Neonatal tele-homecare

When a child is born prematurely parents may struggle to bond with their children. The staff can be perceived by parents as an obstacle to their own contact with the child and the conditions of the hospital premises can mean that the time spent by the family together is limited. Neonatal home care means that the child is cared for in the home but is still enrolled in the neonatal care ward, where rounding takes place at home visit, instead of continued care in the hospital.

Telemedicine, or telehealth, means medical care at a distance. In this response we address neonatal tele-homecare, a variant of the neonatal home care where the parents communicate with the ward directly from their own home. Most often, the neonatal tele-homecare takes place via video link, in order for the staff to be able to assess the child's status. One reason for using tele-homecare is that it is thought that the scarce resources of the health care system can be used more efficiently than in traditional home care.

Reading time approx. 16 minutes Published: Publication type:

SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Question

What scientific studies are there on neonatal tele-homecare?

Identified literature

Table 1. Health economic studies with sufficient quality regarding economic aspects and transferability of economic results.
Population Intervention/Control Outcomes
Rasmussen et al. 2019 [1]
Preterm infants and their parents.
  • gestational age at birth <37 + 0 weeks
  • weight ≥1500g
  • post menstrual age ≥34 weeks
  • tube fed (exclusively/partially)
  • expected tube feeding for at least 7 days
  • cardiopulmonary stable
  • parents able to collaborate with clinicians and use their guidance
  • one parent must be speaking Danish
 Neonatal tele-homecare, NTH (n=96) compared to regular care at a neonatal intensive care unit, NICU (n=278).
The tele-health service was an app developed for NTH. The app had options for videoconferences and chat messages between the NICU nurses and parents. At least twice a week, a videoconference between a nurse and at least one parent was conducted.
  • NTH resource utilization
  • In-NICU hospital bed days from birth to discharge
  • Re-admissions to NICU
  • Total costs on average per infant
Costs included investments (app development, devices, education), intervention costs (introduction for families, videoconferences, chat messages and hospital check-ups), and resource utilization in hospital (bed day at NICU and re-admission to NICU)
Authors' conclusion:
“The costs of providing NTH for preterm infants and their parents were outweighed by a reduction in inhospital days for the group of infants with GA>32+0 weeks. The group of infants with GA<32+0 weeks had lower costs on average compared to the control group, and the statistically significant difference in bed days between groups suggests that NTH may reduce in-hospital bed days. NTH is an appropriate model of care for preterm infants and their families, is clinically effective and is less expensive than similar services delivered in hospitals.”

References

  1. Rasmussen MK, Clemensen J, Zachariassen G, Kidholm K, Brodsgaard A, Smith AC, Holm KG. Cost analysis of neonatal tele-homecare for preterm infants compared to hospital-based care. Journal of telemedicine and telecare 2019;1357633x19843753.
  2. Anwar Siani S, Dol J, Campbell-Yeo M. Impact of Parent-Targeted eHealth on Parent and Infant Health Outcomes: A Scoping Review. The Journal of perinatal & neonatal nursing 2017;31:332-40.
  3. Nordtug B, Brataas HV, Rygg LO. The use of videoconferencing in nursing for people in their homes. Nursing Reports 2018;8:1-8.
  4. Sasangohar F, Davis E, Kash BA, Shah SR. Remote Patient Monitoring and Telemedicine in Neonatal and Pediatric Settings: Scoping Literature Review. Journal of medical Internet research 2018;20:e295.
  5. Ericson J, Eriksson M, Hellstrom-Westas L, Hoddinott P, Flacking R. Proactive telephone support provided to breastfeeding mothers of preterm infants after discharge: a randomised controlled trial. Acta paediatrica (Oslo, Norway : 1992) 2018;107:791-98.
  6. Ericson J, Flacking R, Udo C. Mothers' experiences of a telephone based breastfeeding support intervention after discharge from neonatal intensive care units: a mixed-method study. International breastfeeding journal 2017;12:50.
  7. Garne Holm K, Brodsgaard A, Zachariassen G, Smith AC, Clemensen J. Parent perspectives of neonatal tele homecare: A qualitative study. Journal of telemedicine and telecare 2019;25:221-29.
  8. Gund A, Sjoqvist BA, Wigert H, Hentz E, Lindecrantz K, Bry K. A randomized controlled study about the use of eHealth in the home health care of premature infants. BMC medical informatics and decision making 2013;13:22.
  9. Holm KG, Clemensen J, Brodsgaard A, Smith AC, Maastrup R, Zachariassen G. Growth and breastfeeding of preterm infants receiving neonatal tele-homecare compared to hospital-based care. Journal of neonatal-perinata medicine 2019;12:277-84.
  10. Lindberg B, Axelsson K, Öhrling K. Taking care of their baby at home but with nursing staff as support: The use of videoconferencing in providing neonatal support to parents of preterm infants. Journal of Neonatal Nursing 2009;15:47-55.
  11. Robinson C, Gund A, Sjoqvist BA, Bry K. Using telemedicine in the care of newborn infants after discharge from a neonatal intensive care unit reduced the need of hospital visits. Acta paediatrica (Oslo, Norway : 1992) 2016;105:902-9.
  12. Willard A, Brown E, Masten M, Brant M, Pouppirt N, Moran K, et al. Complex Surgical Infants Benefit From Postdischarge Telemedicine Visits. Advances in neonatal care : official journal of the National Association of Neonatal Nurses 2018;18:22-30.
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Published: Report no: ut201935 Registration no: SBU 2019/374

