777 - The Impact of Teleneonatology on the Transport Risk Index of Physiologic Stability (TRIPS) Score for Outborn Neonates: A Prospective, Observational Study

Poster Number: 777
Publication Number: 777.248

Rahul Patel, Mayo Clinic Alix School of Medicine, Scottsdale, AZ, United States; Beth Kreofsky, Mayo Clinic, Elgin, MN, United States; Roland Hentz, Mayo Clinic Children's Center, Albuquerque, NM, United States; Jennifer Fang, Mayo Clinic, Rochester, MN, United States

Background: Teleneonatology (TN) allows neonatologists to use real-time, audio-video telemedicine to evaluate and manage critically ill neonates located in community hospitals (CH). The Transport Risk Index of Physiologic Stability (TRIPS) score is a validated metric that predicts risk of 7-day mortality for neonates that undergo medical transport.

Objective: Our primary objective was to evaluate how TN impacts the TRIPS score assigned upon arrival of the transport team to the CH. We hypothesized that neonates who received TN consults would have lower (better) TRIPS scores. Secondary objectives included evaluating how TN affects the TRIPS score assigned upon arrival to the NICU and the score’s individual physiologic metrics.

Design/Methods: Outborn neonates born between 12/8/2018 - 7/31/2022 who were admitted to the NICU were screened for eligibility. TN was available at 50% (12/24) of CH. CH care teams decided when to activate the service. Study data was abstracted from medical transport documents and electronic health records.
Proportions were compared using chi-square test, Fisher’s exact test, and logistic regression. TRIPS scores were evaluated using zero-inflated negative binomial regression. Other variables were tested with linear regression or Wilcoxon rank-sum test. Regression models were adjusted to mitigate confounding bias.

Results: Forty-two percent (161/385) of neonates received a TN consult. Neonates that received TN had lower birth weight, gestational age, and Apgar scores and were more often admitted with respiratory distress syndrome and respiratory failure (Table 1). In the CH, neonates that received TN were less likely to have a TRIPS score of zero (OR 0.51, 95%CI 0.33, 0.78).  When adjusted for baseline characteristics, this difference was no longer significant. Non-zero TRIPS scores were not different between groups. Neonates that received TN more frequently had abnormalities in temperature, systolic blood pressure, and respiratory status (Table 2). On arrival to the NICU, neonates that received TN were less likely to have a TRIPS score of zero (OR 0.47, 95%CI 0.31, 0.72), and non-zero scores were 10% higher (mean ratio 1.1, 95%CI 1.0, 1.3). After adjustment, these findings were no longer significant. Neonates that had TN consults received pressors more frequently (Table 3).

Conclusion(s): In this observational study, neonates that received TN did not have lower (better) TRIPS scores. Findings may be limited by confounding bias given differences in baseline patient characteristics. Randomized studies are needed to determine whether TN impacts the physiologic stability of outborn neonates.