Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals and Tertiary Care Centers.

Rachel Coffey, Misty Melendi, Anya K Cutler, Alexa K Craig
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Abstract

Introduction: Teleconsultation is used in tertiary care hospitals to evaluate neonatal encephalopathy. Neonates born in community hospitals, however, often experience delayed evaluation due to transport to the tertiary care center. We studied teleconsultations in community hospitals to decrease this disparity.

Methods: Prospective observational study in 9 community hospitals and 1 neonatal intensive care unit. Inclusion criteria: gestational age greater than or equal to 35 weeks and one of the following: umbilical cord pH less than or equal to 7.2, 5-minute Apgar less than 7, prolonged respiratory support, perinatal event, or abnormal neurological exam. We performed synchronized, unscheduled telemedicine consults with the main outcome of time to teleconsultation.

Results: From April 2018 to September 2020, we performed 53 teleconsultations: 34 (64%) in community hospitals and 19 (36%) in the tertiary care center. Teleconsultations occurred at a median of 98 minutes (IQR, 76-127) in community hospitals versus 68 minutes (IQR, 43-91) in the tertiary care center (p = .004). Nine (26%) neonates born in a community hospital remained with their parents and were not transferred to the tertiary care center for further assessment.

Discussion: Neonates born in rural community hospitals have slightly later teleconsultations than neonates born in the tertiary care center. Telemedicine use reduced this disparity from nearly 5 hours in our prior study to 98 minutes in this study by permitting evaluation of neonates in community hospitals without transporting them to the tertiary care center.

Conclusions: Teleconsultations to evaluate neonatal encephalopathy are a feasible, accessible, and reliable way to bring expert-level care into rural community hospitals.

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远程医疗咨询评估农村社区医院和三级医疗中心的新生儿脑病。
导言:三级医院采用远程会诊评估新生儿脑病。然而,在社区医院出生的新生儿往往会因为被送往三级医疗中心而延误评估。为了缩小这一差距,我们对社区医院的远程会诊进行了研究:方法:在 9 家社区医院和 1 家新生儿重症监护室进行前瞻性观察研究。纳入标准:胎龄大于或等于 35 周,且出现以下情况之一:脐带 pH 值小于或等于 7.2、5 分钟 Apgar 值小于 7、呼吸支持时间过长、围产期事件或神经系统检查异常。我们进行了同步、不定期的远程医疗会诊,主要结果是远程会诊时间:从 2018 年 4 月到 2020 年 9 月,我们进行了 53 次远程会诊:其中 34 次(64%)在社区医院进行,19 次(36%)在三级医疗中心进行。社区医院远程会诊的中位时间为 98 分钟(IQR,76-127),而三级医疗中心为 68 分钟(IQR,43-91)(p = .004)。9名(26%)在社区医院出生的新生儿留在父母身边,没有转到三级护理中心接受进一步评估:讨论:在农村社区医院出生的新生儿接受远程会诊的时间略晚于在三级医疗中心出生的新生儿。通过使用远程医疗,我们可以在社区医院对新生儿进行评估,而无需将其送往三级医疗中心,从而将这一差距从之前研究中的近 5 个小时缩短至本研究中的 98 分钟:评估新生儿脑病的远程会诊是将专家级医疗服务引入农村社区医院的一种可行、方便和可靠的方式。
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