A preterm infant is about to be born at 32 weeks’ gestation in a small rural hospital. There is fetal distress, and an urgent C-section is needed. The nearest neonatal intensive care unit (NICU) is nearly 3 h away. As the local pediatrician drives to the hospital, the obstetric staff activates the teleresuscitation service offered by their regional level IV NICU. Within 5 min, a neonatologist joins a real-time, two-way audio–video connection, obtains relevant history, and dispatches the neonatal transport team. With guidance from the remote neonatologist, the team prepares supplies, defines participant roles, and confirms available resources. The neonatologist proceeds with coaching the team through the preterm resuscitation.

The scenario above is becoming increasingly common throughout the United States. There has been a steady closure of rural hospitals and obstetric units in recent years [1], causing families to travel longer distances for prenatal and obstetric care. The March of Dimes has identified 1119 counties as “maternity deserts”, affecting over 150,000 babies annually [2], and initial research shows that decreased obstetric care access has negative impacts on maternal and infant health outcomes [1]. In addition, upcoming changes to the national General Pediatrics residency training requirements may reduce physician training in newborn care [3]. The result is that low-volume rural birth centers may face increasing challenges with staffing, training, and providing advanced neonatal resuscitation and stabilization [4].