AzTrials
AzTrials

Surfactant Deficiency Syndrome NeonatalFAST2NCT05638568

Fast Assessment of Surfactant Deficiency in Preterm Infants to Speed up Treatment

A study testing LS test in people with Surfactant Deficiency Syndrome Neonatal and Respiratory Distress Syndrome, Newborn, run by Copenhagen University Hospital, Rigshospitalet at 4 sites in Denmark.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
Search all trials

Trial summary

Recently the investigators have developed a point of care test (LS-test) to measure surfactant as lecithin in gastric aspirates from preterm infants. This test can be done immediately at delivery and potentially be used to guide surfactant treatment. Read more about this study

Who is it for?
Ages Up to 45 minutes
What is being tested?
LS test
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
4 sitesDenmark
Study dates
1 Jul 2024to 1 Jan 2029
Phase
Interventional
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 Up to 45 minutes
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • GA ≤ 29+6, inborn at a participating centre
  • Age less than 45 minutes as GAS must be sampled within 45 minutes from delivery.

Who cannot join

  • Treated with surfactant before randomisation and obtaining gastric aspirates
  • Diagnosis of major malformations (major congenital heart defects, congenital diaphragmatic hernia, gastroschisis/omphalocele, pulmonary abnormalities including pulmonary hypoplasia and trachea-oesophageal fistula
  • Antenatal suspicion of significant oligohydramnios and lung hypoplasia
  • Any intrauterine intervention except if done for genetic testing

Trial locations and contacts

4 sites in 1 country.

Denmark4 sites
  • Aalborg University Hospital

    Aalborg, 9000

  • Aarhus Universtity Hospital

    Aarhus, 8200

  • Department of Neonatology, Rigshospitalet

    Copenhagen, 2100

  • Odense University Hospital

    Odense

Other trials in Denmark

About this study

Official title: FAST TRIAL 2 - Fourier-transform Infrared Spectroscopy(FTIR) Guided Surfactant Therapy - RCT

Recently the investigators have developed a point of care test (LS-test) to measure surfactant as lecithin in gastric aspirates from preterm infants.

This test can be done immediately at delivery and potentially be used to guide surfactant treatment.

To obtain evidence-based knowledge on harms and benefit of surfactant therapy guided by the L/S test, a randomized clinical trial with relevant clinical short-and long-term outcomes needs to be performed, which is why the FAST 2 Trial has been designed.

Read the detailed description

Treatment of respiratory distress syndrome (RDS) has evolved greatly over the past three decades. Major advances in treatment include antenatal steroids, early nasal continuous positive airway pressure (nCPAP) combined with early rescue surfactant replacement strategies such as Intubation Surfactant Extubation (INSURE) and Less Invasive Surfactant Administration (LISA), together with use of lung protective ventilation and overall reduced use of mechanical ventilation. However, RDS and bronchopulmonary dysplasia (BPD) are still major causes of mortality and morbidity in premature infants. To improve the outcome, very early treatment with surfactant is necessary. However, only about half of infants with a gestational age (GA) below 30 weeks need surfactant treatment and prophylactic surfactant treatment increases the combined mortality and incidence of BPD contrary to selective rescue surfactant treatment. Therefore, there is a need for a rapid test to guide early targeted surfactant treatment.

The investigators have recently developed a new test of lung maturity based on measuring the lecithin sphingomyelin ratio (L/S) in fresh gastric aspirates (GAS) from newborn preterm infants using mid-red Fourier Transform Infrared spectroscopy (FTIR). The sphingomyelin concentration in amniotic fluid and accordingly in GAS is relatively constant during the pregnancy, whereas the lecithin (or dipalmitoylphosphatidylcholine (DPPC), the lung surfactant phospholipid with the highest surface activity) concentration increases with the lung maturation.

It has been demonstrated in clinical observational trials that this laboratory based L/S-test predicts development of RDS when measured immediately at delivery (FAST 1 Trial).

The L/S-test has now been developed into an easy-to-use Point of Care (POC) test for bedside use that expresses the L/S ratio in approximately 10 minutes. It is believed this new POC test can be used to guide surfactant therapy, enabling very early rescue treatment, potentially even before symptoms occur.

