Feeding late and moderately preterm infants
| ISRCTN | ISRCTN15469594 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN15469594 |
| Protocol serial number | CPMS 37485 |
| Sponsor | Newcastle Hospitals NHS Foundation Trust |
| Funder | Danone Nutricia Research |
- Submission date
- 30/04/2018
- Registration date
- 14/05/2018
- Last edited
- 10/06/2024
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Neonatal Diseases
Plain English summary of protocol
Background and study aims
The rates of premature birth are increasing, with most occurring between 32 and 36 weeks gestation, called Late and Moderately PreTerm (LMPT) infants. These babies weigh 1.25-2.5kg at birth and have different nutritional requirements to those born full term. However, most nutrition studies have tended to focus on extremely premature infants (gestation < 32 weeks) and there are few data on growth in LMPT infants. There are strong data to show that breastfeeding results in better outcomes, but establishing breastfeeding in LMPT infants is challenging as many initially require support with nasogastric tubes. The duration of breastfeeding in the UK is shorter than other countries, and most LMPT infants grow more slowly. In later life LMPT infants are more likely to require additional educational support, and more likely to be obese as adults. These later life complications are associated with nutrition in early life.
Who can participate?
Healthy LMPT infants
What does the study involve?
Nutrition data is collected until 2 years of age, including breastfeeding, use of vitamin supplements, growth (weight, length etc), body composition (fat mass etc) and age at introduction of solid foods. If parents choose not to continue breastfeeding, infants are randomly allocated to either a standard milk formula or an intervention formula that only differs in the structure of the fat globule (the amount of fat is the same). The larger fat globule in the intervention formula is more similar to human milk. Differences in weight gain and fat mass are measured.
What are the possible benefits and risks of participating?
The study will provide parents with expert advice on optimal feeding practices based on up to date international consensus guidelines and will strongly support breastfeeding. The specific study design is chosen to be fully supportive of breastfeeding as preferred nutrition in early life, and will adhere to all aspects of the WHO code on the use of breastmilk substitutes as well as supporting the Baby Friendly Initiative (BFI, UNCIEF). It offers all participants regardless of maternal feeding choice the opportunity for close follow-up and advice from a paediatrician. There are no significant risks for those taking part as all formula used meet current international recommendations. However, there may be minimal disruption to family life as parents will need to return to the hospital for regular clinic visits until 2 years of age.
Where is the study run from?
Royal Victoria Infirmary (UK)
When is the study starting and how long is it expected to run for?
April 2018 to May 2023
Who is funding the study?
Danone Nutricia Research (Netherlands)
Who is the main contact?
Dr Nicholas Embleton
nicholas.embleton@ncl.ac.uk
Contact information
Scientific
Ward 35 Neonatal Unit
Royal Victoria Infirmary
Newcastle upon Tyne
NE1 4LP
United Kingdom
| 0000-0003-3750-5566 | |
| Phone | +44 (0)191 2825034 |
| nicholas.embleton@ncl.ac.uk |
Study information
| Primary study design | Interventional |
|---|---|
| Study design | Randomized; Both; Design type: Treatment, Prevention, Dietary, Cohort study |
| Secondary study design | Randomised controlled trial |
| Study type | Participant information sheet |
| Scientific title | Feeding Late and Moderately Preterm Infants Nutrition and Growth Outcomes (FLAMINGO) |
| Study acronym | FLAMINGO |
| Study objectives | The rates of premature birth are increasing, with most occurring between 32 and 36 weeks gestation, so-called Late and Moderately PreTerm (LMPT) infants. These babies weigh 1.25-2.5kg at birth and have different nutritional requirements to those born full term. However, most nutrition studies have tended to focus on extremely premature infants (gestation < 32 weeks) and there are few data on growth in LMPT infants. There are strong data to show that breast-feeding results in better outcomes, but establishing breast-feeding in LMPT infants is challenging as many initially require support with nasogastric tubes. The duration of breast-feeding in the UK is shorter than other countries, and most LMPT infants grow more slowly. In later life LMPT infants are more likely to require additional educational support, and more likely to be obese as adults. These later life complications are associated with nutrition in early life, but there are few longitudinal studies. The FLAMINGO study (Feeding Late And Moderately preterm Infants Nutrition and Growth Outcomes) will collect nutrition data in LMPT infants until 2 years age, including breastfeeding, use of vitamin supplements, growth (weight, length etc.), body composition (fat mass etc.) and age at introduction of solid foods. The study will provide parents with expert advice on optimal feeding practices based on up to date international consensus guidelines and will strongly support breastfeeding. If parents choose not to continue breast-feeding, infants will be eligible to join a randomised trial. In this, a standard milk formula will be compared to an intervention formula that only differs in the structure of the fat globule (the amount of fat is the same). The larger fat globule in the intervention formula is more similar to human milk. Differences in weight gain and fat mass will be determined. |
| Ethics approval(s) | North East - York Research Ethics Committee, 11/04/2018, ref: 18/NE/0040 |
| Health condition(s) or problem(s) studied | Late and moderately preterm infants |
| Intervention | Please note that infants are first recruited to an observational cohort. From within this cohort infants who are eligible will be enrolled to an RCT. Outcomes are the same for both groups. Infants will be enrolled and randomised using an online randomisation programme https://www.sealedenvelope.com. Infants are assigned to a product code (A, B, C or D) using a minimisation process (with a 30% chance of simple random allocation) and will use two stratification factors. All members of the research team are blinded to treatment allocation. Stratification is applied for: 1. Multiple births (single vs multiple birth) 2. Gestational age (32-33 vs 34-36 weeks) In case of multiple births, the first eligible sibling is randomised according to the stratification factors above and if applicable, the other sibling(s) will be automatically provided the same treatment code. Infants will be allocated of two study formula milks (control and intervention) which will be fed on demand until 6 months corrected age (total duration 6 – 7 months). Infants will be reviewed by telephone and at pre-planned clinic visits. After 6 months corrected age the study intervention will stop and infants will be advised on feeding methods according to standard guidelines. Infants will be followed in clinic until 2 years corrected age. The two milk formula meet international recommendations for nutrient intakes in infancy and contain similar amounts of macro- and micro-nutrients. They differ only in the structure of the lipid droplet which is larger in the intervention formula. |
| Intervention type | Other |
| Primary outcome measure(s) |
Daily weight gain from randomisation until 3 months corrected age. Weight measured using standard weighing scales at baseline, discharge, term equivalent age (TEA), 3,6,12 and 24 months corrected age |
| Key secondary outcome measure(s) |
1. Growth (weight, length and head circumference) from term equivalent age (TEA) until 3 months. Length and head circumference are measured using standard linear length boards and head circumference using non-stretchable tape measures at term and 3 months corrected age |
| Completion date | 21/05/2023 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | All |
| Target sample size at registration | 250 |
| Total final enrolment | 182 |
| Key inclusion criteria | 1. Healthy moderate to late preterm infants (gestational age ≥ 32 and ≤ 36 6/7 weeks) 2. Age at inclusion ≤ term equivalent age 3. Birth weight between 1.25-2.5 kg 4. Infants who are predominantly formula fed (max. 1 breastfeeding per day) using a standard term infant formula 5. Written informed consent from parent(s) and/or legal guardian, aged ≥ 18 years, to be enrolled into a randomised trial |
| Key exclusion criteria | 1. Any gastrointestinal, congenital or other problem likely to affect growth and nutrition, or requiring use of specialised milk formula or other diet e.g. due to confirmed allergy; or where the attending medical team feel that trial participation is inappropriate for any other medical condition 2. Ongoing child protection procedures or maternal drug misuse requiring social services involvement 3. Family circumstances where follow-up not likely to be possible e.g. family travel abroad for prolonged periods, or where it appears likely that the family will be unable to comply with the necessary research visits 4. Participation in another interventional study that may potentially confound or interact with this study 5. Family unable to understand English |
| Date of first enrolment | 21/05/2018 |
| Date of final enrolment | 28/02/2020 |
Locations
Countries of recruitment
- United Kingdom
- England
Study participating centre
Newcastle Hospitals NHS Foundation Trust
Newcastle upon Tyne
NE1 4LP
United Kingdom
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Data sharing statement to be made available at a later date |
| IPD sharing plan | The data sharing plans for the current study are unknown and will be made available at a later date. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Results article | 01/10/2022 | 10/06/2024 | Yes | No | |
| Protocol article | 08/03/2021 | 26/03/2021 | Yes | No | |
| HRA research summary | 28/06/2023 | No | No | ||
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
Editorial Notes
10/06/2024: Publication reference added.
26/03/2021: Publication reference added.
24/04/2020: The following changes have been made:
1. The recruitment end date has been changed from 01/04/2022 to 28/02/2020.
2. The final enrolment number has been added.
22/03/2019: The condition was updated from "Specialty: Children, Primary sub-specialty: Neonatal; UKCRC code/ Disease: Reproductive Health and Childbirth/ Disorders related to length of gestation and fetal growth" to "Late and moderately preterm infants".
22/05/2018: The funder name was corrected.