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Katheria AC, Schmölzer GM, Law B, Yoder BA, Clark E, El-Naggar W, Morales A, Dorner RA, Mooso B, Rich W, Vora F, Finer N. Parental perspectives on a trial using waived informed consent at birth. J Perinatol 2024; 44:415-418. [PMID: 38129598 DOI: 10.1038/s41372-023-01853-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To determine parental perspectives in a trial with waived consent. STUDY DESIGN Anonymous survey of birth parents with term infants who were randomized using a waiver of consent, administered after infant discharge. RESULTS 121 (11%) survey responses were collected. Of the 121 responding parents 111 (92%) reported that this form of consent was acceptable and 116 (96%) reported feeling comfortable having another child participate in a similar study. 110 (91%) respondents reported that they both understood the information provided in the consent process and had enough time to consider participation. Four percent had a negative opinion on the study's effect on their child's health. CONCLUSIONS Most responding parents reported both acceptability of this study design in the neonatal period and that the study had a positive effect on their child's health. Future work should investigate additional ways to involve parents and elicit feedback on varied methods of pediatric consent.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA.
| | | | - Brenda Law
- University of Alberta, Edmonton, AB, Canada
| | | | - Erin Clark
- University of Utah, Salt Lake City, UT, USA
| | | | - Ana Morales
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
| | - Rebecca A Dorner
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
| | - Benjamin Mooso
- University of California at San Diego, San Diego, CA, USA
| | - Wade Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
| | - Farha Vora
- Loma Linda University, Loma Linda, CA, USA
| | - Neil Finer
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
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Katheria A, Schmolzer G, Law B, Yoder B, Clark E, El-Naggar W, Morales A, Dorner R, Mooso B, Rich W, Vora F, Finer N. Parental Perspectives on a Trial Using Waived Informed Consent at Birth. RESEARCH SQUARE 2023:rs.3.rs-3487820. [PMID: 37961362 PMCID: PMC10635395 DOI: 10.21203/rs.3.rs-3487820/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objectives To determine parental perspectives in a trial with waived consent. Study Design Biological parents of non-vigorous term infants randomized using a waiver of consent for a delivery room intervention completed an anonymous survey after discharge. Results 121 survey responses were collected. Most responding parents reported that this form of consent was acceptable (92%) and that they would feel comfortable having another child participate in a similar study (96%). The majority (> 90%) also reported that the information provided after randomization was clear to understand future data collection procedures. Four percent had a negative opinion on the study's effect on their child's health. Conclusions The majority of responding parents reported both acceptability of this study design in the neonatal period and that the study had a positive effect on their child's health. Future work should investigate additional ways to involve parents and elicit feedback on varied methods of pediatric consent.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Wade Rich
- Sharp Mary Birch Hospital for Women & Newborns
| | - Farha Vora
- Loma Linda University Children's Hospital
| | - Neiil Finer
- Sharp Mary Birch Hospital for Women & Newborns
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Fairchild K. Assisted ventilation prior to umbilical cord clamping: Potential benefits, challenges, and research studies. Semin Perinatol 2023:151788. [PMID: 37380529 DOI: 10.1016/j.semperi.2023.151788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Delayed cord clamping (DCC) is beneficial for many infants, and the American College of Obstetrics and Gynecology recommends at least 30-60 seconds of DCC for both term and preterm vigorous infants. For newly born infants that are not vigorous, some evidence in animal models suggests that providing assisted ventilation prior to cord clamping (V-DCC) leads to a more stable transition of cerebral, pulmonary and systemic circulation and oxygenation and may confer not only short-term physiologic benefits but perhaps also improvement in clinically important outcomes. This review is based around 7 questions to help the reader understand the physiologic underpinnings and challenges of V-DCC as well as the published and ongoing research studies aimed at determining whether V-DCC is beneficial for preterm or term infants.
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Affiliation(s)
- Karen Fairchild
- Division of Neonatology, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA 22908, USA.
