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Editor,—The new guidelines1 and the commentary by Professor Sir David Hull have highlighted the difficulties and problems of blood analysis in the paediatric population. However, I would like to point out that blood analysis is a very common practice in everyday paediatrics compared to its rarer use in research. Unfortunately, most of the blood analysis in everyday practice is carried out by junior house officers, under excuses such as “routine investigations”, often without consultation with more senior members of staff and full explanation either to the older child or to the parents as to the necessity of such investigations. I just wonder whether it is more appropriate for the college to issue guidelines on the appropriateness of investigations in the childhood population.
Editor,—All concerned with the care of children will welcome the scholarly and authoritative guidelines recently published by the Royal College.1-1However, one aspect of research in children was perhaps insufficiently stressed, namely the ethical imperative to try to maximise the information obtained from clinically indicated procedures, which applies whatever the age of the subject. Thus an invasive procedure such as intubation or fibreoptic bronchoscopy, performed for purely clinical reasons, can legitimately be made an opportunity for gathering research specimens, such as bronchoalveolar lavage fluid1-2or bronchial brushings,1-3 subject to prior informed consent being obtained from the child and family, and subject to the safeguards set out in the guidelines. Since such invasive procedures can never legitimately be performed solely for research purposes, it is surely incumbent upon researchers to actively seek these serendipitous opportunities to gather information that would otherwise be unobtainable. Failure to do so might itself be considered unethical, or at least not best practice and a wasted opportunity.