Robotic Neonatal Telemedicine RocksRobotic Neonatal Telemedicine Rocks

12 Advances In Medical Robotics

A team at the Children's Hospital Los Angeles that conducted a first-of–a-kind study that compared the findings of an on-site neonatologist at a neonatal intensive care unit (NICU) to off-site neonatologists using remote robotic telemedicine technology found that the technology is not only feasible and safe, but can also help neonatologists at a different location accurately evaluate a neonate patient.

"Aside from proving that the system is safe in the NICU, for the first time ever, the visual and audio accuracy and the ease of use of the system was an interesting finding," Dr. Istvan Seri, head of the USC Division of Neonatal Medicine at Children's Hospital Los Angeles and co-author of the report, told information Healthcare. "In addition, the acceptance of the robot in the unit by the faculty, trainees, nursing, and respiratory staff as well as, apparently, by the parents was truly remarkable."

The appeal of telemedicine in NICUs has coincided with the demand for more NICUs in the U.S. during the past several decades. With the increase in preterm deliveries, especially late preterm births and multiple births, as well as advances in neonatal medicine, there has been improved survival of critically ill preterm and term neonates.

However, most hospitals with a lower level NICU are financially constrained, have a limited work force, and are unable to have an on-site neonatologist that constantly observes infant patients. Therefore, in emergency situations in these NICUs, the neonates may be cared for by a neonatologist who is off-site and assesses the patient based on the information provided during a phone call by nursing staff and/or respiratory therapists.

The report notes that information received via telephone in emergency situations may be unreliable, which can cause the off-site neonatologist to make recommendations based on limited and potentially inaccurate information.

"Telemedicine technology can provide the off-site neonatologist with direct visual and auditory information about the patient and the clinical scenario in real-time, and may facilitate the decision-making process for the neonatologist," the report states. The study, entitled: The use of mobile robotic telemedicine technology in the neonatal intensive care unit, was recently published in the Journal of Perinatology. Of the 304 patient encounters on 46 preterm and term neonates at the Hollywood Presbyterian Medical Center's NICU, a bedside neonatologist and a neonatologist at a distant location evaluated selected demographic information, laboratory data, and clinical and radiological findings of the neonates observed.

The off-site neonatologist used a telemedicine system that was outfitted with a control station and a remote-controlled robot, which was linked via the Internet over a secure broadband connection.

Other features included a bi-directional audio and video communications capability, with real-time video, rapid-response cameras with zoom and auto-focus, panoramic visualization system, a digital camera for image capture, audio microphones, amplification circuitry, and custom software.

Researchers noted that while the two physicians were blinded to each other's findings, the results showed there were excellent or intermediate-to-good agreements noted for all but a few physical examination assessments between both the on-site neonatologist and off-site neonatologist and an additional experiment with two on-site neonatologists. Poor agreements were found for certain physical examination parameters (breath-, heart-, and bowel-sounds and capillary refill time) with or without the use of telemedicine.

According to Dr Seri, the few findings with poor agreement were not related to telemedicine, but were the result of the subjective nature of the findings.

"We have proved this by performing an additional study, testing the agreements for the same findings between two on-site neonatologists who were blinded to each other's findings at the bedside," Dr Seri explained. "We found that the same findings that showed poor agreements between the on-site and the off-site (telemedicine) neonatologist also showed similarly poor agreements between the two on-site neonatologists examining the baby at the bedside at the same time."

The researchers cautioned, however, that: "as a robotic telemedicine exam cannot replace a bedside exam, robotic telemedicine technology should not be conceived as a replacement for the provision of on-site intensive care but rather a way to ensure that prompt attention and early intervention based on direct and accurate information can be provided to sick neonates.

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