Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring

Abstract

Objective Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions.

Study Design A pre–post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar's score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders.

Results There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79–1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85–0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59–0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85–0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36–0.65, p < 0.001).

Conclusion In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate.

Key Points

• CRFM may decrease unexpected term NICU admissions in some clinical settings.

• CRFM may decrease cesarean delivery rates in some clinical settings.

• CRFM may decrease OVD rates in some clinical settings.

Keywords

fetal monitoring - neonatal intensive care unit admissions - centralized remote fetal monitoring

Note

These findings were presented as a poster at the 40th annual Society for Maternal Fetal Medicine meeting in Grapevine, TX, February 6, 2020: Abstract 248.

Publikationsverlauf

Eingereicht: 03. September 2020

Angenommen: 02. März 2021

Artikel online veröffentlicht:
21. April 2021

• References

• 1 Belfort MA, Saade GR, Thom E. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. A randomized trial of intrapartum fetal ECG ST segment analysis. N Engl J Med 2015; 373 (07) 632-641
• 2 Wiberg-Itzel E, Lipponer C, Norman M. et al. Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial. BMJ 2008; 336 (7656): 1284-1287
• 3 Neilson JP. Fetal scalp sampling in labour. BMJ 2008; 336 (7656): 1257-1258
• 4 Tagliaferri S, Esposito FG, Ippolito A. et al. Telemedicine to improve access to specialist care in fetal heart rate monitoring: analysis of 17 years of TOCOMAT network clinical activity. Telemed J E Health 2017; 23 (03) 226-232
• 5 Xi H, Gan G, Zhang H, Chen C. Design of smart care tele-monitoring system for mother and fetus] (in Chinese). Zhongguo Yi Liao Qi Xie Za Zhi 2015; 39 (02) 102-104
• 6 Alfirevic Z, Devane D, Gyte GM, Cuthbert A. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Cochrane Database Syst Rev 2017; 2 (02) CD006066
• 7 Su F, Guo X. [Clinical application of the expert type terminal of remote electronic fetal heart rate home monitoring system] (in Chinese). Zhonghua Fu Chan Ke Za Zhi 2002; 37 (08) 459-461
• 8 Tapia-Conyer R, Lyford S, Saucedo R. et al. Improving perinatal care in the rural regions worldwide by wireless enabled antepartum fetal monitoring: a demonstration project. Int J Telemed Appl 2015; 2015: 794180
• 9 Michikata K, Sameshima H, Urabe H, Tokunaga S, Kodama Y, Ikenoue T. The regional centralization of electronic fetal heart rate monitoring and its impact on neonatal acidemia and the Cesarean birth rate. J Pregnancy 2016; 2016: 3658527
• 10 AWHONN position statement. Fetal heart monitoring. J Obstet Gynecol Neonatal Nurs 2015; 44 (05) 683-686
• 11 ACOG practice bulletin 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009; 114 (01) 192-202
• 12 Celi LA, Hassan E, Marquardt C, Breslow M, Rosenfeld B. The eICU: it's not just telemedicine. Crit Care Med 2001; 29 (8, suppl): N183-N189
• 13 Ahluwalia IB, Morrow B, Hsia J, Grummer-Strawn LM. Who is breast-feeding? Recent trends from the pregnancy risk assessment and monitoring system. J Pediatr 2003; 142 (05) 486-491
• 14 Colaizy TT, Morriss FH. Positive effect of NICU admission on breastfeeding of preterm US infants in 2000 to 2003. J Perinatol 2008; 28 (07) 505-510
• 15 Kornhauser M, Schneiderman R. How plans can improve outcomes and cut costs for preterm infant care. Manag Care 2010; 19 (01) 28-30
• 16 Rauf Z, Alfirevic Z. Continuous remote fetal monitoring with MONICA AN24 during home induction of labor. Am J Obstet Gynecol 2011; 204 (01) S263