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Literature search

PubMed via NLM 2019-09-05
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. ("Infant, Newborn"[Mesh]) OR "Premature Birth"[Mesh] 594 549
2. (preterm[tiab] OR newborn[tiab] OR neonat*[tiab] OR prematur*[tiab]) 501 829
3. 1 OR 2 859 454
Intervention:
4. ("Telemedicine"[Mesh]) 25 805
5. remote[tiab] OR NTH[tiab] OR telemedicine[tiab] OR tele-care[tiab] OR tele-homecare[tiab] OR "tele care"[tiab] OR "tele home care"[tiab] OR telephone[tiab] OR video[tiab] OR smartphone[tiab] NOT medline[sb] 39 948
6. 4 OR 5 68 461
Final 3 AND 6 1 182

 

PubMed via NLM 2019-10-17
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. NICU[tiab] 9 328
Intervention:
2. ("Telemedicine"[Mesh]) 26 121
3. (remote[tiab] OR NTH[tiab] OR telemedicine[tiab] OR tele-care[tiab] OR tele-homecare[tiab] OR "tele care"[tiab] OR "tele home care"[tiab] OR telephone[tiab] OR video[tiab] OR smartphone[tiab] OR webcam[tiab] OR web-cam[tiab]) NOT medline[sb] 40 355
4. 2 OR 3 66 476
Final 1 AND 4 73

 

PubMed via NLM 2019-10-17
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; [MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. ("Infant, Newborn"[Mesh]) OR "Premature Birth"[Mesh] 596 875
2. (preterm[tiab] OR newborn[tiab] OR neonat*[tiab] OR prematur*[tiab] OR NICU[tiab]) 505 263
3. 1 OR 2 863 586
Intervention:
4. (webcam[tiab] OR web-cam[tiab]) 317
Final 1 AND 4 6

 

Cochrane Library via Wiley 2019-09-05
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”; CRM = Method Studies; DARE = Database Abstracts of Reviews of Effects, “other reviews”; EED = Economic Evaluations; HTA = Health Technology Assessments
Search terms Items found
Population:
1. MeSH descriptor: [Infant, Newborn] explode all trees 15243
2. MeSH descriptor: [Premature Birth] explode all trees 1155
3. (preterm):ti,ab,kw OR (neonat*):ti,ab,kw OR (Newborn):ti,ab,kw OR (prematur*):ti,ab,kw (Word variations have been searched) 49519
4. 1 OR 2 OR 3  
Intervention:
5. MeSH descriptor: [Telemedicine] explode all trees 2174
6. (remote):ti,ab,kw OR (telemedicine):ti,ab,kw OR (tele-care):ti,ab,kw OR ("tele care"):ti,ab,kw OR ("tele homecare"):ti,ab,kw (Word variations have been searched) 7 696
7. ("tele-homecare"):ti,ab,kw OR (video):ti,ab,kw OR (telephone):ti,ab,kw OR (smartphone):ti,ab,kw (Word variations have been searched) 32949
8. 5 OR 6 OR 7  
Final 4 AND 8 1250 

