Pharmacogenetics to avoid loss of hearing
| ISRCTN | ISRCTN13704894 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN13704894 |
| IRAS number | 253102 |
| Secondary identifying numbers | B00321, IRAS 253102 |
- Submission date
- 18/04/2019
- Registration date
- 25/04/2019
- Last edited
- 06/05/2025
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Neonatal Diseases
Plain English Summary
Background and study aims
Gentamicin is an antibiotic that is routinely used to treat or protect against infection in over 95% of babies admitted to Neonatal Intensive Care Units (NICUs). Some children have a genetic change (variant) that predisposes to severe hearing loss or total deafness after a single dose of gentamicin. About 1 in 500 people have this variant. Groups with a higher risk of repeated chest infections throughout their lives (i.e. people with cystic fibrosis) are routinely tested for this variant using a technique known as pyrosequencing. This current test takes at least three days to return a clinically relevant result. Newborn babies with suspected sepsis should be treated within the first hour of suspicion. The current genetic test is therefore unsuitable in this situation. The researchers have developed a point-of-care test (PoCT) to detect this genetic variant via a buccal (mouth) swab, delivering a reliable result in less than 40 minutes. This study aims to trial this new genetic testing approach in two large newborn intensive care units (NICUs). The aim is to assess the performance of this device in providing an accurate result, in a time that will indicate if the child can or cannot be treated with gentamicin (a safe alternative can be used), and therefore avoid the risk of deafness.
Who can participate?
Babies admitted to the NICU or requiring a screen for infection within 72 hours of birth
What does the study involve?
All participating babies are tested for the genetic variant before antibiotic treatment. There is no follow up as part of the study.
What are the possible benefits and risks of participating?
Babies included in this study will benefit from a rapid, non-invasive genetic test which will allow personalised antibiotic prescribing to avoid hearing loss in at-risk individuals. If successful, the use of this technology across the UK could avoid permanent, severe hearing loss in about 180 babies every year.
Where is the study run from?
1. Manchester University NHS Foundation Trust (UK)
2. Liverpool Women's NHS Foundation Trust (UK)
When is the study starting and how long is it expected to run for?
June 2018 to November 2020
Who is funding the study?
National Institute for Health Research (UK)
Who is the main contact?
Dr Rachel Mahood
rachel.mahood@mft.nhs.uk
Contact information
Public
Manchester Centre for Genomic Medicine
6th Floor, St Mary’s Hospital
Oxford Road
Manchester
M13 9WL
United Kingdom
| Phone | +44 (0)1617019139 |
|---|---|
| rachel.mahood@mft.nhs.uk |
Scientific
Manchester Centre for Genomic Medicine
6th Floor, St Mary’s Hospital
Oxford Road
Manchester
M13 9WL
United Kingdom
| Phone | +44 (0)1617019139 |
|---|---|
| william.newman@manchester.ac.uk |
Study information
| Study design | Multi-centre clinical feasibility study |
|---|---|
| Primary study design | Observational |
| Secondary study design | Feasibility study |
| Study setting(s) | Hospital |
| Study type | Screening |
| Participant information sheet | Not available in a web format, please use contact details to request a participant information sheet. |
| Scientific title | Pharmacogenetics to avoid loss of hearing (clinical implementation study) |
| Study acronym | PALOH |
| Study hypothesis | A clinical implementation study to critically assess the use of a novel point-of-care pharmacogenetic testing device to detect neonates at risk of aminoglycoside-induced hearing loss secondary to the genetic variant m.1555A>G. The primary objective is to assess the performance of the device and any barriers to implementation. |
| Ethics approval(s) | Current ethics approval as of 04/11/2019: Approved 22/08/2019, North West - Liverpool East Research Ethics Committee (Barlow House, 3rd Floor, 4 Minshull Street, Manchester, M1 3DZ; nrescommittee.northwest-liverpooleast@nhs.net), ref: 19/NW/0400 Previous ethics approval: NHS Health Research Authority Research Ethics Service - approval pending |
| Condition | Neonatal intensive care |
| Intervention | This study involves the use of a novel genetic test to detect the m.1555A>G variant which is associated with aminoglycoside-induced hearing loss. All neonates admitted to the participating neonatal intensive care units during the study period will be tested for this variant prior to antibiotic treatment, to allow personalised prescribing and avoiding permanent, irreversible hearing loss in at-risk individuals. The intervention is a one-off genetic test at the point of admission to neonatal intensive care. The objective is to look at feasibility of incorporating the test into the current clinical pathway rather than the efficacy of the intervention, which is already known. There is no follow up period as part of the study. |
| Intervention type | Genetic |
