Differences in demographics and outcomes based on method of consent for a randomised controlled trial on heat loss prevention in the delivery room

Differences in demographics and outcomes based on method of consent for a randomised controlled trial on heat loss prevention in the delivery room
Original Research
Sunita Vohra, Maureen Reilly, Valeria E Rac, Zafira Bhaloo, Denise Zayak, John Wimmer, Michael Vincer, Karla Ferrelli, Alex Kiss, Roger Soll, Michael Dunn
Archives of Disease in Childhood – Fetal and Neonatal Edition, 24 November 2020
Informed consent is standard in research. International guidelines allow for research without prior consent in emergent situations, such as neonatal resuscitation. Research without prior consent was incorporated in the Vermont Oxford Network Heat Loss Prevention Trial. We evaluated whether significant differences in outcomes exist based on the consent method.
Subgroup analysis of infants enrolled in a randomised controlled trial conducted from 2004 to 2010.
A multicentre trial with 38 participating centres.
Infants born 24–27 weeks of gestation. 3048 infants assessed, 2231 excluded due to fetal congenital anomalies, failure to obtain consent or gestation less than 24 weeks. 817 randomised, 4 withdrew consent, total of 813 analysed.
Main outcome measure
The difference in mortality between consent groups.
No significant differences were found in mortality at 36 weeks (80.2%, 77.4%, p=0.492) or 6 months corrected gestational age (80.7%, 79.7%, p=0.765). Infants enrolled after informed consent were more likely to have mothers who had received antenatal steroids (95.2%, 84.0%, p<0.0001). They also had significantly higher Apgar scores at 1 (5.0, 4.4, p=0.019), 5 (7.3, 6.7, p=0.025) and 10 min (7.5, 6.3, p=0.0003).
Conclusions and relevance
Research without prior consent resulted in the inclusion of infants with different baseline characteristics than those enrolled after informed consent. There were no significant differences in mortality. Significantly higher Apgar scores in the informed consent group suggest that some of the sicker infants would have been excluded from enrolment under informed consent. Research without prior consent should be considered in neonatal resuscitation research.

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