CDSR/29 
CENTRAL/1220

 

Embase via embase.com 2019-09-05
Neonatal telemedicine
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. 'newborn'/exp OR 'child, newborn':ti,ab OR 'full term infant':ti,ab OR 'human neonate':ti,ab OR 'human newborn':ti,ab OR 'infant, newborn':ti,ab OR 'neonate':ti,ab OR 'neonatus':ti,ab OR 'newborn':ti,ab OR 'newborn baby':ti,ab OR 'newborn child':ti,ab OR 'newborn infant':ti,ab OR 'newly born baby':ti,ab OR 'newly born child':ti,ab OR 'newly born infant':ti,ab OR 'prematurity'/exp OR 'infant, extremely premature':ti,ab OR 'infant, premature':ti,ab OR 'infant, premature, diseases':ti,ab OR 'neonate, premature':ti,ab OR 'pre-mature infant':ti,ab OR 'pre-term baby':ti,ab OR 'pre-term child':ti,ab OR 'pre-term infant':ti,ab OR 'pre-term neonate':ti,ab OR 'pre-term newborn':ti,ab OR 'premature':ti,ab OR 'premature baby':ti,ab OR 'premature birth':ti,ab OR 'premature child':ti,ab OR 'premature childbirth':ti,ab OR 'premature infant':ti,ab OR 'premature neonate':ti,ab OR 'premature newborn':ti,ab OR 'premature syndrome':ti,ab OR 'prematuritas':ti,ab OR 'prematurity':ti,ab OR 'preterm baby':ti,ab OR 'preterm child':ti,ab OR 'preterm infant':ti,ab OR 'preterm neonate':ti,ab OR 'preterm newborn':ti,ab OR 'NICU':ti,ab 803 011
Intervention:
2. 'telemedicine'/exp OR 'tele medicine':ti,ab OR 'telemedicine':ti,ab OR 'teleconsultation'/exp OR 'remote consultation':ti,ab OR 'tele-consultation':ti,ab OR 'teleconsultation':ti,ab OR 'telephone consultation':ti,ab OR 'tele homecare':ti,ab OR 'tele care':ti,ab 38 582
Final 1 AND 2 787

 

Embase via embase.com 2019-10-17
Neonatal telemedicine
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. ('newborn'/exp OR 'child, newborn':ti,ab OR 'full term infant':ti,ab OR 'human neonate':ti,ab OR 'human newborn':ti,ab OR 'infant, newborn':ti,ab OR 'neonate':ti,ab OR 'neonatus':ti,ab OR 'newborn':ti,ab OR 'newborn baby':ti,ab OR 'newborn child':ti,ab OR 'newborn infant':ti,ab OR 'newly born baby':ti,ab OR 'newly born child':ti,ab OR 'newly born infant':ti,ab OR 'prematurity'/exp OR 'infant, extremely premature':ti,ab OR 'infant, premature':ti,ab OR 'infant, premature, diseases':ti,ab OR 'neonate, premature':ti,ab OR 'pre-mature infant':ti,ab OR 'pre-term baby':ti,ab OR 'pre-term child':ti,ab OR 'pre-term infant':ti,ab OR 'pre-term neonate':ti,ab OR 'pre-term newborn':ti,ab OR 'premature':ti,ab OR 'premature baby':ti,ab OR 'premature birth':ti,ab OR 'premature child':ti,ab OR 'premature childbirth':ti,ab OR 'premature infant':ti,ab OR 'premature neonate':ti,ab OR 'premature newborn':ti,ab OR 'premature syndrome':ti,ab OR 'prematuritas':ti,ab OR 'prematurity':ti,ab OR 'preterm baby':ti,ab OR 'preterm child':ti,ab OR 'preterm infant':ti,ab OR 'preterm neonate':ti,ab OR 'preterm newborn':ti,ab OR 'nicu':ti,ab) AND [embase]/lim 543 895
Intervention:
2. ('web-cam':ti,ab OR 'webcam':ti,ab) AND [embase]/lim 315
Final 1 AND 2 6