| Primary outcome measure | The total number of neonates who are successfully tested for the m. 1555A>G genetic variant out of all babies given antibiotics on admission or assessment in the two participating sites, measured using patient medical notes and real-time data collection at the end of the study period |
| Secondary outcome measures | 1. The total number of neonates identified with the m. 1555A>G genetic variant, measured using retrospective data collection from device at the end of the study period 2. Average time from admission to antibiotic administration for all participants tested throughout the 6-month study period, measured using patient medical notes and real-time data collection 3. Total number of incidences where time to antibiotic administration exceeds the 60-minute target and the reasons for these, measured using patient medical notes and real-time data collection 4. Total number of assay failures within the 6-month testing period and the reasons for these, measured using retrospective data collection from device 5. Resource impact: additional staff time required to secure samples and undertake testing, measured using staff observations 6. Total number of babies where testing was not undertaken during the 6-month testing period and the reasons for these, measured using patient medical notes and real-time data collection 7. The overall correlation of the point-of-care testing result with the current in-house reference assay (pyrosequencing) |
| Overall study start date | 01/06/2018 |
| Overall study end date | 30/11/2020 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Neonate |
| Sex | Both |
| Target number of participants | 900 |
| Total final enrolment | 751 |
| Participant inclusion criteria | 1. All babies admitted to NICU at Manchester University NHS Foundation Trust (MFT, Oxford Road Campus) and Liverpool Women's NHS Foundation Trust (LWH), for 6 months commencing from the trial start date 2. Babies requiring a screen for infection within 72 hours of birth (an infection screen for suspected early onset neonatal infection) at LWH who are not formally admitted to the neonatal unit, for 6 months commencing from the trial start date |
| Participant exclusion criteria | Neonates requiring antibiotics immediately with already established IV access |
| Recruitment start date | 01/01/2020 |
| Recruitment end date | 30/11/2020 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
Manchester
M13 9WL
United Kingdom
Crown Street
Liverpool
L8 7SS
United Kingdom
Sponsor information
Hospital/treatment centre
Oxford Road
Manchester
M13 9WL
England
United Kingdom
| Phone | +44 (0)161 276 4125 |
|---|---|
| lynne.webster@mft.nhs.uk | |
| Website | https://mft.nhs.uk/ |
"ROR" |
https://ror.org/00he80998 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 31/12/2021 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request, Published as a supplement to the results publication |
| Publication and dissemination plan | The researchers intend to publish the protocol. Outcomes relating to the project will be published in peer-reviewed medical journals and presented at regional, national and international meetings for paediatrics, neonates, genetics and audiology. The researchers will work with Bliss (Charity for the care of neonates) and the National Deaf Children’s Society to disseminate the project outcomes through their websites and other media. Plans for an implementation strategy, if outcomes are positive, will be developed in consultation with NIHR. |
| IPD sharing plan | The datasets generated during and/or analysed during the current study are/will be available upon request from Prof. William Newman (William.newman@manchester.ac.uk). Data pertaining to clinical timings associated with testing (e.g. time of NICU admission, time of swab, time of antibiotic administration etc) can be provided to researchers upon request to CI Prof Newman. Data will be anonymised. Consent for this data collection was presumed under an “opt-out” consent model. The datasets generated and/or analysed during the current study will be included in the subsequent results publication. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol article | 16/06/2021 | 18/06/2021 | Yes | No | |
| HRA research summary | 28/06/2023 | No | No | ||
| Results article | Qualitative study | 07/01/2024 | 08/01/2024 | Yes | No |
| Other publications | 23/07/2020 | 06/05/2025 | Yes | No | |
| Other publications | 22/01/2021 | 06/05/2025 | Yes | No | |
| Results article | 21/03/2022 | 06/05/2025 | Yes | No |
Editorial Notes
06/05/2025: Publication references and total final enrolment added.
08/01/2024: Publication reference added.
08/06/2022: Publication reference added.
02/11/2021: The intention to publish date was changed from 01/05/2021 to 31/12/2021. Individual participant data (IPD) sharing statement added.
18/06/2021: Publication reference added.
02/06/2020: The following changes were made to the trial record:
1. The recruitment end date was changed from 31/05/2020 to 30/11/2020.
2. A study contact was added.
04/11/2019: The following changes have been made:
1. The ethics approval has been updated.
2. The IRAS number has been added.
3. The recruitment start date has been changed from 01/11/2019 to 01/01/2020.
23/04/2019: Trial's existence confirmed by the NIHR.
