558 - Tele-NICU services may improve neonatal outcomes and monitoring in a resource constrained setting in India: A proof of concept study

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 558
Publication Number: 558.41

Ryan CL. Brewster, Boston Children's Hospital, Boston, MA, United States; geetanjali srivastava, cloudphysician, Hyderabad, Telangana, India; Dileep Raman, Cloudphysician Healthcare, Bangalore, Karnataka, India; Sitarah Mathias, Boston Children's Hospital, Boston, MA, United States; Carl Britto, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Ryan CL Brewster, MD

Resident Physician
Boston Children's Hospital
Boston, Massachusetts, United States

Background: Newborn deaths account for the majority of global under-5 mortality. While improving neonatal survival has been prioritized by the United Nation’s Sustainable Development Goals, meaningful progress has been hindered by limited critical care resources in low and middle income countries (LMICs). Tele-NICU services, wherein intensivists manage patient care remotely via telemedicine, has the potential to expand NICU capacity and augment data collection and monitoring in settings without electronic medical records.

Objective:
To describe trends in NICU outcomes and performance indicators following implementation of a tele-NICU service

Design/Methods:
We conducted a retrospective, proof-of-concept analysis of neonatal clinical outcomes from a level 3, resource constrained NICU in Uttar Pradesh, India with tele-NICU care enabled by CloudPhysician Healthcare Private Limited (Bengaluru, India). The CloudPhysician platform connects remote intensivists to bedside providers through a hub-and-spokes model and proprietary electronic medical record system (RADAR). NICU outcomes and performance indicators were defined a priori and obtained from RADAR. We characterized changes in outcomes with proportions relative to total weekly admissions and linear regression, adjusted for severity. The study period was from CloudPhysician implementation in August 2022 through November 2022.

Results: Between August 2022-November 2022, There were a total of 163 newborns admitted and managed by tele-NICU services. The majority were term gestation (70.6%), low birth weight (59.4%), and male (80.4%). Rates of all cause mortality (Slope: -0.20%/week, 95% confidence interval [CI]: -0.48%-0.08%/week), disseminated intravascular coagulation (DIC) ( -0.38%/week, 95% CI: -0.85%-0.08%/week), and prolonged respiratory support >5 days (-0.24%/week, 95% CI: -0.54%-0.05%/week) showed a downward trend. Rates of sepsis (0.16%/week, 95% CI: -0.51%-0.82%/week), acute kidney injury (Slope: 0.02%/week, 95% CI: -0.71%-0.66%/week), and prolonged length of stay >5 days (0.08%/week, -0.45%-0.62%/week) either remained stable or increased.

Conclusion(s):
Operationalization of a tele-NICU platform in a resource constrained NICU in India facilitated robust surveillance of neonatal outcomes and performance indicators. Although modest, improving trends in mortality and acute complications, such as DIC, suggest that a tele-NICU model may enhance local healthcare delivery over a longer period of implementation. The lack of a native electronic medical record at our study site limited comparison to baseline data.