Hydrogen In Neonatal Encephalopathy (HIE) Trial

Overview

Despite advances in neonatal care, moderate-to-severe acute perinatal HIE in late preterm and term infants remains a cause of mortality, neurological injury, and long-term neurodevelopmental disability. The current standard of care includes therapeutic hypothermia for 72 hours, but 40-50% of infants will die or suffer significant neurodevelopmental impairment. It has been shown that administration of hydrogen gas (H2) significantly diminishes ischemic injury in swine, and that H2 administration at the dose and duration proposed herein is well-tolerated in healthy adults. The purpose of this project is to test the feasibility and safety of H2 administration as an adjunct to therapeutic hypothermia in infants with HIE. Under exemption from informed consent, infants with severe, acute brain injury at birth will be randomized to standard therapy with or without the administration of 2% hydrogen in gases administered via the ventilator, non-invasive ventilation, or nasal cannula for 72 hours.

Interventions

• Drug Hydrogen Gas (H2)
  Patients randomized to the hydrogen group will receive 2% hydrogen gas incorporated into all gas mixtures for 72 hours. The hydrogen gas will be administered via the ventilator, non-invasive ventilation, or nasal cannula.

Primary outcome measures

• Hydrogen Gas Adminstration Safety [Time frame: 30 days post randomization]
• Hydrogen Gas Adminstration Feasibility [Time frame: 72 hours post randomization]

Secondary outcome measures (4)

• Evidence of Brain Injury on Clinically Ordered Imaging [Time frame: 3-7 days post randomization]
• Markers of Ischemic Injury [Time frame: 0, 1, 2, 3, and 4 days post randomization]
• Survival [Time frame: post-randomization through 6 months of age]
• Neurodevelopmental Outcome [Time frame: 24-36 months of age]

Eligibility criteria

Inclusion criteria

• Infants born ≥36 weeks gestation.
• Any one of the following:

• sentinel event prior to delivery, such as uterine rupture, profound fetal bradycardia, or cord prolapse
• low Apgar scores (≤ 5 at 10 minutes of life)
• prolonged resuscitation at birth (chest compressions and/or intubation and/or mask ventilation at 10 minutes)
• severe acidosis (pH < 7.0 from cord or neonate blood gas within 60 minutes of birth)
• abnormal base excess (≤ -16 mEq/L from cord gas or neonate blood gas within 60 minutes of birth)
• Moderate or severe encephalopathy present in the first 2 hours of life.
• Intubated and mechanically ventilated at the time of enrollment.

Exclusion criteria

• Enrollment in the opt-out program.
• Presence of known cyanotic congenital heart disease.
• Presence of known or suspected genetic/chromosomal syndrome or multiple congenital anomalies.
• Presence of known congenital malformation that is expected to require urgent surgical intervention in the neonatal period, including congenital diaphragmatic hernia (CDH), gastroschisis, omphalocele, intestinal atresia, or imperforate anus.
• Presence of antenatally diagnosed central nervous system malformation, including hemorrhage, hydrocephalus, or structural anomaly of the brain (eg. polymicrogyria).
• Need for high frequency ventilation (HFV) at time of enrollment.
• Patients receiving respiratory support via Drager Babylog ventilators.
• Study enrollment and randomization after 2 hours of age

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07411911 · IRB-P00052510

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