{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:43:14Z","timestamp":1791229394132,"version":"4.1.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Res"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Study design<\/jats:title>\n            <jats:p>This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was &lt;60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): \u221216 (\u221243 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Time to intubation (214\u2009s vs 230\u2009s; <jats:italic>p<\/jats:italic>\u2009=\u20090.58) and epinephrine (395\u2009s vs 444\u2009s; <jats:italic>p<\/jats:italic>\u2009=\u20090.21) were comparable between groups.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology\u2019s impact on delivery outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>ClinicalTrials.gov ID<\/jats:title>\n            <jats:p>NCT04258722<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Impact<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1038\/s41390-024-03545-1","type":"journal-article","created":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T11:01:55Z","timestamp":1727521315000},"page":"222-228","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial"],"prefix":"10.1038","volume":"97","author":[{"given":"Samuel J.","family":"Gentle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah G.","family":"Trulove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Rockwell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrystal","family":"Rutledge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Gaither","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie","family":"Norwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Wallace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waldemar A.","family":"Carlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy M.","family":"Tofil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,28]]},"reference":[{"key":"3545_CR1","doi-asserted-by":"crossref","unstructured":"Weiner G. M., Zaichkin J., Kattwinkel J., American Academy of Pediatrics, American Heart Association. Textbook of neonatal resuscitation, 7th edition. edn. American Academy of Pediatrics: Elk Grove Village, IL, 2016.","DOI":"10.1542\/9781610020251"},{"key":"3545_CR2","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1038\/jp.2011.29","volume":"31","author":"JH Chung","year":"2011","unstructured":"Chung, J. H. et al. Examining the effect of hospital-level factors on mortality of very low birth weight infants using multilevel modeling. J. Perinatol. 31, 770\u2013775 (2011).","journal-title":"J. Perinatol."},{"key":"3545_CR3","doi-asserted-by":"publisher","first-page":"2165","DOI":"10.1056\/NEJMsa065029","volume":"356","author":"CS Phibbs","year":"2007","unstructured":"Phibbs, C. S. et al. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N. Engl. J. Med. 356, 2165\u20132175 (2007).","journal-title":"N. Engl. J. Med."},{"key":"3545_CR4","doi-asserted-by":"publisher","first-page":"185 e181","DOI":"10.1016\/j.ajog.2016.10.011","volume":"216","author":"MD Brantley","year":"2017","unstructured":"Brantley, M. D., Davis, N. L., Goodman, D. A., Callaghan, W. M. & Barfield, W. D. Perinatal regionalization: a geospatial view of perinatal critical care, United States, 2010\u20132013. Am. J. Obstet. Gynecol. 216, 185 e181\u2013185 e110 (2017).","journal-title":"Am. J. Obstet. Gynecol."},{"key":"3545_CR5","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1001\/jamapediatrics.2019.6055","volume":"174","author":"KP Shah","year":"2020","unstructured":"Shah, K. P., deRegnier, R. O., Grobman, W. A. & Bennett, A. C. Neonatal mortality after interhospital transfer of pregnant women for imminent very preterm birth in Illinois. JAMA Pediatr. 174, 358\u2013365 (2020).","journal-title":"JAMA Pediatr."},{"key":"3545_CR6","doi-asserted-by":"publisher","first-page":"1464","DOI":"10.1089\/tmj.2021.0527","volume":"28","author":"V Thao","year":"2022","unstructured":"Thao, V. et al. Modeling the cost of teleneonatology from the health system perspective. Telemed. J. e-Health 28, 1464\u20131469 (2022).","journal-title":"Telemed. J. e-Health"},{"key":"3545_CR7","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1097\/PCC.0000000000000977","volume":"18","author":"D Drummond","year":"2017","unstructured":"Drummond, D. et al. Google Glass for Residents dealing with pediatric cardiopulmonary arrest: a randomized, controlled, simulation-based study. Pediatr. Crit. Care Med. 18, 120\u2013127 (2017).","journal-title":"Pediatr. Crit. Care Med."},{"key":"3545_CR8","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.chest.2022.01.017","volume":"162","author":"ID Peltan","year":"2022","unstructured":"Peltan, I. D. et al. Telemedical intensivist consultation during in-hospital cardiac arrest resuscitation: a simulation-based, randomized controlled trial. Chest 162, 111\u2013119 (2022).","journal-title":"Chest"},{"key":"3545_CR9","doi-asserted-by":"publisher","first-page":"1518","DOI":"10.1016\/j.resuscitation.2014.07.019","volume":"85","author":"JL Fang","year":"2014","unstructured":"Fang, J. L., Carey, W. A., Lang, T. R., Lohse, C. M. & Colby, C. E. Real-time video communication improves provider performance in a simulated neonatal resuscitation. Resuscitation 85, 1518\u20131522 (2014).","journal-title":"Resuscitation"},{"key":"3545_CR10","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1097\/PEC.0000000000000653","volume":"33","author":"CP Yang","year":"2017","unstructured":"Yang, C. P. et al. Can telemedicine improve adherence to resuscitation guidelines for critically Ill children at community hospitals? a randomized controlled trial using high-fidelity simulation. Pediatr. Emerg. Care 33, 474\u2013479 (2017).","journal-title":"Pediatr. Emerg. Care"},{"key":"3545_CR11","doi-asserted-by":"publisher","first-page":"1735","DOI":"10.1016\/j.mayocp.2016.08.006","volume":"91","author":"JL Fang","year":"2016","unstructured":"Fang, J. L. et al. Emergency video telemedicine consultation for newborn resuscitations: the mayo clinic experience. Mayo Clin. Proc. 91, 1735\u20131743 (2016).","journal-title":"Mayo Clin. Proc."