ABSTRACT
Objectives. To identify scientific evidence on the use and results of information and communication technologies for the improvement of neonatal health in general or specific health problems or interventions, and to describe the type of intervention and its results. Methods. A systematic review of the available evidence was performed. The search was carried out in peer reviewed journals between January 1, 2008 and April 30, 2018, in English and Spanish. The searched key terms were (health informatics OR telemedicine OR mHealth) AND (newborn OR newborn care OR neonatal care). Results. From a total of 305 articles initially identified, 10 articles fulfilled the inclusion criteria. The main domains of eHealth identified as applied to neonatal health were telemedicine (3 studies), eLearning (1 study) and mHealth (7 studies). Target population were health care providers or parents. The studies aimed at diagnosis, provision of health care and training, promoting adherence to interventions in parents or improving quality of care. Conclusions. The use of eHealth in general and specifically focused on neonatal health shows important possibilities for development and expansion, given the advances and present needs, and should be considered a key tool for the reduction of inequalities.
Keywords
Information technology, infant health, evidence-based medicine, perinatal care, eHealth strategies, telemedicine.
INTRODUCTION
It has been proposed that information and communication technologies (ICTs) applied to health and healthcare systems can increase their efficiency, ultimately improving people’s quality of life (1–4). eHealth is the use of ICT in health products, services and processes combined with organizational change in healthcare systems and new skills, in order to improve the health of individuals, efficiency and productivity in healthcare delivery, and the economic and social value of health. eHealth covers the interaction between patients and healthcare providers, institution-to-institution transmission of data, or peer-to-peer communication between patients and/or health professionals (5).
eHealth applications contribute to progress towards universal health coverage and its goals (6). The Strategy for Universal Access to Health and Universal Health Coverage (7) calls for addressing barriers especially for vulnerable groups, including mothers and their newborns. During the past two decades, important progress in child survival has been made and, at present, neonatal mortality is the main component. The risk of dying was highest in the first month of life, at an average rate of 18 deaths per 1,000 live births globally in 2018 (8). There are important limitations in the implementation of evidence-based interventions in newborn health from both the global and regional perspective. Conversely, the potential impact on reducing perinatal mortality due to preventable causes linked to such interventions is estimated as important (9). Evidence has shown that health care provided around the time of birth saves mothers and their newborns and prevents stillbirths and disability. Evidence on best practices and strategies that broaden the coverage of interventions for newborns, reducing mortality, morbidity and disabilities has been accumulating over recent decades. Innovative thinking aimed at increasing the participation of all stakeholders and reaching the poorest and most underserved populations is needed, as well as more research and development to optimize the application of knowledge of which interventions and strategies are most effective (9).
There are efficacious, cost-effective interventions that can prevent these deaths, including stillbirths. However, these interventions are not universally accessible across Latin America and the Caribbean (9,10). eHealth has the potential to enable a positive transformation in the delivery of healthcare, making it safer, more effective and efficient. In different organizations the implementation of interoperable health information systems built around an electronic health record has shown gains. However, as the implementation of health informatics is not widespread yet, only few health organizations have shown the improvement of care and management of costs. There is a need for further expansion and experiences on implementing eHealth and evaluating results at a local, national and regional level (2). Global and regional strategies and plans of action promote investment in building country capacity, linking evidence to policy and practice and testing and scaling up innovations in order to achieve the objectives of reducing preventable deaths, ensuring health and wellbeing and expanding enabling environments among women, newborns, children and adolescents (11,12).
Knowledge and technological advances are recognized as important as economic resources in improving health and well-being, and innovation is considered as a starting point for translating evidence into practice (13). In Latin America and the Caribbean, considerable inequities persist in access to health services due to a number of factors that limit the possibilities of receiving timely quality health care. Conditions such as income level, geographical location and ethnicity, among others, are determinants of health and disease and of important inequities in the Region of the Americas (14). In contrast to inequities in access to quality health care and specific interventions and their outcomes, access to ICTs may be less inequitable (9). There is a need to analyze the inequities in access to technology in contraposition to other aspects, and to discuss the possible impact of the use of information technology to facilitate information access for the general population as well as for healthcare teams.
The purpose of this review is to assess the availability of evidence on how health informatics applications can help to provide better care for newborns, and to address the knowledge gap and the lack of significant literature accounting for the use of ICTs in neonatal health and evidence-based interventions. The objective is to identify scientific evidence on the use and results of ICTs for the improvement of neonatal health –in general or oriented to specific health problems or interventions– and to describe the type of intervention and its results.
DISCUSSION
We found that telemedicine, eLearning and mHealth have been studied with the objectives of improving access, quality of care and selected outcomes in newborn health, reporting different results. Interventions targeted the health workforce and also the newborns’ parents or caregivers. Studies on telemedicine (17–19,26) analyzed its results in improving diagnosis (17) or clinical care (18,19). These studies are aligned with the main pillars that support the application of telemedicine, such as providing clinical support and connecting distant users using different kinds of technologies, and had the improvement of health outcomes as main goal. The use of telemedicine contributes substantially to the delivery of healthcare services, using ICTs for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers (28). When telemedicine was applied for diagnosis or prenatal/postnatal care, reported results support its use, improving the use of resources, facilitating access to health care and contributing to achieving results similar to those obtained when the diagnosis is made in person and with greater efficiency in terms of the use of resources.
