Treatment of Neonatal Encephalopathy With Oral Sildenafil Suspension to Repair Brain Injury Secondary to Birth Asphyxia

Trial statusRecruiting
Trial phasePhase 2
Trial typeInterventional
Biological sexAll
Age0-48
SponsorPia Wintermark

About this trial

Around the time of birth, some babies experience a condition called asphyxia, which means that their brain and other organs do not receive enough blood and/or oxygen to work properly. This life-threatening condition accounts for nearly 1 out of 4 deaths of all babies around the world, and often leads to severe brain damage, cerebral palsy, epilepsy, and trouble with learning and functioning in everyday life. At this time, no treatment is available to repair the brain damage caused by asphyxia. Excitingly, a drug called sildenafil (Viagra®) is already given safely to babies who suffer from increased blood pressure in their lungs' vessels. Recent studies using a laboratory model of asphyxia at birth suggest that sildenafil may also repair the brain damage caused by asphyxia. Similarly, recent small studies have shown that it is both feasible and safe to give sildenafil to human babies, who suffered from asphyxia at birth. These studies also highlight the first promising signs that sildenafil may improve how the brains of these babies work, which is consistent with the abovementioned laboratory studies.

On the basis of these previous researches, the investigators predict that sildenafil can repair the damage to a baby's brain. The investigators will test whether sildenafil can be safely given to a large group of human babies who suffer from asphyxia at birth, and will confirm whether sildenafil improves or not how their brains and hearts/lungs work.

This project will enable to determine whether sildenafil is a promising treatment for repairing brain damage in babies who suffer from asphyxia at birth. This project may also provide new solutions for these babies to improve their future life.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Gestational age ≥36weeks and birth weight ≥1800g;

Evidence of fetal distress, i.e., history of an acute perinatal event, cord pH ≤7.0 or base deficit

16 mEq/L;

Evidence of neonatal distress, such as an Apgar score ≤5 at 10 minutes, postnatal blood gas pH obtained within the first hour of life ≤ 7.0 or base deficit ≤ - 16 mEq/L, or a continued need for ventilation initiated at birth and continued for at least 10 minutes;

Disqualifiers

Neonates with complex congenital heart disease

Neonates with cerebral malformations

Neonates with genetic syndrome

Neonates with intraventricular and/or intraparenchymal hemorrhage on MRI performed on day 2 of life

Trial design

Design model

Parallel

Treatments tested in this trial

  • Sildenafil

    Drug

    Sildenafil per os twice a day for seven consecutive days (from day 2 of life to day 9 of life) if brain injury on day 2 of life (dose 1=2mg/kg/dose, dose 2=2.5mg/kg/dose, and doses 3-14=3mg/kg/dose)

  • Ora-Blend

    Drug

    Ora-Blend per os twice a day for seven consecutive days (from day 2 of life to day 9 of life) if brain injury on day 2 of life (dose 1=2mg/kg/dose, dose 2=2.5mg/kg/dose, and doses 3-14=3mg/kg/dose)

Treatment groups

60 Participants
are divided into 2 treatment groups
Group A: SildenafilActive comparator 1 intervention
Group B: Ora-BlendPlacebo comparator 1 intervention

Trial outcomes

Primary outcomes

1

Extent of brain injury

Primary outcome to explore efficacy (brain injury)

Time frame
Day 30 of life, compared to day 2 of life

Secondary outcomes

1

Serious adverse events

Close monitoring for adverse events such as death, hypotension, persistent pulmonary hypertension, altered renal or hepatic function, etc to assess the safety of sildenafil

Time frame
Day 1 to 10 of life

Other outcomes

1

Ejection fraction (EF) in % (reflecting left ventricular function) and tricuspid annular plane systolic excursion (TAPSE) in cm (reflecting right ventricular function)

Secondary outcome to explore efficacy (cardiopulmonary hemodynamics)

Time frame
Day 2 to 4 of life

Sponsors and contacts

Click on the lead sponsor to view all of their trials.

Pia Wintermark

Lead sponsor

McGill University Health Centre/Research Institute of the McGill University Health Centre

Sponsor institution