Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools and knowledge sources. Merging data from multiple sources adds value to this data collection. Neonatal databases assist with collecting, displaying, and analyzing data from a number of sources. Although the construction of such databases can be difficult, it can provide helpful support to clinical practice including surveillance of infectious diseases and even medical error. Along with recording outcomes, such systems are extremely useful for the support of audit and quality improvement as well as research. Electronic information sources are often helpful in education and communication with parents and others, both within the unit and at a distance. Systems are beginning to be used to help with decision making – for example in the case of weaning neonates from ventilators, and this work is likely to become more important in the future.
An informatics approach has much to offer in terms of both efficiency and clinical safety. Firstly, it may serve as a web-based resource or repository for information. Secondly, it can provide web-based tools, such as drug calculators or nomograms, which aid the clinician with procedures such as estimation of length of insertion of catheters or endotracheal tubes 2, 3. Thirdly, informatics may include the provision of a portal or web-based interface with other applications giving up-to-date access to clinical information stored elsewhere such as radiology, lab results, and clinical documents. Fourthly, data from physiological monitoring can be analyzed, albeit largely after a clinical event requiring review. Finally once data has been collected it can then be used to generate an automated discharge summary that includes physiological parameters, radiology and laboratory results, as well as clinical information.
In the screenshot above, an example is given of the clinical workstation interface in place in our institution. The menu to the left provides the user with access to clinical information for specific patients (Figure 1). Electronic results can be “signed off” by the clinician once the results have been acknowledged or acted on. Other results, such as radiology reports, can also be viewed. Radiology images can be viewed directly for this patient by choosing the logo resembling an x-ray of the hand. Similarly, the electronic clinical record used within our institution can be accessed directly through this interface. The triangle logo with an exclamation mark alerts the user to the presence of important specific information such as a drug reaction, child protection issues, or infection with an organism that may have infection control implications. (Figure 2 and Figure 3)
Clinical workstation interface in our institution
Trend graph of pulse oximeter saturation in a newborn infant with congenital cyanotic cardiac disease
Output from a bedside EEG monitor demonstrating both real time raw EEG data (upper two boxes) and trend amplitude integrated summary data (bottom two boxes) to assess response to treatment