Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, United States.
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States.
Resuscitation. 2018 Apr;125:48-55. doi: 10.1016/j.resuscitation.2018.01.045. Epub 2018 Feb 3.
We hypothesized that telemedicine consults provided by neonatologists to local care teams (termed teleneonatology) would improve the quality of high-risk newborn resuscitations that occur in community hospitals.
This retrospective cohort study compared 47 newborns who received a teleneonatology consult during their resuscitation at a community hospital to 45 controls who did not. Controls were matched on gestational age, sex, admission diagnosis, and level of newborn care. A two-person expert panel blinded to the intervention reviewed demographic and resuscitation data for each patient and assigned a resuscitation quality rating using a 1-10 descriptive rating scale. Paired comparisons between groups were evaluated using the Wilcoxon signed rank test for continuous measures and the McNemar's test for dichotomous measures.
The median resuscitation quality rating was 7 for the teleneonatology group and 4 for the control group, with a median difference of 1 between matched pairs (P = .002). Neonates who received a teleneonatology consult were more likely to undergo measurement of temperature, glucose, and blood gases. When analyzing the 35 matched pairs that had a consult within one hour of birth, the positive impact of teleneonatology was greater (median rating 8 vs 4, median difference 2, P = .003). Subgroup analysis demonstrated teleneonatology significantly improved the resuscitation of preterm neonates (median rating 8 vs 4, median difference 1.5, P = .004) CONCLUSION: Teleneonatology improves the quality of high-risk newborn resuscitations that occur in community hospitals and increases adherence to process metrics. Earlier teleneonatology consults appear to have greater positive impact.
我们假设由新生儿科医生向当地护理团队提供远程医疗咨询（称为远程新生儿学）将改善社区医院中高危新生儿复苏的质量。
这项回顾性队列研究比较了在社区医院接受复苏治疗的 47 名接受远程新生儿学咨询的新生儿和 45 名未接受咨询的对照组。对照组按胎龄、性别、入院诊断和新生儿护理水平进行匹配。一个由两名专家组成的小组对每个患者的人口统计学和复苏数据进行了盲法评估，并使用 1-10 描述性评分量表对复苏质量进行评分。使用 Wilcoxon 符号秩检验对连续变量进行组间配对比较，使用 McNemar 检验对二分类变量进行配对比较。
远程新生儿学组的中位数复苏质量评分为 7 分，对照组为 4 分，配对中位数差异为 1 分（P=0.002）。接受远程新生儿学咨询的新生儿更有可能进行体温、血糖和血气测量。当分析出生后 1 小时内进行咨询的 35 对匹配对时，远程新生儿学的积极影响更大（中位数评分为 8 对 4，中位数差异 2，P=0.003）。亚组分析表明，远程新生儿学显著改善了社区医院中高危新生儿的复苏情况（中位数评分为 8 对 4，中位数差异 1.5，P=0.004）。
远程新生儿学改善了社区医院中高危新生儿复苏的质量，并增加了对流程指标的依从性。早期的远程新生儿学咨询似乎具有更大的积极影响。