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Abstract
Children are considered a vulnerable population and have traditionally been excluded from research studies. This exclusion of children in general, and neonates in particular, from clinical research hampers the development of safe and effective therapies in this population. However, research involving children (including infants) is essential to guide therapy and optimize care. Neonatal research is complex, time intensive, difficult and expensive to conduct, and raises some unique ethical considerations. The complexity of research in this population is highlighted by the fear of causing harm to fragile sick infants which has led to the creation of special regulations on the degree of risk exposure permissible in research involving infants. This is further compounded by the inability of infants to provide informed consent or assent and the reliance on obtaining surrogate consent from parents who may themselves be vulnerable and overwhelmed by their infant's illness and the amount of information provided to them. In this review, we discuss the evolution of ethical regulations related to research, the justification for research in infants, and some of the ethical nuances of research in this population.
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Affiliation(s)
- Sunil Krishna
- Department of Pediatrics, University of Illinois College of Medicine, Rockford, IL
| | - Mamta Fuloria
- Division of Neonatology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
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Abstract
Deferred consent has gained traction in some countries as a possible adjunct to prospective consent for evaluating emergency therapies in the neonatal population. This form of consent has been shown to increase recruitment of acutely and critically unwell patients, potentially reduce parent decision-making burden, and provide more robust evidence for clinical treatments where equipoise exists. However, deferred consent raises complex ethical concerns and guidelines for its use vary across different jurisdictions. The views of all stakeholders, including neonatal providers and parents, are important in determining the appropriateness of deferred consent in high-risk patients. Deferred consent may be ethically justifiable for assessing various treatments, particularly those used in emergency medical management. We present a framework based on neonatal deferred consent trials that assess both non-drug and drug interventions, our experience conducting deferred consent neonatal studies in Australia, and the views of providers and parents on how to best implement deferred consent in the neonatal research setting.
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Special issues raised by evolving areas of clinical research. ETHICAL CONSIDERATIONS WHEN PREPARING A CLINICAL RESEARCH PROTOCOL 2020. [PMCID: PMC7329119 DOI: 10.1016/b978-0-12-386935-7.00014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Each study presents its own set of ethical considerations. Certain kinds of ethical issues are inherent in particular areas of clinical research, regardless of specific ethical questions associated with a specific study. In this chapter, some of the most common special areas of clinical research are presented, highlighting the ethical issues most frequently associated with each.
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Rich WD, Katheria AC. Waived Consent in Perinatal/Neonatal Research-When Is It Appropriate? Front Pediatr 2019; 7:493. [PMID: 31850290 PMCID: PMC6901905 DOI: 10.3389/fped.2019.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022] Open
Abstract
Informed consent is a process ensuring that subjects enrolled in research are appropriately informed of the risks and benefits. While this process is well-defined when it is possible and practical to obtain consent prior to the research intervention, it can be less clear in cases of deferred or waived consent. Defining minimal risk, such as when research is attempting to determine which of two currently practiced interventions is safest and/or most effective, is critical to moving forward in establishing appropriate care in newborns. For perinatal/neonatal research the challenge lies between the ethical justification for approaching women in labor or under medication vs. the scientific integrity of excluding a number of subjects that may potentially benefit the most from an intervention. Researchers must work with their IRBs as well as families who have participated in trials to determine the most appropriate method for obtaining informed consent from expectant parents. Clinical researchers and IRBs ultimately need to find a middle ground for the appropriate use of deferred or waived consent.
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Affiliation(s)
- Wade D Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States
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8
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Walsh V, Oddie S, McGuire W. Ethical Issues in Perinatal Clinical Research. Neonatology 2019; 116:52-57. [PMID: 30947194 DOI: 10.1159/000494934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Perinatal clinical research to improve the quality of care and outcomes for newborn infants relies on transparency, trust, and respect for the autonomy and well-being of study participants and their families. METHODS Here we consider the underpinning principles of ethical research with a focus on perinatal clinical research in the acute care or emergency setting where particular challenges to parental engagement and informed consent exist. RESULTS Several approaches to improving the validity of the consent process for perinatal research have been proposed and evaluated. These include consent waiver, antenatal consent, deferred consent preceded by verbal assent, and continuous consent. These have strengths and weaknesses and uncertainty remains about their validity and acceptability in certain research contexts. Prior exploration with parents and parent-advocacy groups of approaches to engagement and consent, and independent evaluation and ongoing monitoring of research studies, can enhance adherence to the ethical principles of justice and autonomy, and ensure that benefits to participants and their families exceed harm. CONCLUSIONS High-quality research and ethics are interdependent. Only research that meets ethical standards can be regarded as valid and applicable, and only research designs that are methodologically rigorous and appropriate can be regarded as ethical.
