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CompletedNCT04419857Updated Jun 30, 2026Results posted

A Trial to Determine Weight Gain Benefits of Caloric Supplementation for NAS Infants

An interventional study of High-calorie formula in Neonatal Abstinence Syndrome, sponsored by Yale University. Completed at 1 site in United States. Per ClinicalTrials.gov, last updated 2026-06-30.

Sponsored by Yale University · Not applicable, Interventional, and Supportive care

Phase
Not applicable
Study type
Interventional
Enrollment
39
Allocation
Randomized
Sex
All
01

Study summary

A randomized clinical study in NAS infants managed via the Eat, Sleep, Console (ESC) approach comparing early weight loss on a standard-caloric density versus high-caloric density feeding regimen.

Read the detailed description

The aims of the study is to systematically evaluate the benefit of high-caloric diet regimens given to NAS infants in the first three weeks of life. Breastfeeding is the preferred feeding method for NAS infants as it has shown to reduce NAS severity and infant weight loss, though women who are not adherent to drug treatment programs or have the potential to use illicit drugs are not able to breastfeed due to the risks posed to the infant. Several studies have demonstrated the potential for caloric enhancement of formula and breast milk to support weight gain in NAS infants. Through a randomized control trial analyzing infant weight gain on standard-calorie vs. high-calorie diet regimens, we aim to quantify weight patterns in NAS infants and show that increasing caloric intake can improve weight gain.

02

Conditions studied

  • Neonatal Abstinence Syndrome

Keywords

  • high-caloric diet regimens
03

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
All
Accepts healthy volunteers
No

Eligibility criteria

Infant Inclusion Criteria:

  • Infants with NAS born to mothers age 18-45 with methadone exposure before or during pregnancy who do not intend to place their infants for adoption
  • Infants > 2200 g Infants at least 36 weeks gestational age
  • Delivered at: Yale New Haven Hospital
  • Mothers/infants able to return to outpatient pediatric provider for 2 month and 4 month weights visits

Infant Exclusion Criteria:

  • Infants with major congenital malformations
  • Infants enrolled to NICU >24 hours for medical conditions other than NAS treatment before 3 days of life

Mother's Inclusion criteria -

  • Pregnant women (age 18-45) who have started methadone treatment at obstetrics or other YNHH appointments
  • Confirm methadone treatment is received from a licensed treatment program
  • Confirm that mothers are planning to deliver their infant(s) at Yale New Haven Hospital
  • Confirm that mothers do not intend to place the infant(s) for adoption
  • Confirm mother's willingness to participate in the study (including attending the 2-month and 4-month follow up weigh-ins with pediatrician)
  • Consent forms will be signed and faxed to study staff
04

Study design

Phase
Not applicable
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
39 participants (actual)

Study arms

  • Experimental
    High-calorie formula

    Infant randomly assigned to high-calorie formula for 14 days

    Dietary Supplement: High-calorie formula

  • No intervention
    Standard calorie formula

    Infant randomly assigned to standard-calorie formula for 14 days

Interventions

  • Dietary supplementHigh-calorie formula

    Infant randomly assigned to high-calorie formula for 14 days

05

What researchers measure

Primary outcomes

  1. Maximal Percent Weight Loss Compared to Birth Weight

    this will be measured by twice daily weights while in the hospital and once daily weights at home for two weeks after birth compared with birth weight

    Time frame: 2 weeks

Secondary outcomes

  1. Median Days to Weight Nadir

    Measured by determining the days of life that the maximal percent weight loss was obtained for each patient, assessed within the first two weeks after birth

    Time frame: 2 weeks

  2. Number of Participants That Return to Birthweight

    Number of participants that regained birthweight, assessed within the first month after birth

    Time frame: 1 month

  3. Percent Weight Change Per Day

    Measured by comparing the weight from the weight obtained the day prior, assessed daily for the first 7 days after birth

    Time frame: first 7 days after birth

  4. Length of Hospital Stay

    Measured by comparing admission time to discharge time, assessed at hospital discharge

    Time frame: up to 6.5 days

06

Results

Posted Jun 30, 2026
Limitations and caveats
Study limitations include a small sample size and limited post-discharge retention. In the high-calorie arm, breastmilk was not fortified to 24 kcal/oz however, low intake (average 2 feeds/day) likely biased results toward the null. Additionally, infants with \> 12% weight loss were excluded per protocol for safety. While this may impact weight loss findings, it prioritized patient safety and maintained consistency with the study design.

