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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Prospectively registered

Titles & IDs
Public title
A study of the impact of treating seizures that can be seen and those that can be seen only on a brain monitor in newborn babies, who are having seizures or at high risk of seizures.
Scientific title
A randomised controlled trial comparing the treatment of electrographic seizures and clinical seizures, to the treatment of clinical seizures alone, in term or near-term infants and measuring the impact on death and neurodevelopment at 2 years.
Secondary ID [1] 259792 0
Universal Trial Number (UTN)
Trial acronym
NEST (Neonatal Electrographic Seizure Trial)
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Neonatal Encephalopathy 261260 0
Neonatal seizures 261261 0
Hypoxic-ischemic encephalopathy (HIE) 261262 0
Condition category
Condition code
Neurological 259415 259415 0 0
Other neurological disorders
Reproductive Health and Childbirth 265617 265617 0 0
Complications of newborn

Study type
Description of intervention(s) / exposure
Amplitude integrated electroencephalography monitoring will be applied to consented newborn infants admitted to participating Neonatal Intensive Care Units. Infants will be randomized into two groups:

(1) Clinical seizure group (CSG) - infants who will recieve treatment of clinical seizures alone - this is standard treatment (electrographic seizures will not be revealed to the treating physician).

(2) Electrographic seizure group (ESG) - infants who will be treated for both clinical and electrographic seizures. Electrographic seizures will be detected by a bedside amplitude integrated EEG (aEEG) monitor. Monitoring will be applied for five days.

Treatment of seizures in both groups will follow a strict alogrithim based on current standard practice. Anticonvulsants used will include phenobarbitone, phenytoin and midazolam at standard clinical dosage.
Intervention code [1] 258117 0
Treatment: Other
Comparator / control treatment
Standard Treatment (Clinical seizure group) - The comparator used is the treatment of seizures detected on clinical seizure activity alone which is the standard of care in most Neonatal Intensive Care Units.
A conventional EEG(electroencephologram) will be taken for one hour at the first available opportunity to ensure infants are not in non-convulsive status epilepticus (infant will be withdrawn from the study if status is verified) and decisions to obtain further EEG's will be at the discretion of the primary medical team as per standard care.
Control group

Primary outcome [1] 262222 0
All cause mortality as assessed by data linkage to medical records.
Timepoint [1] 262222 0
At 2 years of age of participant unless death occurs during the intervention phase.
Primary outcome [2] 262223 0
Severe disability as defined as motor and/or cognitive delay more than one standard deviation below the mean (i.e. 15 points) measured with the Bayley Scales of Infant Development, 3rd edition
Timepoint [2] 262223 0
At 2 years of age of participant.
Secondary outcome [1] 273241 0
MRI injury - will be qualitatively scored using a previously published scoring system based on signal from the cortex, white matter and deep nuclear grey matter being scored as normal, mildly abnormal, moderately abnormal or severely abnormal. Scoring system is referenced in the following publication:
Inder TE. Wells SJ. Mogridge NB. Spencer C. Volpe JJ. Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. Journal of Pediatrics. 143(2):171-9, 2003 Aug.
Timepoint [1] 273241 0
10-14 days days of life.
Secondary outcome [2] 273350 0
Seizure burden - will be measured as the total duration of electrographic seizures for the duration of the intervention phase. Accumulative total number of seizure minutes will be calculated from both the medical record and the aEEG and recorded on the appropriate CRF.
Timepoint [2] 273350 0
10 - 14 days of life
Secondary outcome [3] 273572 0
Anti-convulsant use - throughout the inpatient period, anti-convulsant use will be entered daily into the CRF. Data verification will be performed using the participants medical records. Total dosage in mg/kg of each anticonvulsant used during initial inpatient stay will be recorded.

At 2 year follow up, anti-convulsant use will be assessed from parent recall/reporting and through access to the participants medical record. This data will be entered into the appropriate CRF.
Timepoint [3] 273572 0
Two time points:

1. During in-patient period
2. At 2 year follow up
Secondary outcome [4] 273573 0
Length of inpatient stay during initial admission- will be calculated from recorded time of admission to recorded time of discharge (Hours/Days) as per the participants medical record. This figure will be entered into the appropriate CRF.
Timepoint [4] 273573 0
Discharge from hospital
Secondary outcome [5] 273574 0
Development of epilepsy - will be assessed from parent reporting and medical record data. This outcome will be dependent upon the participant fulfilling the clinical diagnosis of epilepsy ascribed by the treating paediatrician or neurologist. This diagnosis will be recorded on the appropriate CRF.
Timepoint [5] 273574 0
At 2 year follow up
Secondary outcome [6] 273575 0
Time to full suck feeds - will be assessed and verified from the participants medical record and clinical medical/nursing team. Participants will be assessed as having achieved full suck feeds when they are able to suck all of their feeds for a full 24 hour period, without supplemental feeds via a nasogastric tube.
Timepoint [6] 273575 0
During in-patient period

Key inclusion criteria
Infants less than or equal to 35 weeks gestation (term or near-term) admitted to a participating Neonatal Intensive Care Unit;

Less than or equal to 48 hours old;

A diagnosis of either:
- Neonatal encephalopathy including coma, stupor or depressed mental state (based on modified Sarnat classification II-III)
- Hypoxic-ischemic encephalopathy or at risk for hypoxic-ischemic encephalopathy (i.e. 2 of the following - apgar score less than 5 at 5 minutes; cord clood gas or postnatal blood gas within 1 hour of birth with a pH less than 7.1 or base excess of greater than -12 within 1 hour of birth; need for ongoing respiratory support at 10 minutes after birth)
- Suspected neonatal seizures
Minimum age
1 Hours
Maximum age
48 Hours
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Infants less than 35 weeks gestation;

Greater than 48 hours old;

Infants in non-convulsive status (as confirmed by conventional electroencephalography taken for one hour as soon as practical);

Infants diagnosed with Cerebral dysgenesis

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Potential subjects will be identified by study staff located at participating sites and the parents will be approached to determine their interest in participation in the project. Those parents who express interest will be provided with an information statement and consent form. All ethical and ICH/GCP procedures will be adhered to in respect to the consent process.

