NICU Virtual Family-Centered Rounds: A Cluster Randomized Controlled Trial

PEDIATRICS · 2026-01-23

BACKGROUND AND OBJECTIVE: The use of telehealth to bring a family member virtually to the bedside for family-centered rounds (FCR) is a promising strategy to increase family members' access. We aimed to evaluate the impact of offering families the option to use virtual FCR in the neonatal intensive care unit (NICU) on parental and neonatal outcomes. METHODS: This 2-arm cluster randomized controlled trial assigned families of hospitalized infants to the option of using virtual FCR (intervention) or to usual care (control). Intervention families could also attend FCR in person (usual care). All eligible families of infants who were admitted to this single-site neonatal intensive care unit during the study period were included. Outcomes included FCR attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. RESULTS: From March 2023 to 2024, 486 families were randomized (325 intervention, 161 control). Infants in the intervention arm were estimated to have 4.81 (95% CI 3.65-6.32) times the parent attendance rate of infants in the control arm (unadjusted incidence rate ratio: 4.62 [95% CI 3.40-6.28]). The intervention arm had 0.37 (95% CI 0.18-0.75) times the adjusted odds of a 30-day emergency department revisit compared with the control arm (unadjusted odds ratio: 0.48 [95% CI 0.25-0.91]). No statistically significant positive intervention effects were observed for other secondary outcomes. CONCLUSIONS: Offering virtual FCR increased parent attendance and reduced 30-day emergency department revisits among NICU infants.

Videoconferencing with the Hospitalized Premature Infant while Expressing Milk: A Randomized Crossover Trial

Telemedicine Journal and e-Health · 2026-02-18

Objective: Human milk supports optimal health outcomes for infants in the neonatal intensive care unit; however, expressing milk is impacted by separation, stress, and time. We examined the impact of using videoconferencing with one’s infant while expressing milk on the volume, efficiency, human milk macronutrient content, and the milk expression experience. Methods: In this randomized controlled crossover trial (NCT03957941), mothers of premature infants expressed milk three times with videoconferencing and three times without. Milk volumes and expression time were self-recorded. Experience was assessed with the Breast Milk Expression Personal Experience (BMEE) subscale. Milk samples were analyzed using the Miris Human Milk Analyzer™. Data were analyzed using a panel data fixed-effects model to estimate within-person mean differences (MDs) between study arms in human milk volume, efficiency, macronutrient content, and BMEE scores. Results: A total of 39 women were enrolled in the study, 28 provided milk volume and efficiency data, 26 completed BMEE scores, and 24 provided milk samples. Videoconferencing improved the milk expression experience, with mean BMEE subscale scores higher with videoconferencing (MD 0.10; 95% confidence interval [CI]: 0.02, 0.18; p = 0.01). There was no difference in milk volume (MD −2.5 mL; CI: −11.9, 6.9; p = 0.6) nor efficiency (MD 0.3 mL/min; CI: −0.4, 0.9; p = 0.4). Conclusions: Videoconferencing with one’s hospitalized premature infant improves the pumping experience. However, the use of videoconferencing was not associated with significant effects on human milk expression nor efficiency.

Impact of Telemedicine and COVID Pandemic on Utilization of Advanced Pediatric Surgical Services

Telemedicine Journal and e-Health · 2026-02-27

Purpose : The COVID-19 pandemic disrupted health care worldwide. We evaluated telemedicine utilization in a pediatric surgery ambulatory setting before and during the pandemic to assess its impact on surgical access. Methods : We conducted a retrospective single-center cohort study of pediatric surgery ambulatory visits from 2019 to 2021. Visit modality, type, and complexity were collected. Socioeconomic and geographic variables included Community Needs Index (CNI) and United States Department of Agriculture rural–urban continuum codes. Chi-square, t tests, and multivariable logistic regression were performed. Results : Among 4,106 visits, monthly volume declined during the pandemic (median 192 vs. 151, p = 0.03), with fewer new patients (26% vs. 30%, p = 0.04). Telemedicine increased (46% vs. 3.6%, p < 0.001), with higher adoption among rural patients (61% vs. 43%, p < 0.001). The proportion of complex visits increased (high complexity: 13–35%, p < 0.001; highest complexity: 1–9%, p < 0.001). In multivariable analysis, utilization increased with rural residence (odds ratios [OR] 1.80, 95% confidence intervals [CI] 1.44–2.25). Utilization was lower among higher-income households (OR 0.90, 95% CI 0.86–0.94) and higher-deprivation communities (CNI OR 0.71, 95% CI 0.61–0.83; all p < 0.001). Conclusions : Telemedicine preserved access to pediatric surgical care during the pandemic, with increased use among rural patients. Lower utilization among both higher-income and higher-deprivation groups highlights complex inequities in access.

