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Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Utility of telemedicine to extend neonatal intensive care support in the community
Abhishek Makkar1, Tavleen Sandhu1, Kerri Machut2
1Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200N. Everett Drive , Oklahoma City, OK 73104, USA.
Insights
Telemedicine can support care for critically ill newborns in lower-level NICUs, potentially reducing costly transfers and improving outcomes for infants in underserved areas.
Area of Science:
- Neonatal care
- Medical technology
- Healthcare access
Background:
- Moderately ill preterm infants in underserved areas often require transfer to urban tertiary NICUs, causing family separation and high costs.
- Revised 2012 guidelines allow Level II NICUs to offer in-house neonatal services, creating a need for remote specialist support.
- Limited neonatologist availability in underserved regions necessitates innovative solutions like telemedicine.
Purpose of the Study:
- To explore the use of telemedicine in supporting lower-level Neonatal Intensive Care Units (NICUs) and transport teams for critical neonate management.
- To evaluate telemedicine as a primary method for providing intensive care in Level I/II NICUs.
- To discuss barriers and future opportunities for telemedicine in NICU settings.
Main Methods:
- Review of existing literature and single-center experiences on telemedicine in neonatal care and transport.
- Description of synchronous telemedicine's feasibility and safety in guiding care for premature infants at lower-level NICUs.
- Analysis of telemedicine's utility as a primary care method in NICUs.
Main Results:
- Telemedicine consultations for pediatric transport show improved outcomes over phone consultations.
- Synchronous telemedicine has demonstrated feasibility and safety in guiding care for premature infants, preventing unnecessary transfers.
- This approach appears to maintain the quality of care comparable to tertiary facilities.
Conclusions:
- Telemedicine offers a viable solution to extend intensive care services to lower-level NICUs, particularly in medically underserved areas.
- Further research is required to evaluate the effectiveness and optimize the implementation of telemedicine for neonatal intensive care.
- Telemedicine holds significant potential to enhance NICU care accessibility and quality, overcoming geographical and resource barriers.
Abstract:
Moderately ill preterm infants residing in medically underserved areas are frequently transferred to tertiary care NICUs that are mostly located in urban areas, resulting in mother-infant separation, high transportation costs, and the emotional costs of limited infant visitation. In 2012, The American Academy of Pediatrics revised neonatal care guidelines, adding in-house neonatal services to the scope of Level II NICUs. Limited availability of neonatologists in medically underserved areas has prompted innovative solutions like telemedicine to meet this requirement. Telemedicine consultations for pediatric transports have demonstrated improved patient outcomes compared with phone consultation, but evidence regarding telemedicine use for neonatal transport is mostly limited to simulation settings. Also, there are limited data on telemedicine use as a primary means to provide intensive care to neonates in Level I/II NICUs. Recently, two groups demonstrated the feasibility and safety of synchronous telemedicine to guide care for premature infants at lower level NICUs. This approach prevented unnecessary transfer and appeared to provide the same quality of care that the baby would have received at the tertiary care facility. As current evidence regarding the use of telemedicine to extend intensive care is based on single-center experiences, additional research and evaluation of the effectiveness of telemedicine for this application is required. This chapter describes the use of telemedicine to support physicians at lower level nurseries and the transport team with management of critical neonates, utility as primary means to provide care at lower level NICUs, barriers for implementation, and future opportunities to enhance telemedicine's impact in NICU settings.
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