Reducing bilirubin-induced neurological dysfunction in preterm infants: additional use of the Bilirubin:Albumin Ratio in the treatment of hyperbilirubinemia

ISRCTN ISRCTN74465643
DOI https://doi.org/10.1186/ISRCTN74465643
Secondary identifying numbers NTR935
Submission date
11/04/2007
Registration date
11/04/2007
Last edited
12/04/2021
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Nervous System Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Not provided at time of registration

Study website

Contact information

Ms Deirdre van Imhoff
Scientific

Beatrix Children's Hospital
University Medical Centre Groningen
Hanzeplein 1
P.O. Box 30001
Groningen
9700 RB
Netherlands

Phone +31 (0)50 361 4215
Email d.e.van.imhoff@bkk.umcg.nl

Study information

Study designRandomised active-controlled parallel-group single-blinded multicentre trial
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use the contact details below to request a patient information sheet
Scientific titleReducing bilirubin-induced neurological dysfunction in preterm infants: additional use of the Bilirubin:Albumin Ratio in the treatment of hyperbilirubinemia
Study acronymBARTrial
Study objectivesNeonatal jaundice due to unconjugated hyperbilirubinemia occurs in almost all preterm infants and is potentially neurotoxic. The current treatment modalities (phototherapy and exchange transfusion) are based on Total Serum Bilirubin (TSB) levels, but are not evidence based.

TSB is an unreliable predictor of Bilirubin Induced Neurological Dysfunction (BIND). Because low albumin levels appear to potentiate BIND, the Bilirubin:Albumin (B:A) ratio is an interesting additional factor to assess in the management of preterm infants with hyperbilirubinemia.
Ethics approval(s)The Medical Ethics Review Committee (METC) of the University Medical Center Groningen (UMCG) reviewed and approved the study protocol on the 9th January 2007 (ref: ABR nr: NL 14811.042.06).
Health condition(s) or problem(s) studiedHyperbilirubinemia, bilirubin induced neurological dysfunction
InterventionStudy group:
Hyperbilirubinemia is evaluated daily, in the first ten days of life using the B:A ratio together with TSB. Treatment guidelines (phototherapy and exchange transfusion limits) are based on B:A ratio and TSB (whichever comes first)

Control group:
Hyperbilirubinemia is evaluated daily, in the first ten days of life using TSB only (care as usual) versus only TSB. Treatment guidelines (phototherapy and exchange transfusion limits) are based on TSB only.
Intervention typeOther
Primary outcome measureBlinded assessment of the participants outcome is performed.

Primary outcome:
1. Neurodevelopmental outcome at the age of 18 to 24 months using standardised neurological examination will be measured from October 2008 till April 2010
2. Mental- and Psychomotor Developmental Index scores (MDI and PDI: Dutch version of Bayley scales of infant development II) will be measured from October 2008 till April 2010
Secondary outcome measuresSecondary outcomes:
1. Peak total serum bilirubin will be measured from April 2007 till January 2008
2. Duration of hyperbilirubinaemia will be measured from April 2007 till January 2008
3. Duration of phototherapy will be measured from April 2007 till January 2008
4. Number of exchange transfusions will be measured from April 2007 till January 2008

Other outcomes are complications of prematurity such as:
1. Mortality will be measured from April 2007 till the end of this study (April 2010)
2. Bronchopulmonary Dysplasia (BPD) will be measured from April 2007 till January 2008
3. Patent Ductus Arteriosus (PDA) will be measured from April 2007 till January 2008
4. Retinopathy of Prematurity (ROP) will be measured from April 2007 till January 2008
5. Necrotising Enterocolitis (NEC) will be measured from April 2007 till January 2008
6. Intraventricular Haemorrhage (IVH) etc., will be measured from April 2007 till January 2008

Other potential outcomes to be evaluated in parts of the study population are:
1. Maturation pattern of serial Auditory Brainstem Responses (ABR) in a part of the study populations that is treated in those Neonatal Intensive Care Units (NICUs) that are able to perform serial ABRs. This will be measured from April 2007 till January 2008
2. Free (unbound) unconjugated bilirubin will be measured in from January 2008 till October 2008
3. Lumirubin will be measured from April 2007 till January 2008
4. CFM (Cerebral Function Monitor) will be measured from April 2007 till January 2008
5. Movement score will be measured from April 2007 till January 2008
6. Transcutane bilirubin measurement will be measured from April 2007 till January 2008
Overall study start date01/04/2007
Completion date01/04/2010

Eligibility

Participant type(s)Patient
Age groupNeonate
SexBoth
Target number of participants614
Key inclusion criteria1. Preterm infants born at gestational age less than 32 weeks, either sex
2. Admittance in the first 24 hours of life to a neonatal intensive care unit care centre in the Netherlands
Key exclusion criteriaMajor congenital malformations, clinical syndromes and chromosomal abnormalities that affect neurodevelopmental outcome
Date of first enrolment01/04/2007
Date of final enrolment01/04/2010

Locations

Countries of recruitment

  • Netherlands

Study participating centre

Beatrix Children's Hospital
Groningen
9700 RB
Netherlands

Sponsor information

University Medical Centre Groningen (UMCG) (The Netherlands)
Hospital/treatment centre

Beatrix Children's Hospital
P.O. Box 30001
Groningen
9700 RB
Netherlands

Website http://www.umcg.nl/azg/nl/english/azg/
ROR logo "ROR" https://ror.org/03cv38k47

Funders

Funder type

Research organisation

The Netherlands Organisation for Health Research and Development (ZonMw) (The Netherlands)

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 01/09/2008 Yes No
Results article results 13/06/2014 Yes No
Results article hearing loss results 07/05/2013 12/04/2021 Yes No

Editorial Notes

12/04/2021: Publication reference added.