Once informed consent has been obtained by the Principal Investigator or his/her delegate, the infant will be randomized by the site via a web based randomisation procedure available 24 hours per day. Should access to the internet be disrupted for any reason, investigators will be able to call the Coorodinating centre on a mobile number for manual randomisation.

Investigators will be required to enter basic subject data such as age, gender, diagnosis at the time of randomisation. Treatment allocation will then be computer generated. Investigators will not be able to influence treatment allocation.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Randomisation has been stratified by diagnosis - Hypoxic-ischemic encephalopathy or other. Therefore, there will be 2 strata.

Treatment allocation is then computer generated using block randomisation with variable block sizes by an independent statistician.
Masking / blinding
Who is / are masked / blinded?

The people assessing the outcomes
Intervention assignment
Other design features
Due to the design of this study it is not possible to conceal treatment allocation from the parents or the treating clinicians as it will be obvious which infants have their monitor covered.

However, at the 2 year follow up the psychologist conducting the assessment of the primary outcome, will effectively be blinded to treatment allocations as they will not have been involved in the inpatient care of the participating infants and parents will be asked not to reveal their treatment allocation to the psychologist.
Not Applicable
Type of endpoint(s)
Statistical methods / analysis

Recruitment status
Active, not recruiting
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment in Australia
Recruitment state(s)
Recruitment postcode(s) [1] 3665 0
Recruitment postcode(s) [2] 3663 0
Recruitment postcode(s) [3] 3664 0
Recruitment postcode(s) [4] 3662 0
Recruitment postcode(s) [5] 3666 0
Recruitment postcode(s) [6] 3661 0
Recruitment postcode(s) [7] 7782 0
3168 - Clayton
Recruitment postcode(s) [8] 3668 0
Recruitment postcode(s) [9] 3667 0
Recruitment postcode(s) [10] 7783 0
4870 - Cairns
Recruitment postcode(s) [11] 3669 0
Recruitment postcode(s) [12] 3671 0
Recruitment postcode(s) [13] 3670 0
Recruitment outside Australia
Country [1] 5834 0
State/province [1] 5834 0
Country [2] 5835 0
State/province [2] 5835 0

Funding & Sponsors
Funding source category [1] 264676 0
Government body
Name [1] 264676 0
National Health and Medical Research Council
Address [1] 264676 0
Level 1
16 Marcus Clarke Street
Canberra ACT 2601
Country [1] 264676 0
Primary sponsor type
Murdoch Childrens Research Institute
Flemington Road
Parkville Victoria 3052
Secondary sponsor category [1] 263810 0
Name [1] 263810 0
Address [1] 263810 0
Country [1] 263810 0

Ethics approval
Ethics application status
Ethics committee name [1] 266670 0
The Royal Children's Hospital, Melbourne
Ethics committee address [1] 266670 0
50 Flemington Road
PARKVILLE Victoria 3052
Ethics committee country [1] 266670 0
Date submitted for ethics approval [1] 266670 0
Approval date [1] 266670 0
Ethics approval number [1] 266670 0

Brief summary
Doctors know that seizures occur more often in babies than older children. Seizures in babies may result in damage to their brain that may lead to epilepsy or affect their learning, thinking and memory. There is not a lot of research as to the best way to treat seizures in babies and to protect their brain function.

The aim of this research project is to compare the treatment of seizures that are physically seen by doctors and nurses (standard clinical care) to when seizures are detected using an amplitude integrated electroencephalograph monitor (aEEG), to see which method is better at protecting brain function in the longer term.

We hope a total of 630 babies will take part in this study. Half of the babies will receive standard treatment and half will be treated when a seizure is seen on the aEEG monitor. After the babies have been discharged from hospital we will follow them up at 2 years of age to assess their development.

This research project is important because it may change the way doctors treat seizures in babies in the future, and we want to make sure that our treatment is protecting the babies brain.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 32234 0
A/Prof Rod Hunt
Address 32234 0
Director Neonatal Services
The Royal Children's Hospital
50 Flemington Road
Parkville Victoria 3052
Country 32234 0
Phone 32234 0
+61 3 9345 5008
Fax 32234 0
Email 32234 0
Contact person for public queries
Name 15481 0
Ms Samantha Francis-Pester
Address 15481 0
Neonatal Research
Level 4, West Building
Murdoch Childrens Research Institute
The Royal Children's Hospital
50 Flemington Road
PARKVILLE Victoria 3052
Country 15481 0
Phone 15481 0
+61 3 9936 6684
Fax 15481 0
Email 15481 0
Contact person for scientific queries
Name 6409 0
A/Prof Rod Hunt
Address 6409 0
Director, Neonatal Services
The Royal Childrens Hospital
50 Flemington Road
PARKVILLE Victoia 3052
Country 6409 0
Phone 6409 0
+61 3 3945 5008
Fax 6409 0
Email 6409 0

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary