Cholestasis in Newborn InfantDBS-SCReNCNCT03667534
Dry Blood Spot Screening Test for Neonatal Cholestasis Patients
An observational study of Cholestasis in Newborn Infant and Biliary Atresia, run by National Taiwan University Hospital at 1 site in Taiwan.
Trial summary
Cholestatic jaundice with multitude of causes affects approximately 1 in every 2,500 infants. Of the many conditions that cause neonatal cholestasis, the most commonly identifiable are biliary atresia (BA) (25%-35%). The incidence in Taiwan was 1.2 to 2.0 per 10,000 live birth. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Cholestasis in Newborn Infant, Biliary Atresia
- What is being tested?
- Dry blood spot screening
- How many people
- 60 participants
- Where
- 1 siteTaiwan
- Study dates
- 9 Sep 2018to 9 Sep 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
- Healthy volunteers accepted
- Child, Adult, Older adult
Study population: Patients with jaundice and healthy volunteers are included for testing the efficacy and accuracy of the screening test.
Who may be able to join
- Patients with jaundice
- Healthy volunteers
Who cannot join
- Subjects who do not agree with study protocol.
Trial locations and contacts
1 site in 1 country.
About this study
Cholestatic jaundice with multitude of causes affects approximately 1 in every 2,500 infants. Of the many conditions that cause neonatal cholestasis, the most commonly identifiable are biliary atresia (BA) (25%-35%). The incidence in Taiwan was 1.2 to 2.0 per 10,000 live birth. Prognosis and survival are improved if bile drainage is restored by a Kasai portoenterostomy. Stool color card was introduced to Taiwan in 2002 and national screening program was started in 2004. The rate of age at Kasai operation <60 days improved from 49.4% before year 2002 to 65.7% after introducing nationwide stool color card screening in Taiwan. There was a great improvement in early diagnosis for biliary atresia after stool color card screening and there were still many researches tried to improve the timing of diagnosis. A prospective cohort observational study on neonates under 27 days old at London showed that serum conjugated bilirubin > 18 micromol/l in plasma measured at 6-10 days is a reliable marker for neonatal cholestasis liver disease with sensitivity 100%, specificity 99.59% (95% CI 99.5-99.67), PPV 10.3% (95% CI 4.50-16.0).
Our study aims to developed a screening test for neonatal cholestasis using dry blood spot to improve patient survival by early diagnosis of treatable neonatal cholestasis disease, such as biliary atresia and inborn error of bile acid metabolism. The diseases markers for neonatal cholestasis we aims including basic clinical blood test examination profiles, inflammatory markers, fibrosis markers, immune profiles. In phase I study we will enroll cholestasis patients at National Taiwan University Children Hospital. We will collect patients' blood on dry blood spot and measure the disease markers for cholestasis disease. In phase II study, we will enroll the cholestasis patients and healthy newborn without cholestasis. We will review their newborn screening at 3 days old. Newborn screening dry blood spot will be examined for the disease markers and compared with healthy control without cholestasis. ROC curve analysis will be performed to find the best cut-off to screen for neonatal cholestasis patients.
The findings will aid early diagnosis in the patients and hence improve the survival.
Read the detailed description
Aims:
- Developed a screening test for neonatal cholestasis using dry blood spot
- Improve patient survival by early diagnosis of treatable neonatal cholestasis disease such as biliary atresia and inborn error of bile acid metabolism.
Phase I - Validation of method for quantification of disease markers on dry blood spot.
Pediatric children with cholestasis diagnose at National Taiwan University Hospital during admission or out-patient clinic will be collected for the Phase I study. 5ml of venous blood will be collected for measurement of disease markers during routine follow-up at National Taiwan University Hospital outpatient clinic. Dried blood spot (DBS) specimens are collected from patients by applying a whole blood, drawn by lancet from the finger, heel or toe, a provided filter paper. To evaluate the stability of disease markers on DBS, a total 10 blood spots (each blood spout contain 50 - 75 microL of blood) will be applied on the filter paper at day 0. The collected blood spots samples of a single patient at day 0 will be evaluated at the day of DBS collection and followed by day 3, day 7, 6 months and 1 year after sample collection. The purpose of repeat measurement of single patient sample at different time point is to evaluate the possible effect of time effect on the accuracy of the data. 5 blood spots are separated and protected from light with a light blocking envelope to compare the light effect on disease markers degradation (Table 1). Serum disease markers measured with conventional method will be served as reference and compared with DBS samples at different time points. 30 patients will be collected to validate the correlation between serum and DBS disease markers level.
