Telemedicine consultations in community hospitals improve neonatal encephalopathy assessment.

Abstract

Objective: We aimed to determine if the implementation of teleconsults in the community hospital would decrease time to initiation of therapeutic hypothermia (TH).

Methods: We compared neonates treated with TH prior to implementation of the teleconsult program (pre-tele) to those treated after (post-tele) for the outcomes of time to initiation of TH, seizures and death/severe injury on brain MRI. We controlled for confounders using multivariable linear and logistic regression models.

Results: There were 52 pre-tele neonates and 49 post-tele who were all born in community hospitals and treated with TH. Mothers in the post-tele group were older and had higher rates of gestational diabetes. Fewer neonates with mild encephalopathy were cooled in the post-tele period (13 (25.0%) pre-tele versus 2 (4.1%) post-tele). After controlling for gestational diabetes, maternal age, and severity of encephalopathy, there was no difference in time to TH initiation (p = 0.445), brain injury or death (p = 0.136), or seizure (p = 0.433) between the pre- and post-tele groups. In sub-analysis of the post-tele group, time to initiation was 4.50 hours (3.75, 5.00) for those with teleconsults versus 3.25 (2.12, 4.00) hours (p=0.007) for those without.

Conclusion: When comparing pre- to post-tele groups, teleconsults in the community hospital did not significantly change the time to initiate TH or result in more adverse short-term outcomes of seizures or death/brain injury. In sub-analysis of the post-tele group, teleconsults did result in delayed initiation of TH but also possible improved patient selection with fewer mildly encephalopathic neonates treated.