},{"key":"3545_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.sintl.2021.100117","volume":"2","author":"A Haleem","year":"2021","unstructured":"Haleem, A., Javaid, M., Singh, R. P. & Suman, R. Telemedicine for healthcare: capabilities, features, barriers, and applications. Sens. Int. 2, 100117 (2021).","journal-title":"Sens. Int."},{"key":"3545_CR13","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/01266021-200600110-00006","volume":"1","author":"JW Rudolph","year":"2006","unstructured":"Rudolph, J. W., Simon, R., Dufresne, R. L. & Raemer, D. B. There\u2019s no such thing as \u201cnonjudgmental\u201d debriefing: a theory and method for debriefing with good judgment. Simul. Health. 1, 49\u201355 (2006).","journal-title":"Simul. Health."},{"key":"3545_CR14","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1001\/archinte.168.10.1063","volume":"168","author":"DP Edelson","year":"2008","unstructured":"Edelson, D. P. et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch. Intern Med. 168, 1063\u20131069 (2008).","journal-title":"Arch. Intern Med."},{"key":"3545_CR15","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1161\/CIRCULATIONAHA.109.852202","volume":"120","author":"J Christenson","year":"2009","unstructured":"Christenson, J. et al. Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation. Circulation 120, 1241\u20131247 (2009).","journal-title":"Circulation"},{"key":"3545_CR16","doi-asserted-by":"publisher","first-page":"1922","DOI":"10.1001\/jama.1995.03530240032036","volume":"274","author":"EJ Gallagher","year":"1995","unstructured":"Gallagher, E. J., Lombardi, G. & Gennis, P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 274, 1922\u20131925 (1995).","journal-title":"JAMA"},{"key":"3545_CR17","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.resuscitation.2016.04.013","volume":"104","author":"L Wik","year":"2016","unstructured":"Wik, L. et al. Why do some studies find that CPR fraction is not a predictor of survival? Resuscitation 104, 59\u201362 (2016).","journal-title":"Resuscitation"},{"key":"3545_CR18","doi-asserted-by":"publisher","first-page":"S640","DOI":"10.1161\/CIRCULATIONAHA.110.970889","volume":"122","author":"JM Field","year":"2010","unstructured":"Field, J. M. et al. Part 1: executive summary: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 122, S640\u2013S656 (2010).","journal-title":"Circulation"},{"key":"3545_CR19","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.1161\/hc4501.098926","volume":"104","author":"RA Berg","year":"2001","unstructured":"Berg, R. A. et al. Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 104, 2465\u20132470 (2001).","journal-title":"Circulation"},{"key":"3545_CR20","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1542\/peds.86.6.835","volume":"86","author":"ME Wegman","year":"1990","unstructured":"Wegman, M. E. Annual summary of vital statistics-1989. Pediatrics 86, 835\u2013847 (1990).","journal-title":"Pediatrics"},{"key":"3545_CR21","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1038\/sj.jp.7210551","volume":"21","author":"N Singhal","year":"2001","unstructured":"Singhal, N., McMillan, D. D., Yee, W. H., Akierman, A. R. & Yee, Y. J. Evaluation of the effectiveness of the standardized neonatal resuscitation program. J. Perinatol. 21, 388\u2013392 (2001).","journal-title":"J. Perinatol."},{"key":"3545_CR22","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1111\/j.1460-9592.2005.01589.x","volume":"15","author":"D Trevisanuto","year":"2005","unstructured":"Trevisanuto, D. et al. Knowledge gained by pediatric residents after neonatal resuscitation program courses. Paediatr. Anaesth. 15, 944\u2013947 (2005).","journal-title":"Paediatr. Anaesth."},{"key":"3545_CR23","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.jpeds.2008.10.005","volume":"154","author":"WA Carlo","year":"2009","unstructured":"Carlo, W. A. et al. Educational impact of the neonatal resuscitation program in low-risk delivery centers in a developing country. J. Pediatr. 154, 504\u2013508 e505 (2009).","journal-title":"J. Pediatr."},{"key":"3545_CR24","doi-asserted-by":"publisher","first-page":"1556","DOI":"10.1016\/j.resuscitation.2010.05.021","volume":"81","author":"EK Weidman","year":"2010","unstructured":"Weidman, E. K., Bell, G., Walsh, D., Small, S. & Edelson, D. P. Assessing the impact of immersive simulation on clinical performance during actual in-hospital cardiac arrest with CPR-sensing technology: a randomized feasibility study. Resuscitation 81, 1556\u20131561 (2010).","journal-title":"Resuscitation"}],"container-title":["Pediatric Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03545-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03545-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03545-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T07:17:34Z","timestamp":1745911054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41390-024-03545-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,28]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["3545"],"URL":"https:\/\/doi.org\/10.1038\/s41390-024-03545-1","relation":{},"ISSN":["0031-3998","1530-0447"],"issn-type":[{"value":"0031-3998","type":"print"},{"value":"1530-0447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,28]]},"assertion":[{"value":"15 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 August 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 September 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}