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Affiliation(s)
- Verena Walsh
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Sam Oddie
- Centre for Reviews and Dissemination, University of York, York, United Kingdom.,Neonatal Unit, Bradford Royal Infirmary, Bradford, United Kingdom
| | - William McGuire
- Centre for Reviews and Dissemination, University of York, York, United Kingdom,
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Abstract
The approach to the management of meconium-stained newborns in the delivery room has been changing for over 40 years. The goal is to prevent meconium aspiration syndrome (MAS) and complications related to MAS. For decades, airway obstruction was believed to be a major component of MAS and, consequently, suction maneuvers to remove meconium from the airways were recommended to decrease the frequency and severity of MAS. Initial recommendations were based on observational studies. However, the incidence of MAS and mortality related to MAS has declined since the 1970s, mostly because of a decrease in the number of postterm deliveries. Recently updated guidelines by the American Heart Association and the Neonatal Resuscitation Program have reflected the strength of evidence supporting tracheal intubation and suctioning for nonvigorous, meconium-stained newborns. This article examines practice change since the 1970s in the delivery room management of meconium-stained newborns and evaluates evidence behind the changes.
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Songstad NT, Roberts CT, Manley BJ, Owen LS, Davis PG. Retrospective Consent in a Neonatal Randomized Controlled Trial. Pediatrics 2018; 141:peds.2017-2092. [PMID: 29288162 DOI: 10.1542/peds.2017-2092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The requirement for prospective consent in clinical trials in acute settings may result in samples unrepresentative of the study population, potentially altering study findings. However, using retrospective consent may raise ethical issues. We assessed whether using retrospective consent affected recruitment, participant characteristics, and outcomes within a randomized controlled trial. METHODS We conducted a secondary analysis of a randomized trial, which compared nasal high flow (nHF) with nasal continuous positive airway pressure (CPAP) for primary respiratory support in preterm infants. In Era 1, all infants were consented prospectively; in Era 2, retrospective consent was available. We assessed inclusion rates of eligible infants, demographic data, and primary trial outcome (treatment failure within 72 hours). RESULTS In Era 1, recruitment of eligible infants was lower than in Era 2: 111 of 220 (50%) versus 171 of 209 (82%), P < .001; intrapartum antibiotic administration was lower: 23 of 111 (21%) versus 84 of 165 (51%), P < .001; full courses of antenatal steroids were higher: 86 of 111 (78%) versus 103 of 170 (61%), P = .004; and more infants received pre-randomization CPAP: 77 of 111 (69%) versus 48 of 171 (28%), P < .001. In Era 1, nHF failure (15 of 56, 27%) and CPAP failure (14 of 55, 26%) rates were similar, P = .9. In Era 2, failure rates differed: 24 of 85 (28%) nHF infants versus 13 of 86 (15%) CPAP infants, P = .04. The χ2 interaction test was nonsignificant (P = .20). CONCLUSIONS The use of retrospective consent resulted in greater recruitment and differences in risk factors between eras. Using retrospective consent altered the study sample, which may be more representative of the whole population. This may improve scientific validity but requires further ethical evaluation.
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Affiliation(s)
- Nils T Songstad
- Newborn Research Centre and .,Department of Pediatrics and Adolescent Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Calum T Roberts
- Newborn Research Centre and.,Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; and
| | - Brett J Manley
- Newborn Research Centre and.,Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; and
| | - Louise S Owen
- Newborn Research Centre and.,Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; and.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre and.,Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; and.,Murdoch Children's Research Institute, Melbourne, Australia
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11
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Vain NE, Batton DG. Meconium "aspiration" (or respiratory distress associated with meconium-stained amniotic fluid?). Semin Fetal Neonatal Med 2017; 22:214-219. [PMID: 28411000 DOI: 10.1016/j.siny.2017.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The designation meconium aspiration syndrome (MAS) reflects a spectrum of disorders in infants born with meconium-stained amniotic fluid, ranging from mild tachypnea to severe respiratory distress and significant mortality. The frequency of MAS is highest among infants with post-term gestation, thick meconium, and birth asphyxia. Pulmonary hypertension is an important component in severe cases. Prenatal hypopharyngeal suctioning and postnatal endotracheal intubation and suctioning of vigorous infants are not effective. Intubation and suctioning of non-breathing infants is controversial and needs more investigation. Oxygen, mechanical ventilation, and inhaled nitric oxide are the mainstays of treatment. Surfactant is often used in infants with severe parenchymal involvement. High-frequency ventilation and extracorporeal membrane oxygenation are usually considered rescue therapies.
