AzTrials
AzTrials

Ischemic-Hypoxic EncephalopathyLyTONEPALNCT02676063

Long Term Prognostic of Neonatal Hypoxic Ischemic Encephalopathy With Hypothermia Treatment

An observational study of Ischemic-Hypoxic Encephalopathy, run by University Hospital, Grenoble at 22 sites in France.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

The primary objective is to evaluate neonatal characteristics, and biological and clinical investigations as predictive factors of death, or of severe and moderate neurodevelopmental disability at 3 years, in a large population-based cohort of full-term and late preterm neonates with moderate or severe HIE. Read more about this study

Who is it for?
Any age
Conditions the study is for
Ischemic-Hypoxic Encephalopathy
How many people
800 participants
Where
22 sitesFrance
Study dates
Sep 2015to Mar 2021
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Study population: This study will be performed on all moderate or severe cases of hypoxic ischemic encephalopathyhie, occurring between 34 and 42 completed weeks gestation in newborns admitted to a neonatal intensive care unit of the participating French regions. Children will be followed-up until the age of 3 years.

Who may be able to join

  • Infants born at a gestational age of 34 weeks or more;
  • Presenting early neurological distress with clinical signs of moderate to severe HIE at a standardized neurologic examination performed by a senior examiner:
  • Moderate HIE: lethargy, hyper-reflexia, miosis, bradycardia, seizures, hypotonia with weak suck and Moro reflex
  • Severe HIE: stupor, flaccidity, small to mid-position pupils that react poorly to light, reduced stretch reflexes, hypothermia or no Moro reflex
  • With criteria for asphyxia:
  • pH of 7.0 or less or a base deficit of 16 mmol per liter or more in a sample of umbilical-cord blood or any blood sampled in the first hour after birth.
Show all 12Show fewer
  • If, during this interval, the pH is between 7.01 and 7.15, base deficit is between 10 and 15.9 mmol per liter, or blood gas is not available, additional criteria will be required. These include:
  • an acute perinatal event (e.g., late or variable decelerations, cord prolapse, cord rupture, uterine rupture, maternal trauma, hemorrhage, or cardiorespiratory arrest)
  • or an abrupt change in fetal heart rate (FHR), defined as a persistent abnormal FHE after a period of normal tracing: bradycardia or prolonged deceleration, persistent variable decelerations, persistent late decelerations, and reduced heart variability
  • or either a 10-minute Apgar score of 5 or less or assisted ventilation initiated at birth and continued for at least 10 minutes.
  • Written parental informed consent
  • Covered by the French social security

Who cannot join

  • Congenital malformations
  • Chromosomal disorders
  • Congenital neuromuscular disorders

Trial locations and contacts

22 sites in 1 country.

22 sites in 1 country

France22 sites
  • Chu Amiens

    Amiens, 80000

  • Chu Besancon

    Besançon, 25000

  • Chu Bordeaux

    Bordeaux, 33000

  • Chu Brest

    Brest, 29200

  • CHU CAEN

    Caen, 14000

  • CHU Clermond-Ferrand

    Clermont-Ferrand, 63000

  • Chi Creteil

    Créteil, 94000

  • Chu Dijon

    Dijon, 21000

  • CHU FORT de France

    Fort de France, 97200

  • Chu Grenoble

    Grenoble, 38000

  • Chru Lille

    Lille, 59000

  • Chu Limoges

    Limoges, 87000

  • Chu Marseille

    Marseille, 13000

  • CHU Montpellier

    Montpellier, 34000

  • Chu La Miletrie

    Poitiers, 86000

  • Chu Reims

    Reims, 51100

  • Chu Rouen

    Rouen, 76000

  • CHU St Denis

    Saint-Denis de La Réunion, 97400

  • CHU St Pierre

    Saint-Pierre, 97410

  • Chu Strasbourg

    Strasbourg, 67000

  • Chu Toulouse

    Toulouse, 31000

  • Chu Tours

    Tours, 37000

Other trials in France

About this study

Official title: Long Term Prognostic of Neonatal Hypoxic Ischemic Encephalopathy in the Era of Neuroprotective Treatment With Hypothermia

The primary objective is to evaluate neonatal characteristics, and biological and clinical investigations as predictive factors of death, or of severe and moderate neurodevelopmental disability at 3 years, in a large population-based cohort of full-term and late preterm neonates with moderate or severe HIE.

Contrary to most previous studies which have often analyzed the accuracy of one factor among all other clinical investigations, the investigators objective's is to seek a relevant combination of several factors among the following list:

  • Neonatal characteristics: gestational age and birthweight, maternal disease, acute intrapartum event, delivery mode, acidosis, neurological examination, place of birth and neonatal transfer
  • Laboratory investigations: pH, lactates and new biological markers as detailed below
  • Clinical investigations: aEEG, EEG, MRI, diffusion-weighted MRI
Read the detailed description

Hypoxic-ischemic encephalopathy (HIE) is a rare neonatal condition affecting about 1‰ births and with a high rate of death and severe neurological disability despite significant improvement of the management of this illness in the last ten years. During the first hours and days of life, different examinations are made by neonatologists to guide decisions about the management of HIE and to provide information to families. Nevertheless, better knowledge about the early and late predictive factors of long-term severe and moderate neurodevelopmental outcomes is badly needed.

