Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine’s current use bears testimony to its effectiveness and potential. Telemedicine’s widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.

Nationally representative hospital data indicate a declining incidence of hospitalizations with a diagnosis of kernicterus in newborn infants over the period 1988-2005. The decline occurred before and immediately after publication of the 1994 American Academy of Pediatrics guideline on hyperbilirubinemia. Epidemiologic findings were mostly consistent with other studies. Healthcare Cost and Utilization Project data provide an important system for monitoring hospitalizations of uncommon newborn conditions such as kernicterus.

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The effect of personalization on mail survey response rates was examined in nine studies that included 17 comparisons under several research conditions. A study of this variable across multiple experiments in five agricultural experiment stations was undertaken because of conflicting results from previous research and from concern that the effectiveness of personalization might have decreased over time. Results show that, while response to general public surveys appeared to increase modestly across all treatment groups, there was no positive effect for populations in which a group identity (e.g., Dear Oregon Gardner or Dear ATV Owner) is employed to address respondents in cover letters. Personalization appears to remain useful for improving response in surveys of the general public.

Despite the growing knowledge of recognition, treatment, and outcomes, NAS continues to challenge clinicians. An increasing number of women receiving prescribed medications for chronic pain conditions and mental illness also have changed the population needing prenatal counseling and postnatal monitoring. NAS develops in more than 50% of all newborns exposed to narcotics in utero, but the signs of withdrawal remain nonspecific, and couplet care or rooming-in on postpartum wards often hinders monitoring and evaluation. Several abstinence scoring systems can assist nurses and physicians in assessing the severity of withdrawal and providing appropriate therapy. Medical therapy is recommended for severe cases, and several medications have proven safe and effective. Although the duration of therapy varies, medications can be titrated so infants can tolerate mild symptoms of withdrawal, and the process can be monitored with abstinence scores. This article reviews the signs of NAS from various substances, existing abstinence scoring systems, current treatment and weaning strategies, and relevant points for prenatal counseling.

The American Academy of Pediatrics (AAP) affirms that the optimal location for children to receive care for acute, nonemergency health concerns is the medical home. The medical home is characterized by the AAP as a care model that “must be accessible, family centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.” However, some children and families use acute care services outside the medical home because there is a perceived or real benefit related to accessibility, convenience, or cost of care. Examples of such acute care entities include urgent care facilities, retail-based clinics, and commercial telemedicine services. Children deserve high-quality, appropriate, and safe acute care services wherever they access the health care system, with timely and complete communication with the medical home, to ensure coordinated and continuous care. Treatment of children under established, new, and evolving practice arrangements in acute care entities should adhere to the core principles of continuity of care and communication, best practices within a defined scope of services, pediatric-trained staff, safe transitions of care, and continuous improvement. In support of the medical home, the AAP urges stakeholders, including payers, to avoid any incentives (eg, reduced copays) that encourage visits to external entities for acute issues as a preference over the medical home.

Objective Practicing clinicians, especially in rural areas, are often isolated from learning opportunities and interaction with subspecialty providers. The Pediatric Physician Learning and Collaborative Education (Peds PLACE), an interactive educational telemedicine program, was developed to address this need. We evaluated the success of this program through surveys with practicing and academic physicians. Methods Peds PLACE was assessed using two evaluation forms collected from October 2007 to May 2008. One of them was completed by 197 attendees from the University of Arkansas for Medical Sciences (UAMS) and 172 from remote sites. Another form was completed by 131 participants from Arkansas Children's Hospital (ACH), an academic free standing children's hospital. Both evaluation forms asked participants to use a 5-point Likert scale to rank a number of criteria and included a section for participants to write comments and recommendations. Additional data was collected through an open-response email survey of participants. Results 95% of the participants agreed that the presentations related to their professional needs, 98% agreed that it increased their subject matter knowledge, 81% evaluated the presentations as some of the best they have attended, and 93% agreed that the information would translate into professional practice, enhancing patient care. Health personnel from UAMS evaluated the presentations significantly higher than remote participants. Nursing staff evaluated the presentations significantly higher than medical staff. Comments were generally positive and correlated with the Likert scale data. Conclusion Participants reported being highly satisfied with Peds PLACE and considered it an effective way to address the continuing education needs of practitioners throughout Arkansas, especially in rural and underserved areas.