INTRODUCTION

Improvements to life-saving treatments for critically ill children have been limited by the ethical and practical challenges involved in seeking consent for clinical trial entry.¹ The process of seeking informed consent requires time, but this is severely constrained in emergency situations, such as acute resuscitation and critical care,² where even minimal treatment delays are likely to be harmful.³ Parents are not always present when a child requires emergency treatment or a mother of a critically ill neonate may be sedated. Children’s critical care set-tings are intensely emotional, and some parents may not wish to be approached about research when their child is critically ill.⁴ Such challenges pose dif?culties for doctors and nurses recruiting to clinical trials in ensuring that parental consent has been informed, the participation voluntary and the recruitment process adhered to ethical principles.⁵ The last decade has seen inter-national efforts to ?nd alternatives to prospective informed consent so that vital research can continue to advance evidence-based children’s medicine.¹