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Trial registered on ANZCTR
Registration number
ACTRN12618000265279p
Ethics application status
Not yet submitted
Date submitted
14/02/2018
Date registered
21/02/2018
Date last updated
21/02/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Restoring gut health of newborns- a clinical trial of probiotics
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Scientific title
Restoring neonatal gut biodiversity and mucosal immunity after postnatal antibiotics exposure (Restore trial)
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Secondary ID [1]
293210
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None
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Universal Trial Number (UTN)
U1111-1204-2229
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Trial acronym
RESTORE
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Neonatal gut microbial biodiversity
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Immune development
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Condition category
Condition code
Reproductive Health and Childbirth
304526
304526
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0
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Complications of newborn
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Oral and Gastrointestinal
305697
305697
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0
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Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
multi-strain probiotic powder (multiple strains of lactobacilli and bifidobacterium, 7 billion cfu per gram- supplied in 3x60gm bottles) - two grams (two scoops) dissolved in expressed breast milk every day for 12 weeks orally
Adherence/compliance to intervention will be monitored by parental diary and by measuring left over powder on return of bottles at the end of intervention
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Intervention code [1]
299468
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Treatment: Drugs
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Comparator / control treatment
similar looking powder of placebo containing maltodextrin (supplied in 3x60gm bottles) - two grams (two scoops) every day for 12 weeks orally
The reference group (40 infants of matched gestation without antibiotic exposure) will not receive any treatment.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Stool microbial diversity - by 16S rRNA sequencing
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Assessment method [1]
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Timepoint [1]
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4 weeks of age
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Secondary outcome [1]
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stool microbial diversity - by 16S rRNA sequencing
This analysis will show whether the effect of probiotics on diversity is sustained beyond post-cessation.
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Assessment method [1]
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Timepoint [1]
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12 weeks of age (at treatment completion), 6 months of age (3 months post-treatment completion) and 12 months of age (9 months post-treatment completion)
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Secondary outcome [2]
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Secretory IgA stool
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Assessment method [2]
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Timepoint [2]
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4 weeks of age (4 weeks post-treatment commencement), 12 weeks of age (at treatment completion), 6 months of age (3 months post-treatment completion) and 12 months of age (9 months post-treatment completion)
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Secondary outcome [3]
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medically diagnosed allergy/eczema/atopy - assessed by parents questionnaire designed for this study
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Assessment method [3]
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Timepoint [3]
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12 months of age (9 months post-treatment completion)
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Secondary outcome [4]
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Secretory IgA in saliva
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Assessment method [4]
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Timepoint [4]
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4 weeks of age (4 weeks post-treatment commencement), 12 weeks of age (at treatment completion), 6 months of age (3 months post-treatment completion) and 12 months of age (9 months post-treatment completion)
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Eligibility
Key inclusion criteria
Newborns (gestation > or equal to 37+0 weeks) who have been given antibiotics for clinical indications (at least two doses) within 48 hours of birth
Age and gestation matched newborns without antibiotic exposure will be included as the 'reference group'
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Minimum age
0
Days
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Maximum age
3
Days
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
-gestational age <37 weeks
-anticipated exposure of antibiotics more than 5 days post birth
-major congenital anomalies (e.g. gastroschisis)
-bilious vomiting
-probiotic intake other than study drug by mum or baby
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Centrally computer-generated randomisation will be used and the trial pharmacist (unblinded) will allocate participants to probiotic or placebo group. Participants, clinicians and the investigators will be blinded to the group allocation.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
block randomization
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
40 probiotic group, 40 placebo and 40 babies not exposed to antibiotics used as reference group
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Intention to treat analysis
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/11/2018
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Actual
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Date of last participant enrolment
Anticipated
30/06/2019
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Actual
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Date of last data collection
Anticipated
30/06/2020
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Actual
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Sample size
Target
120
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
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Fiona Stanley Hospital - Murdoch
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Recruitment postcode(s) [1]
17911
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6150 - Murdoch
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Funding & Sponsors
Funding source category [1]
297840
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Hospital
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Name [1]
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Fiona Stanley Hospital
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Address [1]
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11 Robin warren drive, Murdoch WA 6150
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Country [1]
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Australia
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Primary sponsor type
Hospital
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Name
Fiona Stanley Hospital
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Address
11 Robin warren drive, Murdoch WA 6150
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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NA
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Address [1]
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NA
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Country [1]
296878
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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South Metro Area Health Service Ethics Committee
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Ethics committee address [1]
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Fiona Stanley Hospital, Education Building, 11 Robin Warren Drive, Murdoch WA 6150
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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30/05/2018
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Approval date [1]
298887
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Ethics approval number [1]
298887
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Summary
Brief summary
Due to high susceptibility to infections, antibiotics are the most widely used drugs for newborns. Recent evidence suggests that antibiotics exposure in newborn period (first 4 weeks of life) predisposes to an imbalance in the gut, which may have long lasting consequences. Imbalances in the infants’ gut bacteria (microbiome) caused by antibiotics has been shown to alter the development of the neonate’s immune response. This altered immune development caused by a poorly balanced microbiome during this crucial phase of early life has been associated with the development of atopy, asthma, eczema, allergy, type 1 diabetes and inflammatory bowel disease. Mucosal immunity development in the gut has been shown to be aberrant as early as one month of age in children who go on to develop allergy symptoms in future. RESTORE is a clinical trial of a multi-strain probiotic for antibiotics exposed term newborn infants with aims to restore biodiversity and reduce dysbiosis (imbalance of bacteria) in the newborn gut in early months after birth. This is the first study of its kind to examine effects of probiotics on these high-risk infants’ gut biodiversity and mucosal immune development. Research Questions 1. Can the gut microbial diversity of infants exposed to postnatal antibiotics be restored earlier (within neonatal period after birth) by daily use of multi-strain probiotic supplementation? 2. Is this effect sustained at 3 months and 12 months? 3. Can probiotics in antibiotic exposed infants improve the production of salivary and secretory IgA to that seen in infants without antibiotics exposure? Methodology This randomised control trial will be conducted at Fiona Stanley Hospital. A total of 120 term neonates will be recruited, 80 of whom would have received antibiotics at birth for clinical reasons. Forty of the antibiotic exposed neonates will receive daily probiotics for 3 months and forty infants will receive a placebo. Forty infants without antibiotic exposure will serve as a reference group. Stool, saliva and blood will collected for microbiome and/or immunological tests at five time-points in the first 12 months of life. Predicted Benefits and Relevance: Neonatal infections, antibiotic use and allergy in later life are highly relevant health issues for infants, with gut microbiome as the potential denominator. In Australia, the economic cost of allergic diseases is estimated to be >$30 billion annually. Probiotics have been extensively used to restore microbiome balance in adults and hold potential to be useful for newborns for this indication. Although some promising data exists from animal studies, No human studies have yet determined whether probiotics are effective in rapidly restoring the balance of bacteria in term neonates’ gut following exposure to antibiotics. We are proposing a randomised control trial to determine if multi-strain probiotics can rapidly normalize the infants’ microbiome following neonatal antibiotic exposure during the crucial time of immune development and improve mucosal immunity. This study will provide insights for conducting larger multicentre trial to confirm clinical benefits; which will potentially change the practice to routinely supplement these high-risk babies with probiotics in the newborn period.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Shailender Mehta
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Address
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Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150
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Country
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Australia
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Phone
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+61861522222
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Shailender Mehta
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Address
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Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150
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Country
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Australia
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Phone
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+61861522222
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Shailender Mehta
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Address
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Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch WA 6150
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Country
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Australia
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Phone
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+61861522222
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Fax
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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