Gentle Samuel J, Trulove Sarah G, Rockwell Nicholas, Rutledge Chrystal, Gaither Stacy, Norwood Carrie, Wallace Eric, Carlo Waldemar A, Tofil Nancy M
Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA.
Pediatr Res. 2025 Jan;97(1):222-228. doi: 10.1038/s41390-024-03545-1. Epub 2024 Sep 28.
Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction.
This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration.
Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups.
In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes.
NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.
远程新生儿学，即利用远程医疗进行新生儿复苏和护理，可将经验丰富的护理人员与高危分娩联系起来。在一次模拟复苏中，我们假设与常规复苏相比，远程新生儿复苏会降低无血流比例。
这是一项单中心随机模拟试验，将儿科住院医师随机分为远程新生儿复苏组或常规复苏组。主要结局是无血流比例，定义为无胸外按压时间除以心率<60次/分钟的时间。次要结局包括对气囊面罩通气的纠正性调整以及插管和使用肾上腺素的时间。
51名住院医师完成了模拟场景。与常规复苏组（0.07[0.82]）相比，远程新生儿复苏组的无血流比例（中位数[四分位间距]）显著更好（0.06[0.05]）；效应（95%置信区间）：-16（-43至0）。远程新生儿复苏组的参与者对气囊面罩通气进行纠正性调整的频率更高（60%对15%；p<0.001）。两组之间的插管时间（214秒对230秒；p=0.58）和使用肾上腺素的时间（395秒对444秒；p=0.21）相当。
在这项新生儿复苏的随机模拟试验中，与常规护理相比，远程新生儿复苏减少了不良分娩结局。对远程新生儿学进行进一步的院内评估可能会证实这项技术对分娩结局的影响。
NCT04258722
虽然远程医疗支持的新生儿复苏可能会提高医院环境中的复苏质量，但独特的挑战包括需要进行实时、高保真的音频视频通信且故障率低。无血流比例在其他临床情况下与生存相关，它用于评估有指征时胸外按压的质量。我们报告了远程医疗支持的新生儿复苏中无血流比例的降低，以及新生儿复苏质量的改善。远程医疗支持的新生儿复苏可能会在无法直接接触新生儿科医生的医院环境中提高复苏质量。
