Background Approximately 10% of newborns require some degree of support during the transition to extrauterine life. About 5% need more intensive interventions, such as positive pressure ventilation, while a smaller proportion—ranging from 0.4% to 2%—requires endotracheal intubation. A minority of neonates need chest compressions and pharmacologic support. In such critical scenarios, the quality and timeliness of neonatal resuscitation in the first minutes of life strongly influence outcomes in terms of both morbidity and mortality. Furthermore, several studies have shown that the level of care at the birth center significantly affects neonatal prognosis. In peripheral hospitals, limited exposure to neonatal emergencies may compromise the quality of care. These findings underscore the need to improve the performance of healthcare professionals in lower-level centers, both in terms of speed and technical accuracy. Currently, the management of critically ill neonates born in peripheral facilities relies on the Neonatal Emergency Transport Service (STEN). However, this system presents several logistical limitations, particularly concerning response times. In this context, telemedicine emerges as a promising tool to enhance existing training programs, improve the competencies of healthcare professionals across the territory, and provide real-time clinical support during neonatal resuscitation. Objective This pilot study, the first of its kind in Italy, aims to evaluate the feasibility and effectiveness of a tele-neonatology program in both remote training of healthcare personnel and clinical support during the resuscitation of critically ill neonates. Materials and Methods Two spoke centers in the Eastern Veneto region (Feltre and Belluno Hospitals) were involved, in collaboration with the Neonatal Emergency Transport Service and neonatologists from the Neonatal Intensive Care Unit of the University Hospital of Padua (hub center). A total of 40 healthcare professionals and 2 neonatology specialists participated in the study. A series of online training sessions combined with high-fidelity manikin simulations were conducted to assess the feasibility and efficacy of remote neonatal resuscitation training. Validated tools from the literature were employed, including the NeoScore Evaluation Assessment Tool and custom-designed psychometric instruments for measuring self-efficacy and self-perceived knowledge. Following this initial training phase, a clinical trial will be conducted in the participating spoke centers to evaluate the impact of tele-neonatology in real-life neonatal resuscitation scenarios. Results Data analysis from the training phase revealed statistically significant improvements among participants. Both regression models and paired t-tests demonstrated a significant increase in self-efficacy (p << 0.001) and self-perceived knowledge (p = 0.002) following the remote training sessions. Conclusions In recent years, telemedicine has gained recognition as a valuable resource in healthcare, propelled by the COVID-19 pandemic and the widespread adoption of increasingly effective digital technologies. Preliminary results from this pilot project confirm that on-site simulations have a measurable impact on participants’ competencies. The forthcoming comparison with results from remote simulations will allow for evaluation of potential differences between in-person and online training formats. Finally, the data collected during the clinical phase will help determine the effectiveness of tele-neonatology in real-world practice. Consistent with international literature, this study aims to validate the role of telemedicine in both medical education and clinical care in the context of neonatal resuscitation in Italy.
Presupposti dello studio Circa il 10% dei nuovi nati richiede un sostegno di basso grado nella transizione alla vita extrauterina, mentre il 5% dei neonati necessita di un intervento più intensivo con ventilazione a pressione positiva ed una percentuale più piccola, compresa tra lo 0,4% e il 2%, richiede l’intubazione. Una minoranza richiede compressioni toraciche e assistenza farmacologica. In tale contesto emergenziale, la corretta gestione del paziente nei primi minuti impatta fortemente l’outcome neonatale, in termini sia di mortalità che di morbilità. Oltre a ciò, è stato dimostrato che l’outcome è influenzato anche dal livello assistenziale del punto nascita. Questi dati indicano la necessità di un miglioramento delle manovre del personale di centri periferici in termini di tempestività e qualità. Attualmente per la gestione di tali neonati critici ricoverati in centri di basso livello è prevista l’attivazione del “Servizio di Trasporto di Emergenza Neonatale”, che presenta tuttavia una serie di limitazioni. In tale contesto, la telemedicina si offre come nuovo strumento utile nell’ implementare i programmi formativi attualmente presenti, migliorare l’expertise del personale sparso sul territorio, e può essere un efficace strumento nella gestione clinica di neonati critici durante l’esecuzione della rianimazione neonatale. Scopo dello studio Scopo di questo progetto pilota è valutare la fattibilità di un programma di tele-neonatologia e l’efficacia di quest’ultima sia nella formazione del personale che sulla gestione clinica a distanza di neonati critici in rianimazione neonatale. Materiali e metodi Sono stati coinvolti due centri “Spoke” del Veneto Orientale in collaborazione con il Servizio di Trasporto d’ Emergenza Neonatale ed i neonatologi della Terapia Intensiva Neonatale dell’Azienda Ospedaliera-Università di Padova, per un totale di 40 partecipanti e 2 specialisti. Sono stati erogati per via telematica una serie di incontri formativi con relative simulazioni su manichino, per