Video-call based newborn triage system for local birth centres can be established without major instalment costs using commercially available smartphones

Abstract

Neonates often develop transition problems after low-risk birth, precise assessment of which is difficult at primary birth centres. the aim of this study was to assess whether a video triage system can be established without a specially designed communication system between local birth centres and a tertiary neonatal intensive care unit in a region with a population of 700,000. 761 neonates who were referred to a tertiary neonatal intensive care unit were examined. During period 1 (April 2011-August 2015), only a voice call was available for consultations, whereas, during period 2 (September 2015-December 2017), a video call was additionally available. The respiratory condition was assessed based on an established visual assessment tool. A video consultation system was established by connecting personal smartphones at local birth centres with a host computer at a tertiary neonatal intensive care centre. During period 2, video-based triage was performed for 42.4% of 236 consultations at 30 birth centres. Sensitivity and specificity for predicting newborns with critical respiratory dysfunction changed from 0.758 to 0.898 and 0.684 to 0.661, respectively. A video consultation system for ill neonates was established without major instalment costs. our strategy might improve the transportation system in both high-and low-resource settings. Approximately 10% of newborns require some form of special care before spontaneous breathing is established 1. To improve the outcomes of high-risk foetuses, antenatal diagnoses and maternal transportation to higher-level birth centres have been encouraged 2. However, for newborns born near term and at term, who require advanced care because of transition failure, abnormal clinical signs are often unnoticed until much later after birth 3. Dissemination of an evidence-based program of neonatal cardiopulmonary resuscitation (NCPR) led to improved support for ill newborns worldwide 4,5. However, newborns who cannot establish spontaneous breathing need to be transferred to neonatal intensive care units (NICUs) for advanced care support. Indeed, a large-scale survey in Japan conducted in 2012 showed that 20.5% of 55,331 newborns admitted to NICUs were transferred from primary/secondary birth centres after birth 6. Although careful assessments are essential for precise triage decisions, currently, there is no established system for evaluating the conditions of newborns before transportation, potentially leading to diagnostic discordance between the reason for transport and final diagnosis, as reported in paediatric transport 7. Our group has previously developed a visual assessment scale that can objectively predict which ill newborns have low respiratory compliance 8. Implementing such a scale with a video

“We can’t do without it”: Parent and call-handler experiences of video triage of children at a medical helpline

“…However, other areas of pediatric research have studied video-based communication. Video-based triage at low risk birth centers in Japan increased the sensitivity and specificity for predicting newborns with critical respiratory dysfunction prior to transfer to a specialized center [ 26 ]. A Danish study on neonatal tele-homecare showed that telehealth service provided the parents with increased reassurance and empowerment [ 27 ].…”

Is telemedicine suitable for remotely supporting non-tertiary units in providing emergency care to unwell newborns?

“…The mobile cart was more reliable with higher audio-video quality, but requires more space and has limited mobility 10. Okada et al describe non-tertiary units successfully using personal smartphones to establish video calls to a tertiary NICU, viewed on a computer screen 35. FaceTime via Apple iPhone and Zoom were the most popular applications chosen.…”