Telemedicine in Neonatal Resuscitation: A Pilot Project

Background: The quality and timeliness of neonatal resuscitation in the first minutes of life determine morbidity and mortality outcomes. Approximately 11% of newborns require respiratory support at birth, with a smaller proportion requiring advanced interventions like endotracheal intubation (1%), chest compressions (0.1%), or adrenaline (0.1%). Evidence shows the facility's level of care significantly influences neonatal prognosis, raising concern for peripheral hospitals where limited exposure to emergencies may compromise response quality and speed. This underscores the need to enhance the readiness of professionals in low-volume centers. Currently, care for critically ill neonates in peripheral facilities relies on the Neonatal Emergency Transport Service (NETS), which is limited by logistical constraints and response times. Telemedicine emerges as a promising tool to enhance educational programs, reinforce regional competencies, and provide real-time support during resuscitation. Objective: This pilot study, the first in Italy, evaluates the feasibility and clinical efficacy of a teleneonatology program in two domains: remote training and real-time clinical support. Materials and Methods: The study involved two spoke facilities in the Eastern Veneto region (Feltre and Belluno Hospitals) collaborating with NETS and neonatologists from Padua University Hospital (hub). Participants included 40 peripheral professionals and 2 specialists. The educational phase used telemedicine-mediated sessions and low-fidelity simulations to assess remote training. Assessment relied on validated instruments, including the “NeoScore Evaluation Assessment Tool” and custom psychometric questionnaires measuring Perceived Self-Efficacy and Perceived Knowledge. A subsequent clinical trial will evaluate the real-world impact of teleneonatology during emergencies at the spoke centers.Results: The intervention significantly improved Perceived Self-Efficacy (p < 0.001), which remained stable at 6 months, halting the physiological decay of clinical competencies and self-confidence. Concurrently, Perceived Knowledge showed continuous growth (p < 0.001). Post-intervention performance correlated positively with baseline Perceived Self-Efficacy (r = 0.50) and COPE Problem Solving (r = 0.36). Longitudinally, Self-Efficacy growth was more pronounced in participants with higher baseline MLCS Hetero-dependence and attenuated by higher baseline knowledge, independent of prior clinical experience and professional role. Conclusions: Telemedicine is increasingly recognized as a valuable healthcare resource. Results from this pilot project confirm that a "blended" educational strategy significantly impacts learners. Compared to the initial on-site course, six-month telesimulations effectively halted the decay of self-efficacy and promoted clinical knowledge growth. Future data from the clinical phase will determine teleneonatology's real-world effectiveness. In alignment with international studies, we expect to confirm the validity of telemedicine in Italy for both training and clinical practice in neonatal resuscitation.