Telemedicine consults to assess neonatal encephalopathy are feasible in the neonatal intensive care unit.
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ABSTRACT:
SUBMITTER: Craig AK
PROVIDER: S-EPMC8593849 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
Publications
Telemedicine consults to assess neonatal encephalopathy are feasible in the neonatal intensive care unit.
Craig Alexa K AK McAllister Lauren M LM Evans Scott S Melendi Misty E ME
Journal of perinatology : official journal of the California Perinatal Association 20200921 6
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Project description:ObjectiveEvaluate whether telemedicine can be used to perform dysmorphology and neurologic examinations in the neonatal intensive care unit (NICU) by determining the examination accuracy, limitations and optimized procedures.Study designProspective evaluation of NICU patients referred for subspecialty consultation for dysmorphic features (n=10) or encephalopathy (n=10). A physician at bedside (bedside clinician) performed an in-person examination that was viewed in real time by a remote physician (remote consultant). Standardized examinations were recorded and compared. Subsequently, a qualitative approach established technique adjustments and optimization procedures necessary to improve visualization.ResultTelemedicine examinations identified 81 of 87 (93%) dysmorphology examination abnormalities and 37 of 39 (92%) neurologic examination abnormalities. Optimization of remote consultant visualization required an active bedside clinician assisting in camera and patient adjustments.ConclusionTelemedicine can be used to perform accurately many components of the dysmorphology or neurologic examinations in NICU patients, but physicians must be mindful of specific limitations.
| S-EPMC3943754 | biostudies-literature
Project description:IntroductionTeleconsultation is used in tertiary care hospitals to evaluate neonatal encephalopathy. Neonates born in community hospitals, however, often experience delayed evaluation due to transport to the tertiary care center. We studied teleconsultations in community hospitals to decrease this disparity.MethodsProspective observational study in 9 community hospitals and 1 neonatal intensive care unit. Inclusion criteria: gestational age greater than or equal to 35 weeks and one of the following: umbilical cord pH less than or equal to 7.2, 5-minute Apgar less than 7, prolonged respiratory support, perinatal event, or abnormal neurological exam. We performed synchronized, unscheduled telemedicine consults with the main outcome of time to teleconsultation.ResultsFrom April 2018 to September 2020, we performed 53 teleconsultations: 34 (64%) in community hospitals and 19 (36%) in the tertiary care center. Teleconsultations occurred at a median of 98 minutes (IQR, 76-127) in community hospitals versus 68 minutes (IQR, 43-91) in the tertiary care center (p = .004). Nine (26%) neonates born in a community hospital remained with their parents and were not transferred to the tertiary care center for further assessment.DiscussionNeonates born in rural community hospitals have slightly later teleconsultations than neonates born in the tertiary care center. Telemedicine use reduced this disparity from nearly 5 hours in our prior study to 98 minutes in this study by permitting evaluation of neonates in community hospitals without transporting them to the tertiary care center.ConclusionsTeleconsultations to evaluate neonatal encephalopathy are a feasible, accessible, and reliable way to bring expert-level care into rural community hospitals.
| S-EPMC9586178 | biostudies-literature
Project description:AimTo investigate the frequency, etiology, and current management strategies for diarrhea in newborn.MethodsRetrospective, nationwide study involving 5801 subjects observed in neonatal intensive care units during 3 years. The main anamnesis and demographic characteristics, etiology and characteristics of diarrhea, nutritional and therapeutic management, clinical outcomes were evaluated.ResultsThirty-nine cases of diarrhea (36 acute, 3 chronic) were identified. The occurrence rate of diarrhea was 6.72 per 1000 hospitalized newborn. Etiology was defined in 29 of 39 newborn (74.3%): food allergy (20.5%), gastrointestinal infections (17.9%), antibiotic-associated diarrhea (12.8%), congenital defects of ion transport (5.1%), withdrawal syndrome (5.1%), Hirschsprung's disease (2.5%), parenteral diarrhea (2.5%), cystic fibrosis (2.5%), and metabolic disorders (2.5%). Three patients died due to complications related to diarrhea (7.7%). In 19 of 39 patients (48.7%), rehydration was performed exclusively by the enteral route.ConclusionDiarrhea in neonates is a challenging clinical condition due to the possible heterogeneous etiologies and severe outcomes. Specific guidelines are advocated in order to optimize management of diarrhea in this particular setting.