Participant flow

Participant flow — Overall Study
MilestoneStandard Calorie FormulaHigh-calorie Formula
Started1619
Completed1619
Not completed00

Outcome measures

PrimaryMaximal Percent Weight Loss Compared to Birth Weight

this will be measured by twice daily weights while in the hospital and once daily weights at home for two weeks after birth compared with birth weight

Time frame:
2 weeks
Reported as:
Median · percent weight loss
Maximal Percent Weight Loss Compared to Birth Weight
percent weight lossStandard Calorie FormulaHigh-calorie Formula
Maximal Percent Weight Loss Compared to Birth Weight-5.4 (-7.7 to -4.0)-9.1 (-10.4 to -8.2)
Statistical analysis
  • Standard Calorie Formula vs High-calorie Formula · Mixed Models Analysis · p = 0.12
SecondaryMedian Days to Weight Nadir

Measured by determining the days of life that the maximal percent weight loss was obtained for each patient, assessed within the first two weeks after birth

Time frame:
2 weeks
Reported as:
Median · days
Median Days to Weight Nadir
daysStandard Calorie FormulaHigh-calorie Formula
Median Days to Weight Nadir3.5 (2.0 to 5.0)4.0 (3.0 to 4.0)
Statistical analysis
  • Standard Calorie Formula vs High-calorie Formula · Mixed Models Analysis · p = 0.61
SecondaryNumber of Participants That Return to Birthweight

Number of participants that regained birthweight, assessed within the first month after birth

Time frame:
1 month
Reported as:
Count of participants · Participants
Number of Participants That Return to Birthweight
ParticipantsStandard Calorie FormulaHigh-calorie Formula
Yes89
No37
Unknown53
SecondaryPercent Weight Change Per Day

Measured by comparing the weight from the weight obtained the day prior, assessed daily for the first 7 days after birth

Time frame:
first 7 days after birth
Reported as:
Mean · percentage weight change
Percent Weight Change Per Day
percentage weight changeStandard Calorie FormulaHigh-calorie Formula
Day 1-1.43 ± 1.95-2.76 ± 2.16
Day 2-4.85 ± 1.99-6.50 ± 3.5
Day 3-4.99 ± 3.2-8.52 ± 1.92
Day 4-5.7 ± 3.0-8.70 ± 2.50
Day 5-5.67 ± 3.65-8.17 ± 3.02
Day 6-5.29 ± 5.01-7.00 ± 2.85
Day 7-2.34 ± 9.48-5.94 ± 3.27
Statistical analysis
  • High-calorie Formula · Mixed Models Analysis · p = <0.001
  • Standard Calorie Formula · Mixed Models Analysis · p = 0.034
SecondaryLength of Hospital Stay

Measured by comparing admission time to discharge time, assessed at hospital discharge

Time frame:
up to 6.5 days
Reported as:
Mean · days
Length of Hospital Stay
daysStandard Calorie FormulaHigh-calorie Formula
Length of Hospital Stay4.4 ± 2.54.1 ± 1.4

Adverse events

Collected over 1 month. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Standard Calorie Formula0/16 (0%)0/16 (0%)1/16 (6.3%)
High-calorie Formula0/19 (0%)0/19 (0%)3/19 (15.8%)
Most frequent other events
Most frequent other events
EventStandard Calorie FormulaHigh-calorie Formula
Weight lossMetabolism and nutrition disorders1/163/19

Baseline characteristics

Age, Continuous
Age, Continuous(weeks)Standard Calorie FormulaHigh-calorie FormulaTotal
Mean39.4 ± 1.238.9 ± 1.639.1 ± 1.4
Sex: Female, Male
Sex: Female, Male(Participants)Standard Calorie FormulaHigh-calorie FormulaTotal
Female61117
Male10818
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Standard Calorie FormulaHigh-calorie FormulaTotal
American Indian or Alaska Native000
Asian000
Native Hawaiian or Other Pacific Islander000
Black or African American011
White161733
More than one race000
Unknown or Not Reported011
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Standard Calorie FormulaHigh-calorie FormulaTotal
Hispanic or Latino112
Not Hispanic or Latino151631
Unknown or Not Reported022
Birth weight
Birth weight(kilograms)Standard Calorie FormulaHigh-calorie FormulaTotal
Mean3.0 ± 0.42.9 ± 0.53.0 ± 0.5
Head Circumference
Head Circumference(centimeters)Standard Calorie FormulaHigh-calorie FormulaTotal
Mean33.2 ± 1.632.9 ± 2.333.0 ± 2.0
Gestational Age
Gestational Age(weeks)Standard Calorie FormulaHigh-calorie FormulaTotal
Mean39.4 ± 1.238.9 ± 1.639.1 ± 1.4
Delivery, Vaginal
Delivery, Vaginal(Participants)Standard Calorie FormulaHigh-calorie FormulaTotal
Count of participants111122

8 further baseline measures are reported on the registry.

07

Study locations

1 site
  • Yale New Haven Hospital
    New Haven, Connecticut 06512, United States
08

References and documents

Study documents

  • Protocol and statistical analysis plan · Sep 8, 2021
  • Informed consent form · Sep 8, 2021

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT04419857
Lead sponsor
Yale University
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Responsible party
Sponsor
First posted
Jun 5, 2020
Start date
Dec 4, 2020
Primary completion
May 1, 2025
Completion
May 1, 2025
Results posted
Jun 30, 2026
Last update
Jun 30, 2026

Study contacts

Matthew Grossman, MD
principal investigator · Yale University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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