To obtain evidence-based knowledge on harms and benefit of surfactant therapy guided by the L/S test, a randomized clinical trial with relevant clinical short-and long-term outcomes needs to be performed, which is why the FAST 2 Trial has been designed.

During design and development of the FAST 2 Trial protocol extensive engineering work has been conducted towards building a fully automated L/S POC Device (AIMI 1.0/2.0) from the prototypes in the first L/S studies (including FAST 1 Trial).

During this process the accuracy of the L/S algorithm has been improved through machine learning and use of artificial intelligence. Consequently, the previously defined cut-off ratio from the FAST 1 Trial needs to be re-validated using the L/S POC Device in a new population of preterm infants.

The FAST 2 Trial therefore consists of two individual studies starting with the FAST 2 Validation Study which will followed by the FAST 2 Randomized Clinical Trial (FAST 2 RCT) once completed. The FAST 2 Validation study has been registered separately on clinicaltrials.gov (NCT05615428).

This registration concerns the FAST 2 RCT

Participants:

Preterm newborn infants with gestational age at birth of ≤ 29+6 weeks who have not received prophylactic surfactant.

Intervention:

Surfactant treatment guided by fast determination of the L/S-ratio in a fresh gastric aspirate (GAS) obtained at birth, measured by Fourier Transform Mid-infrared Spectroscopy as a POC test.

Comparison:

Standard rescue surfactant treatment based on clinical criteria defined by the European Consensus Guidelines on the management of Respiratory Distress Syndrome

Outcome:

Infants surviving without moderate to severe BPD assessed at 36 weeks post menstrual age as per a modified NIH definition

The primary outcome is a composite of survival without moderate to severe BPD, defined as per a modified "NIH definition"

The primary objective is to compare the rate of survival without moderate to severe BPD between 2 groups:

  • L/S guided treatment of surfactant deficiency with exogenous surfactant (intervention group) vs.
  • Standard treatment of surfactant deficiency (comparison).
Being tested
LS test
Keywords
surfactant assay, surfactant replacement therapy
Medical subject headings
Pulmonary Atelectasis, Respiratory Distress Syndrome, Newborn, Bronchopulmonary Dysplasia

What participants receive

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

  • LS testDiagnostic test

    If the LS test indicated surfactant deficiency based on the cut off ratio early surfactant treatment will be done for patients in the intervention group If the LS test indicated no surfactant deficiency routine surfactant treatment will be done as per European RDS guidelines based on oxygen requirement (FiO2 > 0.30)

Study groups in NCT05638568
Study groupRoleWhat they receive
Intervention arm LS guided treatmentExperimentalall participating infants will have a gastric aspirate (GAS) sampled at birth within 45 minutes of life. The GAS will be analyzed immediately at the bedside by a LS-test POC device. For infants allocated to the interventional group the LS-result will be displayed as "treat with surfactant" or " do not treat with surfactant" depending on wether the LS-ratio is under or above the cut-off ratio for treatment. Those with LS-ratio above the cut-off ratio will be treated with surfactant as per routine in accordance with the European RDS guidelines based on oxygen requirement (FiO2 > 0.30) - ie same as in control group.
Receives: Diagnostic Test: LS test
Control arm - routine surfactant treatmentNo interventionall participating infants will have a gastric aspirate (GAS) sampled at birth within 45 minutes of life. The GAS will be analyzed immediately at the bedside by a LS-test POC device, but result will remain blinded. Infants allocated to the control group will be treated with surfactant as per routine in accordance with the European RDS guidelines based on oxygen requirement (FiO2 > 0.30). The LS-ratio for those infants will remain blinded

What is being measured

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

  1. Survival without moderate to severe bronchopulmonary dysplasia (BPD)

    BPD is defined as per a modified "NIH definition" in which any degree of respiratory support for at least 28 days is considered equal to the need for oxygen:

    • Treatment with oxygen > 21% or any degree of respiratory support for a least 28 days plus
    • Need for treatment with oxygen > 21% or any degree of respiratory support at PMA 36 weeks or at discharge, whichever comes first.

