The Technology Dependence Index (TDI): Development and Validation in Neonatal and Pediatric Populations

The survival of infants and children with complex medical conditions continues to increase, underscoring the need to quantify technology dependence more effectively. Existing measures emphasize mortality risk and fail to capture the burden of ongoing technological support. To address this gap, the Technology Dependence Index (TDI) was developed and initially validated as a standardized measure capturing the technology-dependence component of neonatal and pediatric caregiving complexity. Technology dependence is defined as the complexity and intensity of the skilled, health-related caregiving an infant or child needs to sustain physiological functioning, beyond the presence of any single device. Pooled data from six studies yielded 818 TDI observations across 265 infants. Inter-rater reliability was moderate (κ = 0.61), with intraclass correlations from 0.90 to 0.99 and at least 90% agreement for 10 of 12 domains, noting the medication domain had the lowest inter-rater reliability (45%-48%). Principal components analysis supported a multidimensional internal structure, with the 12 domains loading onto three retained factors. Researchers and clinicians can use the TDI retrospectively through chart review, prospectively in real time, or via parent report, making it adaptable to both research and clinical settings.