First-step validation of a text message-based application for newborn clinical management among pediatricians

Neonatal mortality is high in developing countries. Lack of adequate training and insufficient management skills for sick newborn care contribute to these deaths. We developed a phone application dubbed Protecting Infants Remotely by Short Message Service (PRISMS). The PRISMS application uses routine clinical assessments with algorithms to provide newborn clinical management suggestions. We measured the feasibility, acceptability and efficacy of PRISMS by comparing its clinical case management suggestions with those of experienced pediatricians as the gold standard.

Twelve different newborn case scenarios developed by pediatrics residents, based on real cases they had seen, were managed by pediatricians and PRISMS®^. Each pediatrician was randomly assigned six of twelve cases. Pediatricians developed clinical case management plans for all assigned cases and then obtained PRISMS suggested clinical case managements. We calculated percent agreement and kappa (k) statistics to test the null hypothesis that pediatrician and PRISMS management plans were independent.

We found high level of agreement between pediatricians and PRISMS for components of newborn care including: 10% dextrose (Agreement = 73.8%), normal saline (Agreement = 73.8%), anticonvulsants (Agreement = 100%), blood transfusion (Agreement =81%), phototherapy (Agreement = 90.5%), and supplemental oxygen (agreement = 69.1%). However, we found poor agreement with potential investigations such as complete blood count, blood culture and lumbar puncture. PRISMS had a user satisfaction score of 3.8 out of 5 (range 1 = strongly disagree, 5 = strongly agree) and an average PRISMS user experience score of 4.1 out of 5 (range 1 = very bad, 5 = very good).

Management plans for newborn care from PRISMS showed good agreement with management plans from experienced Pediatricians. We acknowledge that the level of agreement was low in some aspects of newborn care.