 

Cinahl via ebsco.com 2019-09-26
Neonatal telemedicine
Search terms Items found
Population:
1. 'nicu':ti,ab AND [embase]/lim 13 391
Intervention:
2. ('telemedicine'/exp OR 'tele medicine':ti,ab OR 'telemedicine':ti,ab OR 'teleconsultation'/exp OR 'remote consultation':ti,ab OR 'tele-consultation':ti,ab OR 'teleconsultation':ti,ab OR 'telephone consultation':ti,ab OR 'tele homecare':ti,ab OR 'tele care':ti,ab OR 'webcam':ti,ab OR 'web-cam':ti,ab) AND [embase]/lim 23 549
Final 1 AND 2 51
/de= Term from the EMTREE controlled vocabulary; /exp= Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase

 

Cinahl via ebsco.com 2019-10-17 
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. (MH "Infant, Newborn") OR (MH "Infant, Low Birth Weight+") OR (MH "Infant, Premature") OR (MH "Neonatal Assessment+") OR (MH "Intensive Care, Neonatal+") OR (MH "Neonatal Intensive Care Nursing") 125 126
2. TI preterm OR TI newborn OR TI neonat* OR TI prematur* 57 285
3. AB preterm OR AB newborn OR AB neonat* OR AB prematur* 78 779
4. 1 OR 2 OR 3 174 733
Intervention:
5. (MH "Telehealth+") OR (MH "Telephone Consultation (Iowa NIC)") 19 713
6. TI remote OR TI NTH OR TI telemedicine OR TI tele-care OR TI tele-homecare OR TI "tele care" OR TI "tele home care" OR TI telephone OR TI video OR TI smartphone 21 802
7. AB remote OR AB NTH OR AB telemedicine OR AB tele-care OR AB tele-homecare OR AB "tele care" OR AB "tele home care" OR AB telephone OR AB video OR AB smartphone 59 468
8. 5 OR 6 OR 7 83 599
Final 4 AND 8 AND published 20090101-20191231 1 595

 

Cinahl via ebsco.com 2019-10-17
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. (MH "Infant, Newborn") OR (MH "Infant, Low Birth Weight+") OR (MH "Infant, Premature") OR (MH "Neonatal Assessment+") OR (MH "Intensive Care, Neonatal+") OR (MH "Neonatal Intensive Care Nursing") 125 671
2. TI preterm OR TI newborn OR TI neonat* OR TI prematur* OR TI NICU 59 045
3. AB preterm OR AB newborn OR AB neonat* OR AB prematur* OR AB NICU 79 795
4. 1 OR 2 OR 3 176 126
Intervention:
5. TI webcam OR TI web-cam 36
6. AB webcam OR AB web-cam 92
7. 5 OR 6 OR 7 111
Final 4 AND 7 8

 

Cinahl via ebsco.com 2019-10-17
Neonatal telemedicine
The search result, usually found at the end of the documentation, forms the list of abstracts.; AB = Abstract; AU = Author; DE = Term from the thesaurus; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TI NICU 1 769
2. AB NICU 4 921
3. 1 OR 2 6 038
Intervention:
4. (MH "Telehealth+") OR (MH "Telephone Consultation (Iowa NIC)") 19 918
5. TI remote OR TI NTH OR TI telemedicine OR TI tele-care OR TI tele-homecare OR TI "tele care" OR TI "tele home care" OR TI telephone OR TI video OR TI smartphone OR TI webcam OR TI web-cam 21 925
6. AB remote OR AB NTH OR AB telemedicine OR AB tele-care OR AB tele-homecare OR AB "tele care" OR AB "tele home care" OR AB telephone OR AB video OR AB smartphone OR AB webcam OR AB web-cam 59 795
7. 5 OR 6 OR 7 84 107
Final 3 AND 7 160
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