Newborns with neonatal encephalopathy delivered in community hospitals in rural Maine experience critical delays in resuscitation and initiation of therapeutic hypothermia (TH), a standard-of-care neuroprotective therapy. A rapid assessment of neonatal encephalopathy is required to determine eligibility for TH, because TH is only performed in two tertiary care centers in Maine. More than half of the neonates born annually are disadvantaged due to the lack of immediately available expertise in the community hospital and the need to be transported within the first 6 hours of life for assessment and care. There is a critical need to test effectiveness of strategies, such as telemedicine, to provide immediate expert consultation in neonatal critical care in rural community hospital settings. Our long-term goal is to use implementation science to improve survival and neurodevelopmental outcomes for neonates born in rural states. Our objective is to develop our telemedicine consultative network to improve both timeliness and patient selection for TH, and thus improve short-term outcomes and decrease rural healthcare disparities.
In Aim 1, telemedicine consults will be used in eight community hospitals in Maine to determine if the time to initiation of TH can be decreased through the use of telemedicine.
In Aim 2, telemedicine consults will be used in three tertiary care centers to develop evidence for the threshold at which neonates can be safely excluded from hypothermia treatment.
In Aim 3, we will investigate the parent experience of participating in telemedicine consults, and specifically in giving consent for neonatal critical care research through the telemedicine interface.
We aim to understand the parent experience in the context of the trauma associated with a newborn being critically ill at birth. Upon completion of this study, we anticipate that the telemedicine network in New England will include three tertiary care centers in two states and 8 or more community hospitals. This collaboration of tertiary care centers and community hospitals will be poised to welcome new members into the network, which will have the capacity to plan and execute clinical trials addressing topics that will further refine the delivery of timely TH care to neonates who meet criteria. Through implementation science, the proposed project and future projects will insure that neonates born in rural community hospitals have access to the same care available in a tertiary care center. This project is led by Dr. Alexa Craig, a junior investigator and neonatal/pediatric neurologist with a research program to address healthcare outcome disparities for neonates born in rural areas. She recently completed a KL2 project and pilot studies to establish feasibility for the current studies. Her strong mentorship team will bring expertise in clinical pediatrics (M. Ottolini) and pediatric neurology clinical research (G. Holmes), and Dr. Craig will utilize this COBRE to advance her research partnerships and program across northern New England.
