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Telemedicine consults to assess neonatal encephalopathy are feasible in the neonatal intensive care unit

Journal of Perinatology volume 41, pages 1519–1521 (2021)Cite this article

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Neonatal Encephalopathy (NE) is a clinically defined syndrome describing abnormal neurological function in a newborn >35 weeks gestation [1]. NE can be challenging to diagnose [2] as symptoms can range from mild to severe with fluctuations in the first several hours of life [3]. Given the high reproducibility of neonatal neurological exams performed by telemedicine [4], we implemented synchronous, unscheduled teleconsultations for neonates for whom there were clinical concerns for NE following a difficult transition after delivery, a significant resuscitation, or acidotic cord gases. Our goal was to demonstrate that use of telemedicine was feasible within the tertiary care center to allow pediatric neurology and neonatology to jointly examine neonates.

A convenience sample of 26 neonates with gestational age >35 weeks received teleconsultations between October 2017 and October 2018. A high resolution, 5X zoom, camera was used with Cisco Jabber video conferencing software, to connect the neonatologist at the bedside to the pediatric neurologist at a remote location. A modified Sarnat exam [2, 5] was performed by the neonatologist and observed by the neurologist. The following elements were jointly assessed; level of consciousness, spontaneous movement, muscle tone, posture, primitive reflexes (e.g., suck and Moro), and autonomic function (e.g., breathing, heart rate, and pupillary function). Neonates with symptoms of moderate or severe NE and who met other criteria for therapeutic hypothermia were treated. Neonatologists were asked to respond to a short, questionnaire following the teleconsultation (Supplementary 1). The IRB exempted the retrospective abstraction of clinical data from the electronic medical record.

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Acknowledgements

We would like to thank our colleagues from the MaineHealth Telestroke Program for making this project possible through the generous loan of the telemedicine equipment.

Funding

This research was not supported by any funding. The telemedicine equipment was loaned by the MaineHealth Telestroke Program.

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Authors and Affiliations

  1. Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Division of Pediatric Neurology, Portland, ME, USA

    Alexa K. Craig

  2. Tufts University School of Medicine, Boston, MA, USA

    Lauren M. McAllister

  3. Barbara Bush Children’s Hospital at Maine Medical Center, Department of Pediatrics, Division of Neonatology, Portland, ME, USA

    Scott Evans & Misty E. Melendi

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  1. Alexa K. Craig
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  2. Lauren M. McAllister
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  3. Scott Evans
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  4. Misty E. Melendi
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Contributions

AKC conceptualized the study design, designed the study collection instruments, and supervised the data collection. She was involved in data analysis and reviewed and revised all portions of the manuscript. LMM analyzed the data and drafted the first version of the manuscript and reviewed and revised all portions of the manuscript. SE provided the expertise and training in use of the telemedicine system and reviewed and revised all portions of the manuscript. MEM contributed to the data analysis and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Alexa K. Craig.

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Craig, A.K., McAllister, L.M., Evans, S. et al. Telemedicine consults to assess neonatal encephalopathy are feasible in the neonatal intensive care unit. J Perinatol 41, 1519–1521 (2021). https://doi.org/10.1038/s41372-020-00828-3

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