Phase II - Pilot study In the pilot study, we aim to develop dry blood spot method for the screening of neonatal cholestasis. Children with neonatal cholestasis disease previously diagnosed at Department of Pediatrics, National Taiwan University Children's Hospital from 2007 or newly diagnosed children will be recruited retrospectively from chart review. Patients with indirect type hyperbilirubinemia and healthy neonates will be enrolled as control. We will analyze neonatal cholestasis and control patients dry blood spot screening test after birth to quantify disease markers level. ROC curve analysis will be conducted on bilirubin quantity to find the best cutoff to screen for neonatal cholestasis. The sample size of case and control study is 20 cases and 20 controls.
- Conditions
- Cholestasis in Newborn Infant, Biliary Atresia
- Being tested
- Dry blood spot screening
- Keywords
- cholestasis, new born screening, dry blood spot, biliary atresia
- Medical subject headings
- Biliary Atresia, Cholestasis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Dry blood spot screeningDiagnostic test
Dry blood spot measurement of biomarker for screening of cholestasis patients
What is being measured
The primary outcome is the main question the study is designed to answer.
Cholestasis
Direct bilirubin > 1.0mg/dl or Direct bilirubin to total bilirubin ratio > 0.2
Measured: on the time of enrollment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Sep 2018
- Study start9 Sep 2018
- Primary completion8 Jun 2021 (estimated)
- Study completion9 Sep 2021 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Cholestasis in Newborn InfantStudies of the same condition, open and under way.
- More trials run by National Taiwan University HospitalThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Cross-sectional
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- National Taiwan University Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Mei-Hwei Chang, MD, Principal investigator, National Taiwan University Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03667534
- Sponsor's protocol ID
- 201804007RIND
- Acronym
- DBS-SCReNC
- Status last verified
- May 2021
- First submitted
- 10 Sep 2018
- Last updated
- 14 May 2021
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: No sharing plan
Study at a glance
From the registry record, last updated by the sponsor on 14 May 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Dry Blood Spot Screening Test for Neonatal Cholestasis Patients
- ClinicalTrials.gov ID
- NCT03667534
- Acronym / sponsor ID
- DBS-SCReNC / 201804007RIND
- Conditions
- Cholestasis in Newborn Infant, Biliary Atresia
- Keywords
- cholestasis, new born screening, dry blood spot, biliary atresia
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- National Taiwan University HospitalUniversity, hospital or other
- Study start
- 9 Sep 2018 (actual)
- Primary completion
- 8 Jun 2021 (estimated)
- Study completion
- 9 Sep 2021 (estimated)
- First posted
- 12 Sep 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Cholestatic jaundice with multitude of causes affects approximately 1 in every 2,500 infants. Of the many conditions that cause neonatal cholestasis, the most commonly identifiable are biliary atresia (BA) (25%-35%). The incidence in Taiwan was 1.2 to 2.0 per 10,000 live birth. Prognosis and survival are improved if bile drainage is restored by a Kasai portoenterostomy. Stool color card was introduced to Taiwan in 2002 and national screening program was started in 2004. The rate of age at Kasai operation <60 days improved from 49.4% before year 2002 to 65.7% after introducing nationwide stool color card screening in Taiwan. There was a great improvement in early diagnosis for biliary atresia after stool color card screening and there were still many researches tried to improve the timing of diagnosis. A prospective cohort observational study on neonates under 27 days old at London showed that serum conjugated bilirubin > 18 micromol/l in plasma measured at 6-10 days is a reliable marker for neonatal cholestasis liver disease with sensitivity 100%, specificity 99.59% (95% CI 99.5-99.67), PPV 10.3% (95% CI 4.50-16.0).