This study is a prospective national observational population-based study involving all level III intensive care units in France.

This population-based cohort study will be performed including all moderate or severe cases of HIE, occurring between 34 and 42 completed weeks gestation in newborns admitted to a neonatal intensive care unit of the participating French regions. Children will be followed-up until the age of 3 years.

Participating centers will be invited to adhere to current HIE management guidelines and/or clinical investigations considered optimal to date, to ensure standardize clinical practice. The study will ensure high quality data collection.

About indications, timing and characteristics of treatments and investigations will be elaborated by the scientific committee during the preparation stage of the cohort study. This professional advice will have the double advantage of enabling us to record more homogeneous and high-quality data, and to standardize and improve clinical management and investigations among newborns with HIE.

Within this main study, an ancillary study will be performed by 21 centers to address the first secondary objective (predictive value of very early - first 6 hours of life - neurological examination and biological investigations, including specific new biomarkers such as Interleukin-6, Metalloproteinase-9, TIMP-1, Albumin modified by hypoxia, troponin I, acylcarnitins and amino acids).

Keywords
predictive factors, neurodevelopmental disabilities
Medical subject headings
Hypoxia-Ischemia, Brain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT02676063
Study groupRoleWhat they receive
neonatal Hypoxic Ischemic encephalopathymoderate or severe HIE among term and late preterm newborn

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The primary outcome measure is a combined criterion : death, neurodevelopmental disabilities in survivors

    A combined criterion which includes:

    • Death between birth and 3 years of age
    • Neurodevelopmental disabilities in survivors, defined as :
    • Severe disabilities
    • Intellectual impairment with a mental score >2SD below the mean or <70 (ASQ)
    • Or Cerebral palsy with a Gross Motor Function level of 3-5 according to the GMFCS
    • Or bilateral blindness (vision <20/200 acuity)
    • Or deafness requiring amplification (>60dB)and/
    • Or a persistent disorder defined as recurrent seizures after discharge from neonatal intensive care requiring anti-convulsion therapy at the examination time point
    • Moderate disabilities
    • Intellectual impairment with a mental score >1SD below the mean or 70 to 84 (ASQ)
    • Cerebral palsy with a Gross Motor Function level of 1 or 2 according to the GMFCS
    • Or hearing impairment requiring no amplification

    Measured: between birth and 3 years of age

Secondary outcomes (4)
  1. First secondary objective : The relevance of specific new biomarkers : Protein levels (IL-6, MMP-9, TIMP-1, Albumine modified by hypoxia, troponine I), acylcarnitins and amino acids.

    The biologist will evaluate the relevance of specific new biomarkers :

    • Protein levels (IL-6, MMP-9, TIMP-1, Albumine modified by hypoxia, troponine I) unites will be determined using an ELISA
    • the measurement of acylcarnitins and amino acids by tandem liquid phase chromatography coupled with mass spectroscopy.

    The analyses will be blinded and centralized to Reims University laboratory

    Measured: before H6 and at 3 days

  2. Second secondary objective: the predictive value of clinical investigations during the first weeks of life and treatments.

    To analyze the predictive value of clinical investigations during the first weeks of life and treatments, including cooling:

    • for normal outcomes (absence of death, any disability, any epilepsy or any need for physiotherapy, orthophonist or psychologist or other measures of reeducation), moderate or severe neurodevelopmental disabilities, and death
    • At 18 months and 3 years of age
    • In this part, we will assess the ability of a normal developmental assessment at 18 months to predict survival free of disability or retardation at 3 years. This information will be useful in the future to define different strategies of follow up according to the assessment at 18 months of age.

    Measured: first week, At 18 months and 3 years of age

  3. Third secondary objective : Number and percentage of participants with cooling.

    The third secondary objective is analyzed thanks to :

    • number of patients with method of cooling : Criticool, tecotherm, craft, other
    • duration of cooling in hours
    • number of severe or modere HIE according to the Sarnat classification
    • time to initiate cooling in minutes

    Measured: birth

  4. Fourth secondary objective : Number and percentage of various obstetrical conditions leading to the worse outcomes

    Number and percentage of :

    • Maternal pyrexia,
    • a persistent occipito-posterior position,
    • an acute intrapartum event (hemorrhage, maternal convulsions, rupture of uterus, snapped cord, and birth of baby before arrival at obstetric facility),
    • an instrumental vaginal delivery
    • an emergency caesarean section

    Measured: birth

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Feb 2016 (estimated)
  2. Study startSep 2015
  3. Primary completionMar 2019 (estimated)
  4. Study completionMar 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
800 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02676063
Sponsor's protocol ID
DCIC1416
Acronym
LyTONEPAL
Status last verified
Jun 2018
First submitted
28 Sep 2015
Last updated
6 Jun 2018
Results posted
No
Data monitoring committee
No

Publications

  • Volpe JJ. Neonatal encephalopathy: an inadequate term for hypoxic-ischemic encephalopathy. Ann Neurol. 2012 Aug;72(2):156-66. doi: 10.1002/ana.23647.