Regarding the use of mHealth, reviewed studies did not show positive results regarding the adherence to immunization schedules, but it should be noted that one of them was a pilot study. However, positive results were observed in relation to parental adherence to safe sleep recommendations through a similar intervention (27) . In the case of the application of mHealth in the improvement of knowledge and skills by health providers, the results were adequate (22–24). There is a high penetration of mobile technologies worldwide, reaching nearly 90% in low- and middle-income countries. This highlights the enormous potential of technology for healthcare accessibility, especially regarding immunization reminders, antenatal care and skilled birth attendance (29), even though in this review the use of immunization reminders were not successful.
It is important to consider that mHealth, as well as any other eHealth implementation, needs to be integrated as part of a comprehensive health care system (30). Reaching the target audience with a direct communication channel can help reinforce the message to be delivered and also facilitates the timely tracking and recording of vital events (31). The studies analyzed showed a limited use of mHealth in newborn health, as opposed to the possible impact of its use. Therefore, it is essential to strengthen research on this type of interventions. Since new experiences on mHealth appear constantly, partially due to the simplicity and easiness of this technology which facilitates a rapid implementation, a checklist for mHealth reporting and assessment evidence (mERA) has been developed for the proper evaluation of mHealth interventions in order to measure the appropriate results and outcomes (32,33).
Another pillar in improving the quality of neonatal care is education of the healthcare workforce and capacity building. Only one of the papers included in this review addressed eLearning in newborn health (26), and showed the relevance and adequate results of this type of strategy in training health teams. These strategies can lead to a reduction of the costs related to the provision of educational materials, facilitate the access to educational interventions and address limitations and barriers (30,34,35). It has also been shown that when compared with traditional learning, eLearning has good learning outcomes in the clinical context (36). However, again, we found that there is not enough evidence with regard to its application in newborn care.
This review has some limitations. It focused on studies published from 2008 to 2018 and had a resulting small number of papers. The quality of the papers was not measured based on standardized criteria, but assessed qualitatively. Some of the studies presented limitations that could affect the results, including small sample size, external validity, loss of follow-up of the subjects, and limited follow-up time. Although selection bias may be a concern, the risk was reduced by assigning three independent reviewers, and even when our focus was on Latin America and the Caribbean, the search was not restricted to studies from the Region. The application of ICTs can help address challenges and tackle barriers in the provision of healthcare, and enhances access to quality services (37). It has the potential to address barriers as distance and access, but nonetheless it still shares challenges posed to healthcare in general, including poor management, insufficient training, infrastructure limitations and poor access to equipment and supplies (38).
The use of ICTs can contribute to achieving universal health coverage, improving the quality of care, promoting access and reducing inequities as well as reducing fetal and neonatal deaths (8,12,39–41). There is evidence with variable results about the effect of ICTs and eHealth in different population groups and oriented to different health problems. However, as highlighted by this review, the availability of evidence regarding newborns is still limited (6–8,42,43). Similarly, there is a latent chance where eHealth can help with simple interventions that could aid in diminishing inequalities by enabling simple tasks such as communication, education and data collection in any setting. Worldwide access to technology currently available can help in the collection of data and knowledge to improve the population’s and the health workforce’s capacity and accessibility (35). In the context of the current pandemic by COVID-19, innovative approaches using digital platforms allow health systems to better manage the response and to maintain the delivery of essential health services and communicate to the public about how to access these services (42). Therefore, due to the limited evidence on the use of ICTs in neonatal health and particularly in the current context, it is a priority to generate solid evidence that contributes to improving perinatal health and achieving the expected results, as well as facilitating access to care of quality health reducing the negative impact of the still existing barriers and inequalities.
About KSRA
The Kavian Scientific Research Association (KSRA) is a non-profit research organization to provide research / educational services in December 2013. The members of the community had formed a virtual group on the Viber social network. The core of the Kavian Scientific Association was formed with these members as founders. These individuals, led by Professor Siavosh Kaviani, decided to launch a scientific / research association with an emphasis on education.
KSRA research association, as a non-profit research firm, is committed to providing research services in the field of knowledge. The main beneficiaries of this association are public or private knowledge-based companies, students, researchers, researchers, professors, universities, and industrial and semi-industrial centers around the world.
Our main services Based on Education for all Spectrum people in the world. We want to make an integration between researches and educations. We believe education is the main right of Human beings. So our services should be concentrated on inclusive education.
The KSRA team partners with local under-served communities around the world to improve the access to and quality of knowledge based on education, amplify and augment learning programs where they exist, and create new opportunities for e-learning where traditional education systems are lacking or non-existent.
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Information and communication technologies in neonatal healthBibliography
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Nasim Gazerani was born in 1983 in Arak. She holds a Master's degree in Software Engineering from UM University of Malaysia.
Professor Siavosh Kaviani was born in 1961 in Tehran. He had a professorship. He holds a Ph.D. in Software Engineering from the QL University of Software Development Methodology and an honorary Ph.D. from the University of Chelsea.
Somayeh Nosrati was born in 1982 in Tehran. She holds a Master's degree in artificial intelligence from Khatam University of Tehran.
