The primary objective of this study is to reduce respiratory tract infections and wheezing in moderate-late preterms in the first years of life by bacterial lysate administration. Next to determine the correlation of biological markers with respiratory symptoms, immune protection and treatment effect.
This is a randomised placebo-controlled trial including 500 otherwise healthy moderate-late preterm infants. Participants will receive bacterial lysate (OM-85/Broncho-Vaxom, 3,5mg) or placebo powder for ten days each month, from 6-10 weeks after birth until 12 months after birth. At 12 months, parents of participants are asked to join in Protea-2. If they do, participants in the treatment arm of year 1 are randomised again over placebo and OM-85 and treated until the age of 24 months. Clinical data will be continuously collected by e-Health and 3 (possibly digital) study visits; with optional biological sampling and lung function at baseline, 6 and 12 months. And in case of participation in Protea-2 also at 24 months. Main study parameters are doctor diagnosed lower RTI and wheezing episodes in the first year of life. Biological sampling will allow investigation of immune maturation, as well as microbiome development in the respiratory tract and gut. Also, biomarkers for risk-group selection and/or treatment success will be examined.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
500
Broncho-Vaxom is a bacterial extract comprising lyophilised fractions of 21 different inactivated bacterial strains, which are frequently causing RTI.
Placebo powder from a capsule will be given, which will be indistinguishable from the active study drug.
Franciscus Gasthuis & Vlietland
Rotterdam, South Holland, Netherlands
RECRUITINGTotal number of physician diagnosed lower RTI and wheezing episodes in the first year of life
Recorded by frequent questionnaires
Time frame: In the first year of life.
Time to first lower RTI or wheezing episode
Recorded by short weekly questionnaires (which will be filled in during the first year of life) and more extensive questionnaires every six months in the first and second year of life.
Time frame: In the first and second year of life.
Total number of RTI
Recorded by short weekly questionnaires (which will be filled in during the first year of life) and more extensive questionnaires every six months in the first and second year of life.
Time frame: In the first and second year of life.
Total number of wheezing episodes
Recorded by short weekly questionnaires (which will be filled in during the first year of life) and more extensive questionnaires every six months in the first and second year of life.
Time frame: In the first and second year of life.
Distribution of viruses
Viruses present in the nasofarynx during complaints of lower respiratory tract infection or wheezing. Nasofaryngeal swabs will be taken in case of complaints during the first year of life. In the second year of life this will not be done.
Time frame: In the first year of life.
Medication use (bronchodilators, corticosteroids, antibiotics)
Recorded by short weekly questionnaires (which will be filled in during the first year of life) and more extensive questionnaires every six months in the first and second year of life.
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Time frame: In the first and second year of life.
Lung function as measured by expiratory variability index (Ventica)
Measured at age 6-10 weeks (baseline), 6 months and 12 months in a subset of participants.
Time frame: In the first year of life.
Quality of life questionnaires
Recorded by extensive questionnaires every six months in the first and second year of life.
Time frame: In the first and second year of life.
(serious) adverse events
Will be reported by parents immediately. Respiratory episodes are not regarded as an (S)AE since these episodes comprise primary and secondary outcomes. (S)AE's are only expected in the first year of life because the treatment stops at the age of 12 months.
Time frame: In the first year of life.
Serum specific IgE (allergen sensitization) at 12 months
Total IgE and house dust mite specific IgE
Time frame: At age 12 months
Infant vaccination titers at 12 months
Vaccination titers of haemohilus influenza type B, pneumococci, tetanus
Time frame: At age 12 months
Costs- and cost-effectiveness
Estimated from information from standardized questionnaires
Time frame: In the first and second year of life.