title: Telemedicine collaboration improves perinatal regionalization and lowers statewide infant mortality.
abstract: OBJECTIVE
  We assessed a telemedicine (TM) network's effects on decreasing deliveries of very low birth weight (VLBW, <1500 g) neonates in hospitals without Neonatal Intensive Care Units (NICUs) and statewide infant mortality.
  
  
  METHODS
  This prospective study used obstetrical and neonatal interventions through TM consults, education and census rounds with 9 hospitals from 1 July 2009 to 31 March 2010. Using a generalized linear model, Medicaid data compared VLBW birth sites, mortality and morbidity before and after TM use. Arkansas Health Department data and χ(2) analysis were used to compare infant mortality.
  
  
  RESULTS
  Deliveries of VLBW neonates in targeted hospitals decreased from 13.1 to 7.0% (P=0.0099); deliveries of VLBW neonates in remaining hospitals were unchanged. Mortality decreased in targeted hospitals (13.0% before TM and 6.7% after TM). Statewide infant mortality decreased from 8.5 to 7.0 per 1000 deliveries (P=0.043).
  
  
  CONCLUSIONS
  TM decreased deliveries of VLBW neonates in hospitals without NICUs and was associated with decreased statewide infant mortality.
authors.affiliation: Department of Pediatrics/Neonatology, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA.
authors.forename: E W
authors.initials: EW
authors.lastname: Kim
authors.forename: T J
authors.initials: TJ
authors.lastname: Teague-Ross
authors.forename: W W
authors.initials: WW
authors.lastname: Greenfield
authors.forename: D
authors.initials: D
authors.lastname: Keith Williams
authors.forename: D
authors.initials: D
authors.lastname: Kuo
authors.forename: R W
authors.initials: RW
authors.lastname: Hall
mesh_terms: D001131:Arkansas / Q000453:epidemiology; D019058:Community Networks / Q000458:organization & administration*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration*; D012041:Regional Medical Programs / Q000458:organization & administration*; D017216:Telemedicine / Q000458:organization & administration*