Okada Junichiro, Hisano Tadashi, Unno Mitsuaki, Tanaka Yukari, Saikusa Mamoru, Kinoshita Masahiro, Harada Eimei, Iwata Sachiko, Iwata Osuke
Division of Neonatology, St. Mary's Hospital, Fukuoka, Japan.
Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Sci Rep. 2020 May 5;10(1):7552. doi: 10.1038/s41598-020-64223-w.
Neonates often develop transition problems after low-risk birth, precise assessment of which is difficult at primary birth centres. The aim of this study was to assess whether a video triage system can be established without a specially designed communication system between local birth centres and a tertiary neonatal intensive care unit in a region with a population of 700,000. 761 neonates who were referred to a tertiary neonatal intensive care unit were examined. During period 1 (April 2011-August 2015), only a voice call was available for consultations, whereas, during period 2 (September 2015-December 2017), a video call was additionally available. The respiratory condition was assessed based on an established visual assessment tool. A video consultation system was established by connecting personal smartphones at local birth centres with a host computer at a tertiary neonatal intensive care centre. During period 2, video-based triage was performed for 42.4% of 236 consultations at 30 birth centres. Sensitivity and specificity for predicting newborns with critical respiratory dysfunction changed from 0.758 to 0.898 and 0.684 to 0.661, respectively. A video consultation system for ill neonates was established without major instalment costs. Our strategy might improve the transportation system in both high- and low-resource settings.
低风险出生后的新生儿常常会出现过渡问题，而在基层分娩中心很难对这些问题进行精确评估。本研究的目的是评估在一个拥有70万人口的地区，在当地分娩中心与三级新生儿重症监护病房之间没有专门设计的通信系统的情况下，是否能够建立视频分诊系统。对761名转诊至三级新生儿重症监护病房的新生儿进行了检查。在第1阶段（2011年4月至2015年8月），仅通过语音通话进行会诊，而在第2阶段（2015年9月至2017年12月），还可进行视频通话。根据既定的视觉评估工具对呼吸状况进行评估。通过将当地分娩中心的个人智能手机与三级新生儿重症监护中心的主机相连，建立了视频会诊系统。在第2阶段，对30个分娩中心的236次会诊中的42.4%进行了基于视频的分诊。预测严重呼吸功能障碍新生儿的敏感性和特异性分别从0.758变为0.898，从0.684变为0.661。在没有重大安装成本的情况下，为患病新生儿建立了视频会诊系统。我们的策略可能会改善高资源和低资源环境下的转运系统。