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Affiliation(s)
- Nestor E Vain
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Pediatrics and Neonatology, Hospital Sanatorio de la Trinidad, Buenos Aires, Argentina; FUNDASAMIN (Foundation for Maternal Infant Health), Buenos Aires, Argentina.
| | - Daniel G Batton
- Newborn Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA
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12
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Manley BJ, Owen LS, Hooper SB, Jacobs SE, Cheong JLY, Doyle LW, Davis PG. Towards evidence-based resuscitation of the newborn infant. Lancet 2017; 389:1639-1648. [PMID: 28443558 DOI: 10.1016/s0140-6736(17)30547-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/23/2016] [Accepted: 11/25/2016] [Indexed: 01/07/2023]
Abstract
Effective resuscitation of the newborn infant has the potential to save many lives around the world and reduce disabilities in children who survive peripartum asphyxia. In this Series paper, we highlight some of the important advances in the understanding of how best to resuscitate newborn infants, which includes monitoring techniques to guide resuscitative efforts, increasing awareness of the adverse effects of hyperoxia, delayed umbilical cord clamping, the avoidance of routine endotracheal intubation for extremely preterm infants, and therapeutic hypothermia for hypoxic-ischaemic encephalopathy. Despite the challenges of performing high-quality clinical research in the delivery room, researchers continue to refine and advance our knowledge of effective resuscitation of newborn infants through scientific experiments and clinical trials.
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Affiliation(s)
- Brett J Manley
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia.
| | - Louise S Owen
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute for Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC Australia
| | - Susan E Jacobs
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Lex W Doyle
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Peter G Davis
- Neonatal Services, The Royal Women's Hospital, Melbourne, VIC, Australia; Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
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13
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Rich WD, Katheria AC. Waiver of Consent in a Trial Intervention Occurring at Birth-How Do Parents Feel? Front Pediatr 2017; 5:56. [PMID: 28377915 PMCID: PMC5359472 DOI: 10.3389/fped.2017.00056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We have previously demonstrated that it is difficult to obtain a representative subject sample when conducting a randomized controlled trial (RCT) at or near the time of birth and obtaining antenatal consent. Waiver of consent has been used in neonatal trials, but parents' reactions to being enrolled in these trials have never been reported. METHODS The parents enrolled in a RCT involving a waiver of consent with a post-delivery discussion were asked to take part in a brief survey. The survey questions included the timing of when parents were informed about the study, and how they felt about their infants being included in the study. RESULTS Forty-nine parents completed the online survey. Sixty-nine percent (n = 34) remembered a physician discussing their premature baby with them prior to delivery. Thirty-four percent (17) indicated the physician had discussed participation in the study prior to delivery. Sixty-nine percent (34) indicated that they had a positive or strongly positive feeling about the studies impact on their baby's health. CONCLUSION Our study demonstrates that the majority of responding parents of infants who have actually participated in a RCT with a waiver of consent process had a positive response, a minority had a neutral response, and none had a slightly negative or highly negative response to participation in the study.
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Affiliation(s)
- Wade D Rich
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns , San Diego, CA , USA
| | - Anup C Katheria
- Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns , San Diego, CA , USA
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14
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Abstract
The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) has examined the effects of various obstetrical perinatal interventions and neonatal delivery room practices on the newborn with particular focus on those born preterm. Studies exploring the effects and safety of various antepartum maternal medications and the effects of the route and timing of delivery are examined. The NRN has contributed key studies to the evidence base for the International Liaison Committee on Resuscitation neonatal resuscitation guidelines. These studies are reviewed including research on timing of cord clamping, the importance of maintaining euthermia immediately after birth, delivery room ventilation strategies, outcomes following delivery room cardiopulmonary resuscitation, and the effects of prolonged resuscitation efforts. In addition, the NRN's detailed outcome data at the lowest gestational ages have greatly influenced on how providers counsel families regarding the appropriateness of resuscitation efforts at the lowest gestational ages.
