The story of tele-neonatology

Imagine: a newborn baby is hospitalized in Breda. She’s having trouble breathing, and the doctors are unsure whether she should be transferred to Rotterdam for specialist care. A stressful ambulance ride, far from home, uncertainty… But what if the expert from Rotterdam could simply watch digitally?

This is exactly what we tested last year with TeleNeonatology—an advanced video link between two neonatal intensive care units. Using a mobile device with cameras, a neonatologist from Erasmus MC in Rotterdam can directly watch a sick baby at Amphia Hospital in Breda. Not only the baby, but also the monitors, the parents, and the entire care team are in the picture.

The result? In almost one in five acute situations, a baby was able to stay in Breda. No unnecessary ambulance rides, no stress for the child, parents who could stay close to home. I still remember the first time we were able to prevent a transfer. A mother was overjoyed—she didn’t have a car to get to Rotterdam and also had to care for her other child. By monitoring the baby digitally daily, we were able to see that he remained stable. While this baby would normally have been sent to Rotterdam “just to be safe,” he could now simply stay in Breda.

But TeleNeonatology offers more than just medical benefits. Parents can now actively listen in when doctors discuss their baby. They better understand why certain decisions are made. And nurses? They no longer have to wait outside while the doctor calls, but can immediately report on how the baby is doing—their observations are crucial. The technology itself is surprisingly simple. It resembles a video call, but with remotely controlled cameras. The expert in Rotterdam can zoom in, look around, and even see through the wall of an incubator. Within minutes, he has a complete picture of the situation. After a year and 99 consultations, the conclusion is clear: this approach works. Amphia Hospital has now implemented TeleNeonatology as standard care. The next step? Rolling it out to eight other hospitals in the region. Because every child deserves the best care, preferably as close to home as possible.

The research

Real-time audiovisual communication between healthcare providers (HCP) at different hospitals (TeleNeonatology) can improve neonatal outcomes, address capacity challenges, and reduce emotional burden on parents. Despite its potential, TeleNeonatology has yet to be widely implemented in routine clinical care, partly due to non-optimal integration into care pathways and working routines. To provide insights for further adoption, this study presents the evaluation of a pilot in the Netherlands.

Methods
In 2024, we carried out a pilot study to test and improve a program called TeleNeo, which helps neonatal intensive care units (NICUs) communicate better. The program connected Erasmus MC (a level IV NICU) with Amphia (a level II NICU) for both urgent and planned consultations. TeleNeo was developed together with healthcare professionals (HCPs) and parents, so it would fit smoothly into daily care routines. To evaluate the program, we used a mix of methods. The main measure was a usability questionnaire with 21 questions rated on a 5-point scale, completed by parents (50 people) and HCPs (85 people). We also interviewed and surveyed participants to understand what helped or hindered implementation. Effectiveness was assessed through parents’ experiences and clinical data like hospital stay length and transfer rates.

Results
Over 12 months, TeleNeo was used for 99 consultations involving 50 families, including 33 urgent cases where a transfer might have been needed. The program proved practical and widely adopted. Parents (26 respondents) and HCPs (48 respondents) gave high usability scores (median 5 out of 5). Parents appreciated quick access to experts, being involved in transfer decisions, and feeling that care was shared between hospitals. HCPs noted faster communication, quicker medical decisions, better care quality, and smoother transitions. Nurses could act more proactively. In 18% of urgent cases (6 out of 33), transfers were thought to have been avoided. Interviews and surveys revealed some challenges, such as the impact on team autonomy, communication styles, and financial concerns.

Conclusions
The pilot showed that TeleNeo is a feasible way to provide shared care at the best location for each patient. These insights will help us create a strong plan for wider implementation in Southwest Netherlands, improving neonatal care, parent satisfaction, and nursing experience.

Future research

We are currently preparing to expand TeleNeo to eight more hospitals in the region around Erasmus MC. The goal is to implement TeleNeo across the entire region and evaluate its impact on NICU transfers and length of hospital stay through a stepped-wedge cluster trial.In addition, we are starting a qualitative study to compare parents’ experiences with neonatal transport between Amphia (where TeleNeo is already in use) and other similar hospitals. This will help us gain deeper insights into how transport affects parents and further improve care.

Scientific publications

• Wagenaar, J., Van Beek, R., Pas, H., Suurveld, M., Jacobs, A., Van Der Linden, N., Broos, J., Kleinsmann, M., Hinrichs, S., Reiss, I., & Taal, H. R. (2025). Implementation and effectiveness of teleneonatology for neonatal intensive care units: a protocol for a hybrid type III implementation pilot. BMJ Paediatrics Open, 9(1), e002711. https://doi.org/10.1136/bmjpo-2024-002711 [Link]

• Spaan, J., Been, J. V., Wallé, Y., Reiss, I. K. M., Wagenaar, J. H. L., Hulzebos, C. V., & Van Der Geest, B. a. M. (2025). First in-human pilot study of wearable phototherapy for neonatal hyperbilirubinaemia. European Journal of Pediatrics, 184(7). https://doi.org/10.1007/s00431-025-06239-w [Link]

• Wagenaar, J. H., Broos, J., Van Beek, R. H., Pas, H., Suurveld, M., Jacobs, A., Bodell, F., Obermann-Borst, S. A., Cassel, F., Kleinsmann, M. S., Hinrichs-Krapels, S., Reiss, I. K., & Taal, H. R. (2025). Implementation and effectiveness of Teleneonatology for neonatal intensive care unit consultations in the Netherlands: a hybrid type III implementation pilot. BMC Pediatrics, 25(1). https://doi.org/10.1186/s12887-025-05923-y [Link]

• Wagenaar J, Mah C, Bodell F, Reiss I, Kleinsmann M, Obermann-Borst S, Taal H, Opportunities for Telemedicine to Improve Parents’ Well-Being During the Neonatal Care Journey: Scoping Review, https://pediatrics.jmir.org/2024/1/e60610 [Link]