Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Neurology & Neuroscience, Pediatrics
Humans, Infant, Newborn, Telemedicine, Brain Diseases, Recognition, Psychology
Background: In Maine, 75% of neonates treated with Therapeutic Hypothermia (TH) are born in rural hospitals and transferred to tertiary-care centers for evaluation and treatment. In a pilot study, a two-way telemedicine consult was performed with the pediatric neurologist at a remote location and the neonatologist at the bedside. Only 36% of those evaluated for TH had moderate to severe NE and were treated (64% were transferred unnecessarily).
Objective: To assess the feasibility of three-way teleconsults between the provider at the rural hospital and both pediatric neurology and neonatology and to determine if teleconsult use can decrease the time to initiation of TH. Design/Methods: Pilot study of telemedicine as an intervention with a target recruitment goal of 10 treated neonates. Inclusion criteria for teleconsult were age less than 6 hours, gestational age > 35 weeks, umbilical cord pH< 7.20, 5 minute Apgar <7 and/or sentinel event. The teleconsult evaluation assessed the neonate according to the modified Sarnat criteria; level of consciousness, spontaneous activity, muscle tone, posture, Moro reflex, suck reflex and autonomic functions including pupils, respiratory rate and heart rate. Time to initiation of TH was compared to historical controls from the same birth hospitals.
Results: Over a 20 month period from April 2018-December 2019, 8 rural hospitals were provided with a teleconsult system including cart, camera, monitor and network drop as well as two or more training sessions (Table 1). 15 neonates were recruited of whom 10 (66%) were treated with TH and these were compared to 42 historical controls (Table 2). There were no differences in maternal characteristics or for Apgar scores, however the arterial cord gases for the telemedicine group were significantly higher than the historical controls. There were however no differences in the frequency of adverse outcomes. The time to initiation of TH was not faster for the telemedicine group.
Conclusions: Eight rural hospitals successfully established telemedicine capability, but the time to initiation of TH did not decrease. Patient selection for TH did however improve with 66% treated, up from only 36% in the first pilot study. Also noteworthy is the fact that telemedicine neonates had less abnormal arterial cord gases, but similar if not higher rates of adverse events suggesting that without NE evaluations, the cord pH may have excluded them from treatment.
Hashmi, Mohammad; Craig, Alexa; and Melendi, Misty, "Telemedicine Implementation Associated with Increased Recognition of Moderate and High-Risk Encephalopathic Neonates" (2020). Costas T. Lambrew Research Retreat 2020. 86.