Remote neonatal neurocritical care: from the bedside to the cloud

Neonatal neurocritical care (NNCC) has emerged as a specialized discipline to address the unique neurological needs of critically ill newborns. However, disparities in access to brain-focused expertise and neuromonitoring technologies remain a significant global challenge. Remote NNCC, supported by telemedicine and digital health tools, offers a promising approach to extend specialized neurological care beyond tertiary centers, particularly to underserved or resource-limited settings. This review explores the current landscape, opportunities, and limitations of remote NNCC. Key applications include remote consulting and rounding, tele-interpretation of neurophysiological data, integration of multimodal monitoring, remote neuroimaging evaluation, and virtual neurological examinations. Additionally, telehealth platforms are increasingly used to support neurodevelopmental follow-up and therapeutic interventions after NICU discharge. These approaches can enhance diagnostic precision, enable timely intervention, reduce unnecessary transfers, and promote equity in care delivery. Advancements in artificial intelligence, immersive reality, and digital twins modeling may further expand the capabilities of remote NNCC. These emerging technologies hold the potential to optimize real-time decision-making, personalize interventions, and foster large-scale collaboration through cloud-based data integration. However, significant barriers remain, including limitations in infrastructure, interoperability between systems, variability in training, and ethical concerns related to data privacy, algorithmic bias, and equitable access. To ensure the safe and effective adoption of remote NNCC, standardized protocols, robust governance frameworks, and investments in workforce development and infrastructure are essential. Interdisciplinary collaboration and global partnerships will be critical in addressing these challenges and realizing the full potential of remote NNCC in improving neurological outcomes for high-risk neonates worldwide.