Multinational Pediatric Critical Care Research in the Arab Gulf Region across 35 Pediatric Intensive Care Units: Ethical Approval Timelines and Lessons Learned

Objective: Regional multicenter research collaborations in pediatric critical care provide valuable insights through diverse patient data and increased sample sizes. However, cross-border studies face challenges related to ethical approvals and logistical constraints. We aimed to describe the process of conducting a multinational study across Arab Gulf region, the institutional review board (IRB) approval time, and the challenges encountered. SUBJECT AND METHODS: A multinational, multicenter retrospective cohort study was conducted for pediatric intensive care units (PICUs) across the six Gulf countries, comprising Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). Participating centers obtained independent ethical approvals, and data sharing agreements were executed to ensure compliance with local regulations. Site-level data on institutional characteristics and IRB timelines were collected. Median approval durations and interquartile range (IQR) were compared between group-based and individual IRB submissions across the region. RESULTS: A total of 35 regional PICUs participated and completed the study requirements successfully. Challenges included variable IRB approval times across facility types: private hospitals 28 days (IQR: 18-55), governmental hospitals 29 days (IQR: 24-146), and university hospitals 52 days (IQR: 30.25-108.75). CONCLUSION: This study demonstrates the feasibility of regional pediatric critical care research across the Arab Gulf region, despite variability in IRB timelines among private, governmental, and academic institutions. Structured coordination and collaborative planning enabled successful implementation and may serve as a model for future multicenter initiatives. .