Telemedicine brings neonatologists to high-risk newborns' bedside
Approximately 1 in 1,000 newborns will require advanced resuscitation after delivery. When these high-risk deliveries occur in a regional referral center such as Mayo Clinic, newborn outcomes can be optimized under the care of a multidisciplinary team that has frequent experience with neonatal resuscitation. However, if a similar high-risk delivery occurs in a community hospital, the local providers may face unique challenges when responding to delivery room emergencies.
This disparity based on birth location was what motivated Christopher E. Colby, M.D., chair of Neonatal Medicine at Mayo Clinic's campus in Rochester, Minnesota, to explore the use of telemedicine for newborn resuscitation. His first consultation was for an extremely preterm baby with an unknown gestational age due to limited prenatal care. The local physician was unsure if the newborn was viable and if resuscitation was indicated. After examining the baby via video, Dr. Colby determined the neonate was likely 26 to 28 weeks gestation and proceeded to guide the resuscitation and stabilization. After a short time in the Mayo Clinic neonatal intensive care unit (NICU), the baby was transferred back to the local level II nursery. From there, the healthy infant was discharged home.
Since that first consult, Mayo Clinic has become a leader in using emergency video telemedicine to support community providers during high-risk deliveries. This program allows Rochester-based neonatologists to consult with local care teams in 10 health system sites. Prior to using telemedicine, only 43 percent of newborns in Mayo Clinic Health System sites had access to a neonatologist if they required advanced resuscitation. With Mayo Clinic's synchronous newborn telemedicine program, 100 percent of newborns in this region may benefit from the expertise of Mayo's neonatologists should the resuscitation become a challenge.
The department's experience with emergency telemedicine for newborn resuscitation was published in Mayo Clinic Proceedings in December 2016. Since the first pilot case in March 2013, the Division of Neonatal Medicine has provided over 110 telemedicine consultations. The most common indication for consultation is prematurity (including a case of 22-week twins born in a community hospital with a level I nursery) followed by respiratory distress and perinatal depression. Using video telemedicine, the neonatologist is able to assist the local team in the critical steps of newborn resuscitation, including effective ventilation, endotracheal intubation, and other lifesaving procedures such as umbilical line placement and thoracocentesis.
After the neonatal telemedicine consult, nearly one-third of the patients are able to remain in their local hospital. Because the neonatologist can use telemedicine to visualize the baby and provide effective remote-guided care, this may prevent the unnecessary transfer of patients to the NICU. This high-value, telemedicine-based practice model allows babies to remain with their parents in the local community hospital — improving the patient and family experience.
Telemedicine care team
Care for pediatric patient via telemedicine
Mayo Clinic's neonatal telemedicine program has been well-received by the local care teams. Nearly 96 percent of local physicians would use telemedicine again and would recommend it to their colleagues. Most importantly, local physicians agree that the telemedicine consult improved patient safety, the quality of care or both in 95 percent of surveyed cases. According to Jennifer L. Fang, M.D., with Neonatal Medicine at Mayo Clinic in Minnesota, the next step is to study the impact telemedicine has on the quality of newborn resuscitations.
"While we and our colleagues in the health system believe telemedicine is improving delivery room care, we need to design a study to better answer that question," she says. The Division of Neonatal Medicine is conducting a retrospective study to determine the impact telemedicine has on multiple newborn resuscitation quality metrics, including Apgar scores, need for chest compressions or cardiac medications, and the time and value of first temperature, serum glucose and blood gas.
For more information
Fang JL, et al. Emergency video telemedicine consultation for newborn resuscitations: The Mayo Clinic experience. Mayo Clinic Proceedings. 2016;91:1735.