    PubMed 22926849
  • Use and abuse of the Apgar score. Committee on Fetus and Newborn, American Academy of Pediatrics, and Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Pediatrics. 1996 Jul;98(1):141-2.

    PubMed 8668389
  • Fenichel GM. Hypoxic-ischemic encephalopathy in the newborn. Arch Neurol. 1983 May;40(5):261-6. doi: 10.1001/archneur.1983.04050050029002.

    PubMed 6405725
  • Levene ML, Kornberg J, Williams TH. The incidence and severity of post-asphyxial encephalopathy in full-term infants. Early Hum Dev. 1985 May;11(1):21-6. doi: 10.1016/0378-3782(85)90115-x.

    PubMed 4006822
  • Debillon T, Vilotitch A, Guellec I, Marret S, Baud O, Chevallier M, Sentilhes L, Kayem G, Pierrat V, Ego A. Neonatal encephalopathy and 3 year outcomes: a French population-based cohort. Pediatr Res. 2026 Apr 30. doi: 10.1038/s41390-026-05022-3. Online ahead of print.

    PubMed 42062519
  • Binet L, Debillon T, Beck J, Vilotitch A, Guellec I, Ego A, Chevallier M; LYTONEPAL research group. Effect of gestational age on cerebral lesions in neonatal encephalopathy. Arch Dis Child Fetal Neonatal Ed. 2024 Aug 16;109(5):562-568. doi: 10.1136/archdischild-2023-326131.

    PubMed 38418209
  • Guellec I, Ancel PY, Beck J, Loron G, Chevallier M, Pierrat V, Kayem G, Vilotitch A, Baud O, Ego A, Debillon T. Glycemia and Neonatal Encephalopathy: Outcomes in the LyTONEPAL (Long-Term Outcome of Neonatal Hypoxic EncePhALopathy in the Era of Neuroprotective Treatment With Hypothermia) Cohort. J Pediatr. 2023 Jun;257:113350. doi: 10.1016/j.jpeds.2023.02.003. Epub 2023 Feb 23.

    PubMed 36828343
  • Debillon T, Sentilhes L, Kayem G, Chevallier M, Zeitlin J, Baud O, Vilotitch A, Pierrat V, Guellec I, Ancel PY, Bednarek N, Ego A. Risk factors for unfavorable outcome at discharge of newborns with hypoxic-ischemic encephalopathy in the era of hypothermia. Pediatr Res. 2023 Jun;93(7):1975-1982. doi: 10.1038/s41390-022-02352-w. Epub 2022 Oct 22.

    PubMed 36272997
  • Beck J, Debillon T, Guellec I, Vilotitch A, Loron G, Bednarek N, Ancel PY, Pierrat V, Ego A. Healthcare organizational factors associated with delayed therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy: the LyTONEPAL cohort. Eur J Pediatr. 2023 Jan;182(1):181-190. doi: 10.1007/s00431-022-04666-7. Epub 2022 Oct 21.

    PubMed 36269426
  • Beck J, Bednarek N, Pierrat V, Vilotitch A, Loron G, Alison M, Guellec I, Hertz-Pannier L, de Launay C, Ego A, Vo-Van P, Ancel PY, Debillon T. Cerebral injuries in neonatal encephalopathy treated with hypothermia: French LyTONEPAL cohort. Pediatr Res. 2022 Sep;92(3):880-887. doi: 10.1038/s41390-021-01846-3. Epub 2021 Nov 20.

    PubMed 34802036
  • Debillon T, Bednarek N, Ego A; LyTONEPAL Writing Group. LyTONEPAL: long term outcome of neonatal hypoxic encephalopathy in the era of neuroprotective treatment with hypothermia: a French population-based cohort. BMC Pediatr. 2018 Aug 1;18(1):255. doi: 10.1186/s12887-018-1232-6.

    PubMed 30068301

Questions about this trial

What is this clinical trial studying?

An observational study of Ischemic-Hypoxic Encephalopathy, run by University Hospital, Grenoble at 22 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 Jun 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 22 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The primary outcome measure is a combined criterion : death, neurodevelopmental disabilities in survivors (time frame: between birth and 3 years of age). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02676063, which also lists 11 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jun 2018.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in