| S-EPMC2880780 | biostudies-literature
Project description:The incidence, aetiology and pathophysiology of pneumomediastinum (PM), an uncommon and potentially serious disease in neonates and children, were evaluated. A retrospective chart review of all patients diagnosed with PM who were hospitalised in the intensive care unit of the University Children's Hospital Zürich, Switzerland, from 2000 to 2006, was preformed. We analysed the incidence, severity and causes of PM and investigated the possible differences between neonatal and non-neonatal cases. Seven children and nine neonates were identified with PM. All patients had a good outcome. Six cases of PM in the group of children older than 4 weeks were deemed to be caused by trauma, infection and sports, whereas one case was idiopathic. All nine neonatal cases presented with symptoms of respiratory distress. We were able to attribute four cases of neonatal PM to pulmonary infection, immature lungs and ventilatory support. Five neonatal cases remained unexplained after careful review of the hospital records. In conclusion, PM in children and neonates has a good prognosis. Mostly, it is associated with extrapulmonary air at other sites. It is diagnosed by chest X-ray alone. We identified mechanical events leading to the airway rupture in most children >4 weeks of life, whereas we were unable to identify a cause in half of the neonates studied (idiopathic PM).
| S-EPMC2254655 | biostudies-other
Project description:BACKGROUND:Variation in healthcare delivery and outcomes in neonatal intensive care units (NICUs) may be partly explained by differences in safety culture. OBJECTIVE:To describe NICU care giver assessments of safety culture, explore variability within and between NICUs on safety culture domains, and test for association with care giver characteristics. METHODS:NICU care givers in 12 hospitals were surveyed using the Safety Attitudes Questionnaire (SAQ), which has six scales: teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and working conditions. Scale means, SDs and percent positives (percent agreement) were calculated for each NICU. RESULTS:There was substantial variation in safety culture domains among NICUs. Composite mean score across the six domains ranged from 56.3 to 77.8 on a 100-point scale and NICUs in the top four NICUs were significantly different from the bottom four (p<0.001). Across the six domains, respondent assessments varied widely, but were least positive on perceptions of management (3%-80% positive; mean 33.3%) and stress recognition (18%-61% positive; mean 41.3%). Comparisons of SAQ scale scores between NICUs and a previously published adult ICU cohort generally revealed higher scores for NICUs. Composite scores for physicians were 8.2 (p=0.04) and 9.5 (p=0.02) points higher than for nurses and ancillary personnel. CONCLUSION:There is significant variation and scope for improvement in safety culture among these NICUs. The NICU variation was similar to variation in adult ICUs, but NICU scores were generally higher. Future studies should validate whether safety culture measured with the SAQ correlates with clinical and operational outcomes in NICUs.
| S-EPMC3845658 | biostudies-literature
Project description:IntroductionDigital health is an opportune way of facilitating the implementation of point-of-care ultrasound (POCUS) in intensive care units (ICUs) of the Brazilian Unified Health System (SUS) through remote tele-mentored ultrasound (RTMUS). Therefore, this pilot diagnostic accuracy study aims to evaluate the sensitivity and specificity of RTMUS, using POCUS as the gold standard for the diagnosis of pulmonary oedema. As a secondary objective, these metrics will be assessed for pneumonia, chronic obstructive pulmonary disease (COPD), pneumothorax, pulmonary embolism, and cardiac tamponade.MethodsThe study was conducted in three adult ICUs, monitored by the TeleUTI project, and included 23 patients who underwent POCUS carried out by an ICU medical professional and RTMUS carried out by a tele-intensivist from the institution that proposed the project.ResultsThe accuracy in diagnosing pulmonary oedema was 71.43%, COPD 89.96%, and for pneumonia, the results showed an accuracy of 65.22%. Analyses demonstrated that RTMUS has the same capability as POCUS for detecting true positive cases of pulmonary oedema, the same results of true negative cases for COPD, and a limitation in performance for pneumonia.ConclusionsFor COPD and pulmonary oedema, remote examination can support healthcare teams, suggesting that RTMUS has the potential to be a substitute for POCUS. We emphasise that the results should be interpreted within the context of the study, which is considered small and should be validated on a larger scale to consolidate the conclusions.
| S-EPMC11565499 | biostudies-literature
Project description:intensive care unit shotgun raw sequences Metagenome
| PRJNA562118 | ENA
Project description:Characterization of bacterial communities in a hospital NICU during a Serratia marcescens outbreak
| PRJNA432186 | ENA
Project description: Not available
| S-EPMC11909500 | biostudies-literature