    Definitions:

    • Moderate BPD is defined as treatment with oxygen > 21% or any degree of respiratory support for a least 28 days plus need of supplemental oxygen from >21% to < 30% (as low flow O2) at 36+0 weeks PMA
    • Severe BPD is defined as treatment with oxygen > 21% or any degree of respiratory support for a least 28 days plus need of > 30% oxygen and/or continuous need for any level of respiratory support providing positive airway pressure (nHFT, nCPAP, NIV or mechanical ventilation)

    Measured: at 36 weeks PMA or discharge withever comes first

Secondary outcomes (13)
  1. mortality

    assessed at discharged

    Measured: From date of birth until the date of death if this happens before discharge

  2. Bronchopulmonary dysplasia

    BPD is defined as per a modified "NIH definition" in which any degree of respiratory support for at least 28 days is considered equal to the need for oxygen:

    • Treatment with oxygen > 21% or any degree of respiratory support for a least 28 days plus
    • Need for treatment with oxygen > 21% or any degree of respiratory support at PMA 36 weeks or at discharge, whichever comes first.

    Definitions:

    • Moderate BPD is defined as treatment with oxygen > 21% or any degree of respiratory support for a least 28 days plus need of supplemental oxygen from >21% to < 30% (as low flow O2) at 36+0 weeks PMA
    • Severe BPD is defined as treatment with oxygen > 21% or any degree of respiratory support for a least 28 days plus need of > 30% oxygen and/or continuous need for any level of respiratory support providing positive airway pressure (nHFT, nCPAP, NIV or mechanical ventilation)

    Measured: at 36 weeks PMA or discharge withever comes first

  3. LS-ratio

    POC measurement using FTIR Spectroscopy

    Measured: 72 hours

  4. Nectrotizing enterocolitis

    According to Bell classification/AXR

    Measured: From date of birth to 44 weeks of gestational age (usually around 18 weeks)

  5. Spontaneous intestinal perforation

    As diagnosed on AXR

    Measured: From date of birth to 44 weeks of gestational age (usually around 18 weeks)

  6. Intraventricular hemorhage

    According to Papile classification

    Measured: From date of birth to 44 weeks of gestational age (usually around 18 weeks)

  7. Airleak

    Assessed on CXR or lung ultrasound

    Measured: From date of birth to 44 weeks of gestational age (usually around 18 weeks)

  8. surfactant treatment,

    from medical record

    Measured: 72 hours

  9. surfactant treatmentdose,

    from medical record

    Measured: 72 hours

  10. number of surfactant treatments,

    from medical record

    Measured: 72 hours

  11. timing surfactant treatments,

    from medical record

    Measured: 72 hours

  12. gastric aspirate obtained

    from medical record

    Measured: 72 hours

  13. gastric aspirate analyzed

    from medical record

    Measured: 72 hours

Timeline

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

  1. First posted6 Dec 2022
  2. Study start1 Jul 2024 (estimated)
  3. Primary completion1 Jul 2028 (estimated)
  4. Study completion1 Jan 2029 (estimated)

Why it stopped: Concerns about the validity of the method

Resources

More details

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

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Model description
all participating infants will have a gastric aspirate (GAS) sampled at birth within 45 minutes of life. The GAS will be analyzed bedside by a LS-test POC device. For infants allocated to the interventional group the LS-result will be displayed as "treat with surfactant" or " do not treat with surfactant" depending on wether the LS-ratio is under or above the cut-off ratio for treatment. Those with LS-ratio above the cut-off ratio will be treated with surfactant as per routine in accordance with the European RDS guidelines based on oxygen requirement (FiO2 \> 0.30) Infants allocated to the control group will be treated with surfactant as per routine in accordance with the European RDS guidelines based on oxygen requirement (FiO2 \> 0.30). The LS-ratio for those infants will remain blinded
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05638568
Sponsor's protocol ID
H-22007105 RCT Study
Acronym
FAST2
Status last verified
Nov 2023
First submitted
7 Nov 2022
Last updated
7 May 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Questions about this trial

What is this clinical trial studying?

A study testing LS test in people with Surfactant Deficiency Syndrome Neonatal and Respiratory Distress Syndrome, Newborn, run by Copenhagen University Hospital, Rigshospitalet at 4 sites in Denmark.

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 4 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: withdrawn, as of the sponsor's last update on 7 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Denmark. 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?

The study was withdrawn before enrolling participants, so there are no results.

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?

Survival without moderate to severe bronchopulmonary dysplasia (BPD) (time frame: at 36 weeks PMA or discharge withever comes first). 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 7 May 2025.

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