Future of clinical trials in the delivery room: time for pragmatism

Despite increased amounts of research, most of the evidence that supports treatment of newborns in the delivery room is rated 'low' rather than 'high' quality. This assessment stems largely from a lack of evidence from clinical trials. When trials have been performed, the evidence has often been downgraded due to enrolment of small or poorly representative samples, and for lack of blinding of caregivers and outcome assessors. Delivery room trials present particular challenges when obtaining consent, enrolling participants, taking measures to limit bias and identifying appropriate outcome measures. We hope our suggestions as to how future delivery room trials could be more pragmatic will inform the design of large studies that are necessary to allow clinical practice to evolve.

Automated summary

Despite an increase in research, most of the evidence supporting treatment of newborns in the delivery room is of low quality due to a lack of clinical trial evidence. Challenges such as obtaining consent, enrolling participants, limiting bias, and identifying appropriate outcome measures make delivery room trials difficult. Suggestions for more pragmatic future trials could improve the design of large studies necessary for clinical practice evolution.