Agreement Between Telemedicine and In-Person Examination for Neonatal Hypothermia Decisions

Area of Science:

• Neonatal neurology
• Telemedicine
• Medical technology

Background:

• Therapeutic hypothermia is critical for newborns with hypoxic-ischemic encephalopathy (HIE).
• Timely initiation of hypothermia is often delayed by patient transfers.
• Telemedicine (TM) offers a potential solution to expedite hypothermia evaluations.

Purpose of the Study:

• To compare the efficacy of telemedicine (TM) versus in-person (IP) Sarnat examinations for HIE assessment.
• To evaluate the agreement between TM and IP Sarnat examinations in guiding hypothermia decisions.
• To assess the feasibility and technical performance of TM for neonatal neurological assessments.

Main Methods:

• Infants with suspected HIE underwent both IP and TM modified Sarnat examinations within 6 hours of birth.
• Cohen's kappa statistic (κ) was used to measure interrater agreement between IP and TM findings.
• Data collected included neurologic scores, hypothermia qualification decisions, and TM technology metrics.

Main Results:

• Almost perfect agreement (κ = 0.82) was observed between IP and TM for moderate/severe HIE signs and hypothermia decisions.
• Fair to moderate agreement (κ = 0.33-0.58) was found for individual neurologic examination categories.
• TM examinations were efficient, with 93% completed within 15 minutes and 79% experiencing no technical issues.

Conclusions:

• Telemedicine (TM) assessments are feasible and comparable to in-person (IP) evaluations for guiding therapeutic hypothermia in HIE.
• TM can enhance remote Sarnat evaluations, facilitating earlier initiation of life-saving interventions.
• This technology holds promise for improving access to timely HIE care in diverse settings.