Our study aims to developed a screening test for neonatal cholestasis using dry blood spot to improve patient survival by early diagnosis of treatable neonatal cholestasis disease, such as biliary atresia and inborn error of bile acid metabolism. The diseases markers for neonatal cholestasis we aims including basic clinical blood test examination profiles, inflammatory markers, fibrosis markers, immune profiles. In phase I study we will enroll cholestasis patients at National Taiwan University Children Hospital. We will collect patients' blood on dry blood spot and measure the disease markers for cholestasis disease. In phase II study, we will enroll the cholestasis patients and healthy newborn without cholestasis. We will review their newborn screening at 3 days old. Newborn screening dry blood spot will be examined for the disease markers and compared with healthy control without cholestasis. ROC curve analysis will be performed to find the best cut-off to screen for neonatal cholestasis patients.
The findings will aid early diagnosis in the patients and hence improve the survival.
Detailed description
Aims:
- Developed a screening test for neonatal cholestasis using dry blood spot
- Improve patient survival by early diagnosis of treatable neonatal cholestasis disease such as biliary atresia and inborn error of bile acid metabolism.
Phase I - Validation of method for quantification of disease markers on dry blood spot.
Pediatric children with cholestasis diagnose at National Taiwan University Hospital during admission or out-patient clinic will be collected for the Phase I study. 5ml of venous blood will be collected for measurement of disease markers during routine follow-up at National Taiwan University Hospital outpatient clinic. Dried blood spot (DBS) specimens are collected from patients by applying a whole blood, drawn by lancet from the finger, heel or toe, a provided filter paper. To evaluate the stability of disease markers on DBS, a total 10 blood spots (each blood spout contain 50 - 75 microL of blood) will be applied on the filter paper at day 0. The collected blood spots samples of a single patient at day 0 will be evaluated at the day of DBS collection and followed by day 3, day 7, 6 months and 1 year after sample collection. The purpose of repeat measurement of single patient sample at different time point is to evaluate the possible effect of time effect on the accuracy of the data. 5 blood spots are separated and protected from light with a light blocking envelope to compare the light effect on disease markers degradation (Table 1). Serum disease markers measured with conventional method will be served as reference and compared with DBS samples at different time points. 30 patients will be collected to validate the correlation between serum and DBS disease markers level.
Phase II - Pilot study In the pilot study, we aim to develop dry blood spot method for the screening of neonatal cholestasis. Children with neonatal cholestasis disease previously diagnosed at Department of Pediatrics, National Taiwan University Children's Hospital from 2007 or newly diagnosed children will be recruited retrospectively from chart review. Patients with indirect type hyperbilirubinemia and healthy neonates will be enrolled as control. We will analyze neonatal cholestasis and control patients dry blood spot screening test after birth to quantify disease markers level. ROC curve analysis will be conducted on bilirubin quantity to find the best cutoff to screen for neonatal cholestasis. The sample size of case and control study is 20 cases and 20 controls.
Study design
- Observational model
- Cohort
- Time perspective
- Cross-sectional
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Patients with jaundice and healthy volunteers are included for testing the efficacy and accuracy of the screening test.
Key inclusion criteria (2 listed)
- Patients with jaundice
- Healthy volunteers
Key exclusion criteria (1 listed)
- Subjects who do not agree with study protocol.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Dry blood spot screeningDry blood spot measurement of biomarker for screening of cholestasis patients | Diagnostic test | – |
Primary outcome
Cholestasis
Time frame: on the time of enrollment
Direct bilirubin > 1.0mg/dl or Direct bilirubin to total bilirubin ratio > 0.2
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 14 May 2021.
- Individual participant dataSharing planned: No. No sharing plan
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Impact of Intrahepatic Cholestasis of Pregnancy on Neonatal Respiratory Outcomes
Intrahepatic Cholestasis of Pregnancy, Respiratory Distress Syndrome, Newborn
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Mei-Hwei Chang, MD principal investigator
National Taiwan University Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Cholestasis in Newborn Infant and Biliary Atresia, run by National Taiwan University Hospital at 1 site in Taiwan.
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 2 inclusion and 1 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 14 May 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Taiwan. 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?
Cholestasis (time frame: on the time of enrollment). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 14 May 2021.