Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring

Abstract

Objective Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions. Study Design A pre–post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders. Results There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79–1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85–0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59–0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85–0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36–0.65, p < 0.001). Conclusion In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate. Key Points

Ob Hub

“…A recent study using such a model for fi ve hospitals suggested that unanticipated term neonatal intensive care unit (NICU) admissions, cesarean births, and operative vaginal birth rates could be decreased (Martin et al, 2021). With over 19,000 live births in their pre-and postimplementation analysis, they found no signifi cant differences between groups on unexpected admission to the NICU after multivariate regression analysis (Martin et al, 2021). In further analysis of each hospital individually, their highest volume teaching hospital noted a decrease in cesarean births, operative vaginal birth rates, and 5-minute Apgar scores of <7, suggesting that in some settings, remote EFM may be associated with lower cesarean and operative vaginal birth rates (Martin et al, 2021).…”

“…Studies on the value of a remote centralized monitoring system are sparse. A recent study using such a model for fi ve hospitals suggested that unanticipated term neonatal intensive care unit (NICU) admissions, cesarean births, and operative vaginal birth rates could be decreased (Martin et al, 2021). With over 19,000 live births in their pre-and postimplementation analysis, they found no signifi cant differences between groups on unexpected admission to the NICU after multivariate regression analysis (Martin et al, 2021).…”

“…With over 19,000 live births in their pre- and postimplementation analysis, they found no significant differences between groups on unexpected admission to the NICU after multivariate regression analysis (Martin et al, 2021). In further analysis of each hospital individually, their highest volume teaching hospital noted a decrease in cesarean births, operative vaginal birth rates, and 5-minute Apgar scores of <7, suggesting that in some settings, remote EFM may be associated with lower cesarean and operative vaginal birth rates (Martin et al, 2021). In another study, L&D nurses acting in the role of remote EFM monitor nurses participated in a survey to assess their perceptions of the benefits of the role.…”

Effectiveness of Remote Fetal Monitoring on Maternal-Fetal Outcomes: Systematic Review and Meta-Analysis

“…Fetal monitoring is the primary means of monitoring to assess fetal safety and contributes to reducing the risk of stillbirth by detecting fetal hypoxia as early as possible [2,3]. Previous studies have repeatedly demonstrated the clinical value of fetal monitoring in reducing adverse perinatal outcomes (eg, neonatal cerebral palsy, hypoxic-ischemic encephalopathy, or stillbirth) [4,5].…”