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Affiliation(s)
- Sanjay Chawla
- Wayne State University, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 3901 Beaubien Street, Detroit, Michigan 48201, Phone: (313)745-5638, Fax: (313) 745-5867
| | - Elizabeth Foglia
- The University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Division of Neonatology, 3400 Spruce Ave, 8th Floor Ravdin Building, Phone: (216) 662-3228, Fax: (215) 349-8831
| | - Vishal Kapadia
- The University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9063, Phone: (214) 648-3753, Fax: (214) 648-2481
| | - Myra Wyckoff
- The University of Texas Southwestern Medical Center, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9063, Phone: (214) 648-3753, Fax: (214) 648-2481,Corresponding Author: Phone: (214) 648-3753, Fax: (214) 648-2481,
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Ghooi RB, Bhosale N, Wadhwani R, Divate P, Divate U. Assessment and classification of protocol deviations. Perspect Clin Res 2016; 7:132-6. [PMID: 27453830 PMCID: PMC4936072 DOI: 10.4103/2229-3485.184817] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Deviations from the approved trial protocol are common during clinical trials. They have been conventionally classified as deviations or violations, depending on their impact on the trial. METHODS A new method has been proposed by which deviations are classified in five grades from 1 to 5. A deviation of Grade 1 has no impact on the subjects' well-being or on the quality of data. At the maximum, a deviation Grade 5 leads to the death of the subject. This method of classification was applied to deviations noted in the center over the last 3 years. RESULTS It was observed that most deviations were of Grades 1 and 2, with fewer falling in Grades 3 and 4. There were no deviations that led to the death of the subject (Grade 5). DISCUSSION This method of classification would help trial managers decide on the action to be taken on the occurrence of deviations, which would be based on their impact.
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Affiliation(s)
| | - Neelambari Bhosale
- Jehangir Clinical Development Centre, Jehangir Hospital, Pune, Maharashtra, India
| | - Reena Wadhwani
- Jehangir Clinical Development Centre, Jehangir Hospital, Pune, Maharashtra, India
| | - Pathik Divate
- Jehangir Clinical Development Centre, Jehangir Hospital, Pune, Maharashtra, India
| | - Uma Divate
- Jehangir Clinical Development Centre, Jehangir Hospital, Pune, Maharashtra, India
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16
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Bloomfield FH. The challenges of research participation by children. Pediatr Res 2015; 78:109-10. [PMID: 25923012 DOI: 10.1038/pr.2015.75] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Frank H Bloomfield
- 1] Liggins Institute, University of Auckland, Auckland, New Zealand [2] Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand [3] Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand [4] Gravida: National Centre for Growth and Development, Auckland, New Zealand
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17
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Feltman DM. Re: delivery room research: when does poor quality evidence become an ethical issue? Pediatrics 2015; 135:e1368-9. [PMID: 25934904 DOI: 10.1542/peds.2015-0546b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dalia M Feltman
- Evanston Hospital, NorthShore University HealthSystem, and Pritzker School of Medicine, University of Chicago
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18
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Vain NE, Musante GA, Mariani GL. Meconium Stained Newborns: Ethics for Evidence in Resuscitation. J Pediatr 2015; 166:1109-12. [PMID: 25720365 DOI: 10.1016/j.jpeds.2015.01.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Nestor E Vain
- Department of Pediatrics, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; FUNDASAMIN (Fundación para la Salud Materno Infantil), Buenos Aires, Argentina; Department of Neonatology, Hospitals Sanatorio de la Trinidad Palermo and San Isidro, Buenos Aires, Argentina.
| | - Gabriel A Musante
- Department of Pediatrics, Facultad de Ciencias Biomédicas, Universidad Austral, Argentina; Department of Maternal and Child Health, Hospital Universitario Austral, Pilar, Argentina
| | - Gonzalo L Mariani
- Department of Pediatrics, School of Medicine, University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Neonatology Division, Hospital Italiano, Buenos Aires, Argentina
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