Harnessing the power of telemedicine to accomplish international pediatric outcome research during the COVID-19 pandemic

Abstract

The COVID-19 pandemic occurred during planned neurodevelopmental follow-up of Colombian children with antenatal Zika-virus exposure. The objective of the study was to leverage the institution's telemedicine infrastructure to support international clinical child outcome research. In a prospective cohort study of child neurodevelopment (NCT04398901), we used synchronous telemedicine to remotely train a research team and perform live observational assessments of children in Sabanalarga, Colombia. An observational motor and conceptional standardized tool kit was mailed to Colombia; other materials were translated and emailed; team training was done virtually. Children were recruited by team on the ground. Synchronous activities were video-recorded directly to two laptops, each with a telehealth Zoom link to allow simultaneous evaluation of “table” and “standing” activities, and backup recordings were captured directly on the device in Colombia. The U.S. team attended live over Zoom from four states and five distinct locations, made observational notes, and provided real-time feedback. Fifty-seven, 3–4-year-old children with Zika-virus exposure and 70 non-exposed controls were studied during 10 daytrips. Direct laptop recording ensured complete record of child activities due to internet outages. Telemedicine can be used to successfully perform international neurodevelopmental outcome research in children during the COVID-19 pandemic. Telemedicine can benefit global health studies.

Use of Telehealth Methods to Track Infant Neurodevelopment After In Utero SARS-CoV-2 Exposure

“…Innovations in telehealthcapable neurodevelopmental assessments such as the ones reported in these studies 2,4,5 can improve follow-up of children for clinical evaluations and research. 3 Given the protracted course of child development, understanding the full spectrum of neurodevelopment in children after antenatal SARS-CoV-2 exposure will require longitudinal studies to assess later stages of child development. Studies are currently limited to infant and early child development because children born during the pandemic are only now displaying their neurodevelopmental trajectories.…”

“…The COVID-19 pandemic brought a sudden need to expand telehealth capabilities in pediatric clinical care as well as a need to develop telehealth-based tools for child outcomes research. 3 Developmental assessments that rely on observation of infants' developmental skills can naturally make the transition to a telehealth platform. General movement assessment is an observation-based assessment of infants that can be captured by a parent or caregiver on video, and it has been used in neurodevelopmental outcomes studies of children after antenatal SARS-CoV-2 exposure.…”

“…The COVID-19 pandemic brought a sudden need to expand telehealth capabilities in pediatric clinical care as well as a need to develop telehealth-based tools for child outcomes research . Developmental assessments that rely on observation of infants’ developmental skills can naturally make the transition to a telehealth platform.…”

“…Standardized objects needed for assessment of specific behaviors during telehealth visits were mailed to participants ahead of time. Innovations in telehealth-capable neurodevelopmental assessments such as the ones reported in these studies can improve follow-up of children for clinical evaluations and research …”

Preschool neurodevelopment in Zika virus-exposed children without congenital Zika syndrome

“…1). 12 The Colombian team demonstrated learned skills by live telemedicine connection with similar aged children of their own. Telehealth connections were used during study visits for live observation of child activities and remote recording (Fig.…”