat neonatal seizures is significantly greater than 60mg/kg. This study will be an open label dose-escalation, preliminary safety and efficacy study. There will be a randomized control treatment component. Infants recognized as having neonatal seizures or as being at risk of developing seizures will be recruited and started on continuous video EEG monitoring (CEEG). Eligibility will be confirmed and consent will be obtained. In the first 2 phases of the study, neurologists will identify neonates with mild-moderate seizure burden (less than 8 minutes cumulative seizure activity per hour), appropriate for study with LEV, and exclude patients with higher seizure burden where treatment with PHB is more appropriate. Phase 3 of the dose escalation will only proceed if additional efficacy of LEV has been demonstrated in phases 1 and 2. In Phase 3 we will recruit neonates with seizures of greater severity up to 30 minute seizure burden/hour. This will make the final results of study more generalizable.
If seizures are confirmed, enrolled subjects will receive 60mg/kg of LEV. Subjects whose seizures persist or recur 15 minutes after the first infusion is complete, subjects will then be randomized in the dose escalation study. Patients in the dose escalation study will be randomly assigned to receive either higher dose LEV or treatment with the control drug PHB in a 3:1 allocation ratio, stratified by site.
NCT05610085 | Full Study Description
Condition/Diseases Studied
Neonatal Seizure
Neonatal Encephalopathy
Hypoxic-Ischemic Encephalopathy
Seizure Newborn
Intervention/Treatment Groups
Drug: Levetiracetam Injection
Neonates will be treated with intravenous levetiracetam 60mg/kg for first line management of seizures, and if seizures persist will be randomized to receive higher dose Levetiracetam or standard of care phenobarbital
Drug: Phenobarbital Sodium Injection
Standard of care for neonatal seizures
Phase of Study
2b
A phase of research to describe clinical trials that gather preliminary data on whether a drug works in people who have a certain condition/disease (that is, the drug's effectiveness). Safety continues to be evaluated, and short-term adverse events are studied.
Eligibility
Ages Eligible for Study: up to 1 Month (Child)
Sexes Eligible for Study: All
Accepts Healthy Volunteers: No
Inclusion Criteria:
at risk for seizures or suspected to be having seizures;
all seizure etiologies except correctable metabolic abnormalities such as hypoglycemia and hypocalcemia;
Term neonates (corrected gestational age between 35 and 44 weeks, postnatal age less than 28 days);
weight > 2200g.
Exclusion Criteria:
Cumulative seizure burden of 8 minutes/ hour or more in phases 1 and 2, Cumulative seizure burden of 30 minutes/hour or more in phase 3;
Renal failure defined as anuria in the first 24 hours of life;
Subjects in whom death seems imminent;
Seizures caused by correctable metabolic abnormality, such as hypocalcaemia, hypoglycaemia.
Effects of Music Based Intervention (MBI) on Neurodevelopment and Pain Response in Preterm Infants
Brief Summary
Pilot prospective randomized, double blinded, controlled study to test effect of music based intervention (MBI) on pain response and neurodevelopment in preterm infants.
NCT04286269 | Full Project Description (ClinicalTrials.gov) | NIH Project Details (RePORTER)
Project Summary
In 2018, the World Health Organization reported 15 million (>1 in 10) preterm births with rising annual rates. 50% of preterm infants suffer from neurodevelopmental impairments, and all preterm infants experience high volumes of painful procedures as part of medical care. Preterm music intervention shows immediate physiologic improvements in heart rate and oxygen saturation, as well as improved physiologic responses to pain. What remains unknown is how music impacts preterm brain maturation, neurodevelopment, and pain responses in preterm infants.
We propose a R61 project to explore biological mechanisms of music based intervention (MBI) on preterm brain maturation and neurodevelopment using electroencephalography (EEG) and event related potentials (ERPs). EEG captures electrical potential oscillations of the brain which yields valuable information about brain function. Serial EEGs can track brain maturation in preterm infants. ERPs quantify electrical brain potentials changes time-locked with a stimulus. ERPs at 1 month corrected age test recognition memory function and cognitive processing and offers another objective measure to study the early effects of the MBI’s on neurodevelopment.
The R61 will also explore the behavioral processes underlying effects of MBI on pain using EEG and the premature infant pain profile (PIPP). In preterm infants, central EEG amplitudes change when time-locked to a painful stimulus and PIPP scores scale pain responses with painful procedures. Specific recorded lullabies with simple arpeggiated accompaniment will be played for 6 weeks in a small randomized, blinded, controlled study of 50 medically stable 30 week preterms. Exploratory R61 findings will be assessed by specific Go/NoGo milestones that provide insight into the effects of MBI on biological mechanisms underlying neurodevelopment and behavioral processes underlying pain.
By achieving one of the Go/NoGo milestones, the proposal progresses to the R33 proof of concept pilot clinical trial with an additional 100 randomized subjects that will assess two primary outcomes measures:
MBI effects on Late Neurodevelopment using Bayley’s III neurodevelopmental testing at 6 month corrected age, and
Cumulative effects of MBI on Pain Response using longitudinal comparisons of baseline PIPP scores and final PIPP scores after 4 weeks of MBI.
Secondary measures would explore more nuanced aspects of neurodevelopment:
MBI effects on brain maturation with expanded analyses of EEG-sleep components;
repeat ERP analysis at 6 months corrected age with expanded memory and cognitive testing (additional mismatch negativity paradigms); and pain response:
MBI effects on pain related EEG responses with comparative analyses of central EEG amplitude changes to the frontal, parietal, temporal, and occipital lobes.
Public Health Relevance Statement
This project addresses the following public health concerns:
high rates of neurodevelopmental impairments from preterm birth and
detrimental neurodevelopmental sequelae as a result of current preterm pain management regimens.
We will initiate a two phased pilot clinical trial (randomized, double blinded, controlled) to support mechanistic research on the effects of music based intervention on neurodevelopment and pain response in preterm infants, with the second phase, as a proof of concept clinical trial evaluating the effects of music based intervention on late neurodevelopment and the cumulative effects of music on pain response.
The public health relevance of this study is to provide groundbreaking results on effects of music based intervention in preterm infant health to inform future strategies on music research, given that music intervention is low risk, minimally invasive with a high potential health impact.
Condition/Diseases Studied
Preterm birth
Pain
Intervention/Treatment Groups
Music Based Intervention
Participants assigned to MBI will receive a total of 1.5 hours of music intervention 5-6 sessions per week. Music will be alternating: 30 minutes on and 30 minutes off and will be played when the subject is awake to cue pacification and initiate the sleep process. Music will be delivered through headphones using an MP3 player.
Placebo/Sham Treatment
Participants assigned to the control group will have the same treatment as the MBI group, but with no sound played through the headphones.
Eligibility
Ages Eligible for Study: 28-32 Weeks (Child)
Sexes Eligible for Study: All
Accepts Healthy Volunteers: Yes
Inclusion Criteria:
Preterm infant born at 28-32 weeks
Medically stable
Exclusion Criteria:
Treatment for major organ system disease
Significant neurological disorder including, but not limited to, abnormal neurological examination, neonatal abstinence syndrome, intraventricular hemorrhage, seizures, meningitis, or congenital brain malfunction
Scalp lesions affecting EEG placement