Protocol for a single-arm feasibility trial of virtual family-centered rounds: increasing opportunities for family engagement among caregivers with language preference other than English

Pilot and Feasibility Studies · 2025-02-12 · 1 citations

BACKGROUND: Telehealth use during family-centered rounds in the neonatal intensive care unit has been shown to shorten length of hospitalization and improve breastfeeding outcomes. For families who speak languages other than English, access to and use of telehealth technologies can be impeded by lack of interpreter services. We aim to evaluate the feasibility of telehealth use during family-centered rounds in the neonatal intensive care unit for families who speak languages other than English. METHODS: In this study proposal, we will conduct an intervention evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to assess the feasibility of telehealth use during family-centered rounds among families who speak languages other than English in a single-arm feasibility trial. We will provide language-appropriate materials to assist parents with accessing the telehealth technology and bring interpreters into the telehealth encounter directly with neonatal providers. All eligible infants whose families speak languages other than English in a single-site level 4 neonatal intensive care unit during the study period will be included. These families can participate in hospital rounds via telehealth, in-person, or not participate in hospital rounds. We will examine feasibility objectives that assess parental uptake of telehealth for rounds, parental participation in rounds, presence of a certified medical interpreter, telehealth technical issues, and parental survey response rates. We will conduct a mixed methods implementation evaluation using the RE-AIM framework. Exploratory outcomes include parent attendance, length of hospitalization of the infant, human milk feeding, frequency of medical error, parent-reported experience, parental comfort with their child's care, and parental quality of life will be collected. DISCUSSION: This study will aid in understanding gaps to telehealth care in languages other than English. We believe this approach will improve health outcomes for hospitalized premature infants, understanding of medical conditions, improve parental quality of life, and reduce inequities in access to healthcare via telehealth technologies. TRIAL REGISTRATION: NCT05917899 Limited English Proficiency Virtual Family-Centered Rounds, first posted June 26, 2023, last update posted November 11, 2024.

Impact of the “Triple-Demic” on Interfacility Transfers and Consultations: A Retrospective Study

Pediatric Emergency Care · 2025-05-19

BACKGROUND: The erosion of pediatric care capability in community hospitals has heavily impacted rural communities, leading to more transfers to larger regional children's hospitals. The 2022 triple-demic of influenza, respiratory syncytial virus, and COVID-19 worsened these issues, increasing denials and delaying care. OBJECTIVES: This study analyzed interfacility transfer requests, transfer denials, and consultation requests for pediatric services at a large academic regional children's hospital, focusing on the impact of patient surges on transfer denials and the use of telephone and telemedicine consultations to support denials. METHODS: This retrospective study reviewed incoming calls from July 2019 to December 2023 to the UC Davis Children's Hospital transfer center from non-children's hospital emergency departments. Data on transfer requests to the pediatric intensive care unit, neonatal intensive care unit, and pediatric ward were analyzed, focusing on transfer denials due to limited bed space and staffing. RESULTS: Over the 42-month study period, transfer requests to the pediatric intensive care unit, neonatal intensive care unit, and pediatric ward averaged 279 per month, with 211 accepted and 38 denied per month. Telephone consultations averaged 27 per month, while telemedicine consultations averaged 3.3 per month. In November 2022, during the triple-demic, transfer requests spiked to 640 per month, with denials due to bed/staffing shortages rising to 375 (58.6% of requests). Despite these surges, the number of accepted transfers remained stable. CONCLUSIONS: The data highlight the challenges faced by a large regional children's hospital in managing transfer requests during surges, particularly exacerbated by the triple-demic in late 2022. As pediatric units close nationwide, telephone and telemedicine consultations offer valuable support for managing transfers that cannot be accommodated.

1757: SUICIDE AND ABUSE ADMISSIONS TO PICUS IN CALIFORNIA AND WISCONSIN DURING THE COVID-19 PANDEMIC

Critical Care Medicine · 2025-01-01

Re-Examining the Brain Injury Guidelines in Pediatric Traumatic Brain Injury: Can Simple Isolated Non-Displaced Skull Fractures be Treated as a BIG-1 Injury?

