Intravenous magnesium sulfate for the management of severe hand, foot, and mouth disease with autonomic nervous system dysregulation in Vietnamese children: study protocol for a randomized controlled trial.
| Title: | Intravenous magnesium sulfate for the management of severe hand, foot, and mouth disease with autonomic nervous system dysregulation in Vietnamese children: study protocol for a randomized controlled trial. |
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| Authors: | Qui PT; Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. phantuqui@gmail.com.; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. phantuqui@gmail.com.; Khanh TH; Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam. truonghuukhanh@gmail.com.; Trieu HT; Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. huynhtrieu82@gmail.com.; Giang PT; Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. chuotchui1007@yahoo.com.; Bich NN; Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. drngocbich@yahoo.com.vn.; Thoa le PK; Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam. thoalephan@gmail.com.; Nhan le NT; Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam. drnhanbvnhidong1@yahoo.com.vn.; Sabanathan S; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. saras.whitehorn@googlemail.com.; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK. saras.whitehorn@googlemail.com.; Van Doorn R; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. hrogier@gmail.com.; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK. hrogier@gmail.com.; Toan ND; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. toannd@oucru.org.; Merson L; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. lmerson@oucru.org.; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK. lmerson@oucru.org.; Dung NT; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. dungntp@oucru.org.; Khanh LP; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. lampk@oucru.org.; Wolbers M; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. mwolbers@oucru.org.; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK. mwolbers@oucru.org.; Hung NT; Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam. drthanhhung@gmail.com.; Chau NV; Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam. chaunvv@oucru.org.; Wills B; Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam. bwills@oucru.org.; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK. bwills@oucru.org. |
| Source: | Trials [Trials] 2016 Feb 19; Vol. 17, pp. 98. Date of Electronic Publication: 2016 Feb 19. |
| Publication Type: | Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101263253 Publication Model: Electronic Cited Medium: Internet ISSN: 1745-6215 (Electronic) Linking ISSN: 17456215 NLM ISO Abbreviation: Trials Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BioMed Central, 2006- |
| MeSH Terms: | Clinical Protocols*; Autonomic Nervous System Diseases/*drug therapy ; Hand, Foot and Mouth Disease/*drug therapy ; Magnesium Sulfate/*administration & dosage; Hand, Foot and Mouth Disease/complications ; Magnesium Sulfate/adverse effects ; Milrinone/administration & dosage ; Data Interpretation, Statistical ; Double-Blind Method ; Humans ; Informed Consent ; Injections, Intravenous ; Sample Size |
| Abstract: | Background: Over the last 15 years, hand, foot, and mouth disease (HFMD) has emerged as a major public health burden across the Asia-Pacific region. A small proportion of HFMD patients, typically those infected with enterovirus 71 (EV71), develop brainstem encephalitis with autonomic nervous system (ANS) dysregulation and may progress rapidly to cardiopulmonary failure and death. Although milrinone has been reported to control hypertension and support myocardial function in two small studies, in practice, a number of children still deteriorate despite this treatment. Magnesium sulfate (MgSO4) is a cheap, safe, and readily available medication that is effective in managing tetanus-associated ANS dysregulation and has shown promise when used empirically in EV71-confirmed severe HFMD cases.; Methods/design: We describe the protocol for a randomized, placebo-controlled, double-blind trial of intravenous MgSO4 in Vietnamese children diagnosed clinically with HFMD plus ANS dysregulation with systemic hypertension. A loading dose of MgSO4 or identical placebo is given over 20 min followed by a maintenance infusion for 72 h according to response, aiming for Mg levels two to three times the normal level in the treatment arm. The primary endpoint is a composite of disease progression within 72 h defined as follows: development of pre-specified blood pressure criteria necessitating the addition of milrinone, the need for ventilation, shock, or death. Secondary endpoints comprise these parameters singly, plus other clinical endpoints including the following: requirement for other inotropic agents; duration of hospitalization; presence of neurological sequelae at discharge in survivors; and neurodevelopmental status assessed 6 months after discharge. The number and severity of adverse events observed in the two treatment arms will also be compared. Based on preliminary data from a case series, and allowing for some losses, 190 patients (95 in each arm) will allow detection of a 50 % reduction in disease progression with 90 % power at a two-sided 5 % significance level.; Discussion: Given the large numbers of HFMD cases currently being seen in hospitals in Asia, if MgSO4 is shown to be effective in controlling ANS dysregulation and preventing severe HFMD complications, this finding would be important to pediatric care throughout the region.; Trial Registration: ClinicalTrials.gov Identifier: NCT01940250 (Registered 22 August 2013). |
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| Grant Information: | United Kingdom WT_ Wellcome Trust |
| Molecular Sequence: | ClinicalTrials.gov NCT01940250 |
| Substance Nomenclature: | 7487-88-9 (Magnesium Sulfate); JU9YAX04C7 (Milrinone) |
| Entry Date(s): | Date Created: 20160221 Date Completed: 20161213 Latest Revision: 20240524 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC4759733 |
| DOI: | 10.1186/s13063-016-1215-6 |
| PMID: | 26896318 |
| Database: | MEDLINE |
Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't