Antepartum Betamethasone Treatment for Prevention of Respiratory Distress in Infants Born by Elective Cesarean Section

Overview

This is a randomized, multicenter, double blind, placebo controlled trial of betamethasone versus a placebo given prior to the mothers at term and near term gestation (>34 and <40 weeks of gestation) who are scheduled to undergo a planned Cesarean section. The study design is to determine the efficacy and safety of betamethasone in the prevention of breathing problems commonly seen in this population.

In infants born by elective Cesarean section, it is hypothesized that antenatal betamethasone treatment will reduce the risk of neonatal intensive care unit (NICU) admission from 11% to 8% and/or oxygen therapy +/- positive pressure ventilation (PPV) for >30 minutes from 4.5% to 2.5%.

Full Title of Study: “Randomized Controlled Trial of Antepartum Betamethasone Treatment for Prevention of Respiratory Distress in Infants Born by Elective Cesarean Section”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Prevention
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: April 2007

Detailed Description

The purpose of this pilot study is to determine if antepartum betamethasone given to mothers undergoing elective cesarean section (ECS) delivery at term or near term gestation (>34 and < 40 weeks of gestation) is safe and feasible in reducing neonatal respiratory morbidity and the related admissions to neonatal intensive care units (NICU).

The data from this pilot study will be used to support a NIH application for a multicenter randomized trial to determine, if compared to placebo treatment, antenatal betamethasone initiated 2-7 days prior to an ECS results in decreased occurrence of respiratory morbidity and NICU admissions in the newborn.

The multicenter protocol was recently reviewed by the NICHD network for clinical trial. The reviewers were enthusiastic about the scientific merit and public health importance of the study but asked for a pilot study to determine feasibility before launching the national trial. Given the rise in the rate of CS deliveries, we project substantial health cost savings from this preventive strategy if it were found to be successful in reducing neonatal morbidity.

Interventions

  • Drug: Betamethasone
    • Betamethasone injection

Arms, Groups and Cohorts

  • Experimental: Betamethasone
    • Betamethasone injection
  • Placebo Comparator: Placebo
    • Placebo injection

Clinical Trial Outcome Measures

Primary Measures

  • The primary outcome to be studied is the need for NICU admission and/or oxygen therapy or PPV for >30 minutes.
    • Time Frame: 24 hours
    • Respiratory distress in the first 24 hours after birth.

Participating in This Clinical Trial

Inclusion Criteria

  • Pregnant women >/= 34 weeks gestation scheduled to undergo operative delivery within 48-72 hours after study enrollment

Exclusion Criteria

  • Known contraindication to the use of betamethasone in the mother
  • Known lethal or non-lethal congenital anomaly diagnosed antenatally
  • Spontaneous labor
  • Premature rupture of membranes

Gender Eligibility: Female

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Emory University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Lucky Jain, Principal Investigator – Emory University
  • Overall Official(s)
    • Lucky Jain, M.D., Principal Investigator, Emory University Department of Pediatrics, Division of Neonatology

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