Journal of Neurotrauma · 2025-02-27

Children with mild traumatic brain injury (TBI) often receive unnecessary imaging studies, hospital admissions, and interhospital transfers leading to avoidable burdens to patients, caregivers, and health systems. The Brain Injury Guidelines (BIG) consider a non-displaced skull fracture as a BIG-2 injury warranting hospitalization. In our clinical experience, patients with simple isolated non-displaced linear skull fractures seldom develop TBI-related complications. In this study, we evaluated the need for hospital admission for simple isolated linear skull fractures by examining the occurrence of clinically important TBI (ci-TBI) and patient outcome. We performed a retrospective study evaluating pediatric TBI admissions from 2018 to 2023 using an institutional registry of TBI patients requiring neurosurgery consultation. Patients included in our study cohort were 17 years and younger at injury, had a head computed tomography with an isolated skull fracture and a Glasgow Coma Scale (GCS) of 14 to 15. We excluded patients who had an intracranial injury (ICI), fractures extending into the skull base, or crossing the sagittal sinus. We reviewed medical records to identify the presence of ci-TBI: ICI resulting in death, neurosurgical intervention, intubation for more than 24 h, or hospital admission for at least 2 nights due to TBI. Repeat imaging studies obtained were reviewed to assess the progression of injury and association with clinical deterioration. Patient outcome was evaluated with the Glasgow Outcome Score Extended (GOS-E) 6 months after injury. Univariable statistics were calculated for continuous variables and 95% confidence intervals were calculated using the Clopper-Pearson exact method for proportions that were very close to 0 or 1 and the Wilson score interval for small-to-moderate proportions. A total of 804 subjects were analyzed, and 402 (50.0%) patients had a BIG-2 injury. A total of 247 of these BIG-2 patients (61.4%) had a simple, non-displaced fracture, and no associated ICI; 198 of these patients (80.2%) were transferred from referring hospitals. In both primary admissions and transfers, no significant injury progression on imaging was noted, no neurosurgical intervention occurred, and no patient had ci-TBI (0/247; 95% CI: 0% to 1.5%). Six-month GOS-E was available in a subset (53.8%) of patients: 98.5% were discharged home and had a favorable outcome (defined as GOS-E 5 to 7). ci-TBI rarely develops in children with simple isolated non-displaced skull fractures indicating that hospital admission and inpatient observation may not be necessary. In the context of the BIG, these patients can be considered for re-classification to a BIG-1 injury, which can reduce interhospital transfer and admission rates following implementation, while maintaining patient safety. A revised BIG classification for pediatric injuries is proposed.

From Surviving to Thriving: A Qualitative Study of Adapting Telehealth Systems for Specialty Diabetes Care Across Four California Medical Centers

Clinical Diabetes · 2024-04-17 · 1 citations

Telehealth continues to play an important role in specialty diabetes care, but there are variations in how this care is delivered. This article reports on clinician and clinic staff perspectives on providing specialty telehealth diabetes care at four large academic medical centers in California and provides several key recommendations for optimizing telehealth-delivered diabetes care.

Differences in Behavioral Health Treatment among Rural American Clinics Utilizing In-Person and Telehealth Treatment Modalities

Journal of Technology in Behavioral Science · 2024-09-05 · 1 citations

The purpose of this descriptive analysis is to compare patient and encounter characteristics in rural patients who received telehealth versus in-person behavioral health treatment. This study, including over 11,000 rural patients and nearly 35,000 patient encounters, used a non-randomized prospective research design involving two active usual-care treatment groups—a behavioral telehealth treatment group and an in-person behavioral health treatment group. Two-tailed chi-square tests compared treatment groups on patient characteristics and encounter-level variables. Statistically significant differences were found between the telehealth and in-person treatment groups in age, race, ethnicity, primary diagnosis, provider type, service type, insurance status, and treatment billing (all p < 0.001). The telehealth treatment group was more likely to be Hispanic, aged 18 and younger, with ICD-10 diagnoses related to that age group, have government-financed insurance, receive office and outpatient visits for evaluation and management psychiatric services, and be seen by a wide range of providers. The in-person treatment group was more likely to be aged 19–34; have private insurance; have a primary ICD-10 diagnosis of anxiety, dissociative, stress-related, somatoform, and other nonpsychotic mental disorders; receive treatment by clinical social workers; and have 60-min individual therapy. This analysis of real-life data from 95 rural clinic sites in 13 states largely validates national survey data regarding the utilization of telehealth in specific underserved populations but expands these findings to show continued disparities in provider, service, and payer type, which is particularly important for rural communities and pre-existing healthcare equity concerns.

Parent, Physician, and Therapist Experience of In-Person, Hybrid, and All-Virtual Models of Physiatry Care for Children with Special Health Care Needs

Academic Pediatrics · 2024-05-06 · 1 citations