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Prenatal Steroids for Treatment of Congenital Cystic Adenomatoid Malformations (CCAM)

Information source: University of California, San Francisco
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Congenital Cystic Adenomatoid Malformation

Intervention: Betamethasone (Drug); Placebo (Drug)

Phase: Phase 1/Phase 2

Status: Terminated

Sponsored by: University of California, San Francisco

Official(s) and/or principal investigator(s):
Timothy M Crombleholme, MD, Principal Investigator, Affiliation: Children's Hospital of Cincinnati
Douglas Wilson, MD, Principal Investigator, Affiliation: Children's Hospital of Philadelphia
Hanmin Lee, MD, Principal Investigator, Affiliation: University of California, San Francisco

Summary

Congenital cystic adenomatoid malformations (CCAMs) are theorized to be growing immature lung tissue. Administration of maternal steroids in the mid-trimester may stop the growth or decrease the size of the CCAM, thus increasing normal lung tissue and improving survival in fetuses with large CCAMs. This is a prospective, blinded, randomized trial comparing administration of a single course of antenatal steroids (Betamethasone) to control (i. e., placebo). The primary outcome variable will be incidence of hydrops. One month postnatal survival and relative size of the CCAM as determined by CCAM volume: head circumference ratio (CVR) between treatment/no treatment groups will be secondary outcome variables. Change in size of CCAM will be serially followed for both groups with individual growth curves being plotted prenatally and these will be compared with pathology weigh and volume to evaluate treatment effect. Other prenatal data collected will include: incidence of polyhydramnios, incidence of premature rupture of membranes, incidence of material complications. We will also compare mode of delivery, postnatal respiratory compromise, need for resection in the first week of life, and occurrence of complications during newborn administration

Clinical Details

Official title: Investigation of Prenatal Steroids for Treatment of Prenatally Diagnosed CCAMs

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention

Primary outcome: Incidence of Hydrops Fetalis

Secondary outcome:

Comparison of CCAM Size in Mid-trimester Fetuses (Study/Administration vs Control/Placebo)

Survival at One-month Between Study and Control Groups.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Female.

Criteria:

Inclusion Criteria:

- GA < 26 weeks

- Maternal age > 18 years of age

- Singleton pregnancy

- Normal chromosomes

- CCAM volume to head circumference ratio (CVR) > 1. 4

- No maternal medical/surgical contraindications

- No evidence of hydrops

- Not previously randomization

Exclusion Criteria:

- Maternal diabetes or use of insulin

- Preterm labor

- Multiple congenital anomalies with CCAM

- Chromosomal anomaly with CCAM

- Multiple gestation pregnancy with CCAM

- Not willing to be randomized

- Unable or unwilling to return to UCSF for second dose of drug or placebo

- CVR < 1. 4

Locations and Contacts

University of California, San Francisco Fetal Treatment Center, San Francisco, California 94143, United States

Cincinnati Children's Hospital, Cincinnati, Ohio 45229-3039, United States

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, United States

Additional Information

Fetal Care Center of Cincinnati Children's Hospital

Fetal Treatment Center at the University of California, San Francisco

Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia

Related publications:

Vu L, Tsao K, Lee H, Nobuhara K, Farmer D, Harrison M, Goldstein RB. Characteristics of congenital cystic adenomatoid malformations associated with nonimmune hydrops and outcome. J Pediatr Surg. 2007 Aug;42(8):1351-6.

Schumacher A, Sidor J, Bühling KJ. [Continuous glucose monitoring using the glucose sensor CGMS in metabolically normal pregnant women during betamethasone therapy for fetal respiratory distress syndrome]. Z Geburtshilfe Neonatol. 2006 Oct;210(5):184-90. German.

Peltoniemi OM, Kari MA, Tammela O, Lehtonen L, Marttila R, Halmesmäki E, Jouppila P, Hallman M; Repeat Antenatal Betamethasone Study Group. Randomized trial of a single repeat dose of prenatal betamethasone treatment in imminent preterm birth. Pediatrics. 2007 Feb;119(2):290-8.

Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD004454. Review.

Neilson JP. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Obstet Gynecol. 2007 Jan;109(1):189-90.

Tsao K, Hawgood S, Vu L, Hirose S, Sydorak R, Albanese CT, Farmer DL, Harrison MR, Lee H. Resolution of hydrops fetalis in congenital cystic adenomatoid malformation after prenatal steroid therapy. J Pediatr Surg. 2003 Mar;38(3):508-10. Review.

Arca MJ, Teich S. Current controversies in perinatal care: fetal versus neonatal surgery. Clin Perinatol. 2004 Sep;31(3):629-48. Review.

Wilson RD, Baxter JK, Johnson MP, King M, Kasperski S, Crombleholme TM, Flake AW, Hedrick HL, Howell LJ, Adzick NS. Thoracoamniotic shunts: fetal treatment of pleural effusions and congenital cystic adenomatoid malformations. Fetal Diagn Ther. 2004 Sep-Oct;19(5):413-20.

Knox EM, Kilby MD, Martin WL, Khan KS. In-utero pulmonary drainage in the management of primary hydrothorax and congenital cystic lung lesion: a systematic review. Ultrasound Obstet Gynecol. 2006 Oct;28(5):726-34. Review.

Davenport M, Warne SA, Cacciaguerra S, Patel S, Greenough A, Nicolaides K. Current outcome of antenally diagnosed cystic lung disease. J Pediatr Surg. 2004 Apr;39(4):549-56. Review.

Miller JA, Corteville JE, Langer JC. Congenital cystic adenomatoid malformation in the fetus: natural history and predictors of outcome. J Pediatr Surg. 1996 Jun;31(6):805-8.

Starting date: April 2008
Last updated: March 18, 2015

Page last updated: August 23, 2015

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