Cool Prime Comparative Effectiveness Study for Mild HIE

Study Overview
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Brief Summary
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To determine effectiveness of therapy to improve neurodevelopmental outcomes in infants with mild HIE. To determine the adverse effects of Therapeutic Hypothermia (TH) in mild HIE on the neonate and his/her family. Determine heterogeneity of the treatment effect across key subgroups obtained in the first 6 hours after birth prior to the decision to initiate therapy.

Detailed Description
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This study leverages practice variation within and across 15 participating sites to compare the effectiveness of TH versus normothermia for mild HIE on neurodevelopmental outcomes at 2 years of age.After standardizing all aspects of clinical care for mild HIE (except for TH vs. normothermia)we will enroll 460 infants with mild HIE into the longitudinal, observational comparative effectiveness study.The central aim of the comparative longitudinal cohort of mild HIE is (1) to compare the effectiveness of hypothermia to normothermia on neurodevelopmental outcomes at 2 years, (2) determine the adverse effects of TH on the infant and his/her family; and (3) determine the heterogeneity of treatment effects (moderating effect) across mild HIE subgroups as determined by physiological biomarkers obtained during the 6 hours window to initiate hypothermia. The decision to apply TH or normothermia will be entirely determined by practice parameters at each site.

Official Title
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COOLPRIME: Comparative Effectiveness for Cooling Prospectively Infants With Mild Encephalopathy

Conditions
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Mild Hypoxic Ischemic Encephalopathy of Newborn

Intervention / Treatment
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* Procedure: Normothermia
* Procedure: Whole body therapeutic hypothermia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Infants must meet all 3 inclusion criteria Neonates born at ≥ 35 0/7 weeks Mild Encephalopathy on neonatal neurologic exam within 6 hours after birth: defined as presence of at least 2 signs of mild, moderate, or severe encephalopathy with no more than 2 signs in the moderate or severe category. Perinatal Acidosis based on at least one of the following (A or B): pH ≤ 7.00 in any cord or first infant gas (arterial, venous, or capillary) within ≤ 60 min OR base deficit ≥ 16 in any cord or first infant gas (arterial, venous or capillary) within ≤ 60 min If pH is between 7.01 and 7.15, OR base deficit is between 10 and 15.9 mmol/liter, OR blood gas is not available, an acute perinatal event is an additional criteria required (see below definition) An acute perinatal event is defined by at least one of the following: Apgar score at 10 min ≤ 5 Continued need for resuscitation at 10 min (chest compressions, bag mask ventilation, or positive pressure ventilation) Uterine rupture, placental abruption, cord accident (prolapse, rupture, knot or tight nuchal cord) maternal trauma, maternal hemorrhage, or cardiorespiratory arrest fetal exsanguination from either vasa previa or feto-maternal hemorrhage, shoulder dystocia Any evidence suggestive of acute perinatal event. Infants are still eligible for enrollment in the COOLPRIME study if the cord or infant's first blood gas (arterial, venous, or capillary) is obtained >60 minutes of life. Exclusion Criteria: Gestational age at birth < 35 0/7 weeks Birth weight < 1800gm Head circumference <30cm Congenital or chromosomal anomaly associated with abnormal neurodevelopment or death Moderate or Severe HIE of 3 or more moderate or severe abnormalities on COOLPRIME Sarnat exam within 6 hours of life Any seizures within first six hours of life Redirection of care is being considered

Ages Eligible for Study
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Minimum Age: 35 Weeks

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mild HIE<br>Mild HIE identified in the first 6 hours of life according to the published PRIME study definition: newborn with evidence of encephalopathy (using the validated Sarnat Exam) NOT meeting prior cooling trials criteria. | Procedure: Normothermia<br>* Usual care for first 72 hours for neonates with mild encephalopathy maintaining core temperature (36.5°C ± 1 C).<br>Procedure: Whole body therapeutic hypothermia<br>* Whole-body therapeutic hypothermia (33.5°C ± 0.5°C) for 72 hours began by 6 hours of age for neonates with mild encephalopathy per site standard of care practice.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effectiveness of normothermia in infants as measured by Composite Bayley IV score | Effectiveness of normothermia in infants is measured by Composite Bayley IV score scale, which is. an extensive formal developmental assessment tool for diagnosing developmental delays in early childhood. Possible scores range from 55- 120 where lower scores indicate worse outcome. | 22-26 months of age. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adverse events SAE | Safety will be measured by the presence or absence of a serious adverse event (SAE) at discharge. | Discharge (approximately 7 days) | 
| Parent-Infant stress and bonding as measured by MIBS | Parent-Infant stress and bonding is measured by Mother-to-infant bonding (MIBS) scale, which is a validated questionnaire with good psychometric properties that assesses the mother's feelings towards infant (bondedness) from birth to 4 months. Possible scores range from 0-3, where 0 indicates not at all and 3, very much. | 3-4 months | 
| Parent-Infant stress and bonding as measured by IBQR | Parent-Infant stress and bonding is measured by Infant Behavior Questionnaire-Revised (IBQR) which measures differences in reactivity and regulation, and the structure of infant temperament and its relation to parental family functioning. Item scores were summed according to IBQR scoring rules to create scores on the 14 scales, with higher scores indicating greater levels of that temperament dimension. | 3-4 months | 
| Parent-Infant stress and bonding as measured by PSI | Parent-Infant stress and bonding is measured by Parenting Stress Index (PSI) which is an abbreviated version of the full-length test with 36 items in three domains (Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child) that combine to form a Total Stress scale, which helps identify families that are most in need of support services. In general, items are scored using the following 5-point scale: 1) SA (Strongly Agree), 2) A (Agree), 3) NS (Not Sure), 4) D (Disagree), 5) SD (Strongly Disagree). Responses to both the overall stress score and the three subscales are summed to generate representative scores, resulting the total stress score, perceptions of child behavioral problems, parenting distress, and parent-child dysfunctional interactions. | 3-4 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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mild HIE (Hypoxic Ischemic Encephalopathy), neonatal encephalopathy, brain ischemia, brain hypoxia