ā” Quick Summary
A recent study on teleneonatal resuscitation demonstrated that this innovative approach significantly reduced the no-flow fraction in extremely preterm infants compared to routine resuscitation methods. This suggests that telemedicine can enhance the quality of neonatal care during critical deliveries. š¼
š Key Details
- š Participants: 51 pediatric residents
- āļø Methodology: Randomized simulation trial
- š©ŗ Primary Outcome: No-flow fraction during resuscitation
- š Secondary Outcomes: Modifications in bag-mask ventilation, intubation times, and epinephrine administration
š Key Takeaways
- š No-flow fraction was significantly lower in the teleneonatal group (0.06) compared to the routine group (0.07).
- š§ Corrective modifications to bag-mask ventilation were more frequent in the teleneonatal group (60% vs 15%; p < 0.001).
- ā±ļø Time to intubation was comparable between groups (214s vs 230s; p = 0.58).
- š Time to epinephrine administration also showed no significant difference (395s vs 444s; p = 0.21).
- š Teleneonatal resuscitation may improve delivery outcomes for extremely preterm infants.
- š Study Identifier: NCT04258722.
š Background
The advent of teleneonatology represents a significant advancement in neonatal care, particularly for high-risk deliveries. By leveraging telemedicine, healthcare providers can connect with experienced specialists remotely, ensuring that critical interventions are timely and effective. This study aims to explore the efficacy of teleneonatal resuscitation in improving outcomes for extremely preterm infants, a population that is particularly vulnerable during delivery.
šļø Study
Conducted at a single center, this randomized simulation trial involved pediatric residents who were assigned to either the teleneonatal or routine resuscitation group. The primary focus was on measuring the no-flow fraction, which is a critical metric for assessing the quality of chest compressions during resuscitation efforts. Secondary outcomes included the effectiveness of bag-mask ventilation and the timing of essential interventions such as intubation and epinephrine administration.
š Results
The findings revealed that the teleneonatal resuscitation group had a significantly lower no-flow fraction (0.06) compared to the routine group (0.07), indicating improved resuscitation quality. Additionally, participants in the teleneonatal group were more adept at making necessary modifications to bag-mask ventilation, with a striking 60% success rate compared to just 15% in the routine group. While the times to intubation and epinephrine administration were similar across both groups, the overall results suggest a clear advantage for teleneonatal methods.
š Impact and Implications
The implications of this study are profound. By demonstrating that teleneonatal resuscitation can enhance the quality of care for extremely preterm infants, this research opens the door for broader implementation of telemedicine in neonatal settings. However, challenges remain, including the need for reliable, real-time communication technology. As healthcare continues to evolve, integrating telemedicine into neonatal care could lead to improved survival rates and outcomes for vulnerable populations.
š® Conclusion
This study highlights the potential of teleneonatal resuscitation to transform neonatal care during critical moments. By reducing the no-flow fraction and improving the quality of resuscitation efforts, telemedicine could play a pivotal role in enhancing outcomes for extremely preterm infants. Continued research and evaluation in hospital settings will be essential to fully understand and harness the benefits of this innovative approach. š
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Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.
Abstract
OBJECTIVE: 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.
STUDY DESIGN: 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.
RESULTS: 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%; pā<ā0.001). Time to intubation (214ās vs 230ās; pā=ā0.58) and epinephrine (395ās vs 444ās; pā=ā0.21) were comparable between groups.
CONCLUSIONS: 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.
GOV ID: 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.
Author: [‘Gentle SJ’, ‘Trulove SG’, ‘Rockwell N’, ‘Rutledge C’, ‘Gaither S’, ‘Norwood C’, ‘Wallace E’, ‘Carlo WA’, ‘Tofil NM’]
Journal: Pediatr Res
Citation: Gentle SJ, et al. Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial. Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial. 2024; (unknown volume):(unknown pages). doi: 10.1038/s41390-024-03545-1