Abstract
Background: Neonatal encephalopathy (NE) contributes to worldwide perinatal mortality. Therapeutic hypothermia (TH) has turned moderate-to-severe NE into a perinatal emergency, however, identification of NE remains challenging. Our aim was to determine whether telemedicine could improve recognition of moderate-to-severe NE and neurologic outcome. Methods: Population-based, prospective cohort study of consecutive newborn infants with more than 35 weeks’ gestation experiencing perinatal asphyxia admitted at 12 hospitals in Spain between June 1, 2011 and June 1, 2013. Structured neurologic examinations to assess the severity of NE were performed and recorded at one, three, and five hours by the attending physician. The videos were blindly examined after the recruitment period by two experienced neonatologists. Outcome was assessed at 36 months of age using standardized tests. FindingsOf the 32,325 liveborn infants, 217 met the inclusion criteria (93 female [57%]). Video-recordings were available for 174 infants (80%). Weighted kappa statistic (κw) was 0·74 (95% confidence interval [CI], 0·67-0·81; P<0·0001) between the specialists and the attending physician’s. Disagreement occurred in 93 of the 417 (22%) videos, specifically in 39 (14%), 43 (47%), and 11 (34%) and 0 exams categorized as no, mild, moderate, and severe NE, respectively. According to the specialists’ assessment there was disagreement on the TH decision in ten infants. When specialists assessed a more severe NE grading compared to the attending physicians, those infants had lower cognitive and language scores with a median of -9·26 points (95% CI, -17·28 to -1·24; P=0·02) and -10.74 (95% CI, -21·35 to -0·12; P=0·04), respectively. Interpretation: This study supports the feasibility and benefit of using telemedicine to help identify and grade NE in infants with perinatal asphyxia. Telemedicine can be used to improve decisions on TH to achieve better outcomes. Funding Statement: Ernesto Sanchez Villares Foundation (FESV 11/2012 and 09/2014) and Castilla-Leon Regional Health Authority (GRS 828/A/13). Declaration of Interests: No competing financial interests exist. Ethics Approval Statement: The research was conducted according to the Declaration of Helsinki principles, and the Clinical Research Ethics Board approved the study (Protocol Number 916).
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