valutare, attraverso strumenti validati presenti in letteratura, la fattibilità e l’efficacia di programmi di formazione in rianimazione neonatale effettuati a distanza. Per valutare l’impatto delle simulazioni sui partecipanti si è ricorso al “NeoScore Evaluation Assessment Tool” ed altri strumenti creati ad hoc per l’analisi di variabili psicometriche, quali l’“autoefficacia” e “conoscenza autopercepita” degli operatori. Al termine di questa prima fase formativa, è in programma la sperimentazione clinica per la valutazione dell’efficacia della tele-neonatologia in rianimazione neonatale nella pratica clinica. Risultati L’analisi dei dati relativi alle prime fasi formative ha evidenziato miglioramenti significativi nei partecipanti. I risultati dei test statistici condotti (modelli di regressione e test t per dati appaiati) dimostrano incrementi significativi in seguito agli incontri formativi, sia nell’autoefficacia (p-value <<0,001) che nella conoscenza autopercepita (p-value =0,002), Conclusioni Negli ultimi anni la telemedicina rappresenta una nuova risorsa in ambito sanitario, sulla spinta della pandemia da Coronavirus e della diffusione su larga scala di tecnologie sempre più efficaci. Dai dati preliminari ottenuti, questo progetto pilota conferma che le simulazioni in loco hanno un impatto significativo sui partecipanti. I dati che verranno ottenuti dalle simulazioni telematiche verranno confrontati con quelli finora estrapolati, per definire eventuali differenze fra modalità telematica e in presenza. Infine, gli ulteriori dati ottenuti dalla sperimentazione clinica serviranno a definire l’efficacia della tele-neonatologia anche nella pratica clinica. In linea con precedenti studi condotti all’estero, l’aspettativa è di confermare anche in Italia la validità della telemedicina sia ambito formativo che nella pratica clinica
La telemedicina in rianimazione neonatale: dati preliminari di un progetto pilota
SIMIONATO, ALESSIO
2024/2025
Abstract
Background Approximately 10% of newborns require some degree of support during the transition to extrauterine life. About 5% need more intensive interventions, such as positive pressure ventilation, while a smaller proportion—ranging from 0.4% to 2%—requires endotracheal intubation. A minority of neonates need chest compressions and pharmacologic support. In such critical scenarios, the quality and timeliness of neonatal resuscitation in the first minutes of life strongly influence outcomes in terms of both morbidity and mortality. Furthermore, several studies have shown that the level of care at the birth center significantly affects neonatal prognosis. In peripheral hospitals, limited exposure to neonatal emergencies may compromise the quality of care. These findings underscore the need to improve the performance of healthcare professionals in lower-level centers, both in terms of speed and technical accuracy. Currently, the management of critically ill neonates born in peripheral facilities relies on the Neonatal Emergency Transport Service (STEN). However, this system presents several logistical limitations, particularly concerning response times. In this context, telemedicine emerges as a promising tool to enhance existing training programs, improve the competencies of healthcare professionals across the territory, and provide real-time clinical support during neonatal resuscitation. Objective This pilot study, the first of its kind in Italy, aims to evaluate the feasibility and effectiveness of a tele-neonatology program in both remote training of healthcare personnel and clinical support during the resuscitation of critically ill neonates. Materials and Methods Two spoke centers in the Eastern Veneto region (Feltre and Belluno Hospitals) were involved, in collaboration with the Neonatal Emergency Transport Service and neonatologists from the Neonatal Intensive Care Unit of the University Hospital of Padua (hub center). A total of 40 healthcare professionals and 2 neonatology specialists participated in the study. A series of online training sessions combined with high-fidelity manikin simulations were conducted to assess the feasibility and efficacy of remote neonatal resuscitation training. Validated tools from the literature were employed, including the NeoScore Evaluation Assessment Tool and custom-designed psychometric instruments for measuring self-efficacy and self-perceived knowledge. Following this initial training phase, a clinical trial will be conducted in the participating spoke centers to evaluate the impact of tele-neonatology in real-life neonatal resuscitation scenarios. Results Data analysis from the training phase revealed statistically significant improvements among participants. Both regression models and paired t-tests demonstrated a significant increase in self-efficacy (p << 0.001) and self-perceived knowledge (p = 0.002) following the remote training sessions. Conclusions In recent years, telemedicine has gained recognition as a valuable resource in healthcare, propelled by the COVID-19 pandemic and the widespread adoption of increasingly effective digital technologies. Preliminary results from this pilot project confirm that on-site simulations have a measurable impact on participants’ competencies. The forthcoming comparison with results from remote simulations will allow for evaluation of potential differences between in-person and online training formats. Finally, the data collected during the clinical phase will help determine the effectiveness of tele-neonatology in real-world practice. Consistent with international literature, this study aims to validate the role of telemedicine in both medical education and clinical care in the context of neonatal resuscitation in Italy.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/86980