Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System

Makkar, Abhishek; Milsten, Jennifer; McCoy, Mike; Szyld, Edgardo; Lapadula, Maria C.; Ganguly, Abhrajit; DeShea, Lise; Ponniah, Umakumaran

doi:10.1089/tmj.2020.0440

Cited by 12 publications

(14 citation statements)

References 28 publications

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“…Telemedicine has been used globally for many neonatal services, including screening for retinopathy of prematurity, performing tele-echocardiography, newborn resuscitation, and providing family support. 16 Not only has telemedicine been possible, but tele-rounding on NICU patients was found to be a safe and effective approach. 6 The feasibility and efficacy of telemedicine in complicated NICU cases are being explored through an ongoing clinical trial, registered on (ClinicalTrials.gov).…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Telemedicine in the Implementation and Management of Therapeutic Hypothermia for Infants with Neonatal Hypoxic-Ischemic Encephalopathy in a Resource-Limited Country

Hadid

AL-Shantout²,

Terkawi

et al. 2023

Avicenna J Med

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Background Telemedicine is widely used in neonatal services in developed countries, though its outcomes in low- and middle-income countries are controversial. Lack of expertise and/or facilities, however, has limited its use in developing countries and around areas of military conflicts. We aim to study the implementation and management of therapeutic hypothermia (TH) in infants with hypoxic-ischemic encephalopathy (HIE) with the help of telemedicine in a resource-limited country. Methodology This is a retrospective study, evaluating patients who received TH, guided by telemedicine, through a mobile app (Telegram), an application that allows sharing and archiving of information with other beneficial features. We assessed the feasibility of utilizing telemedicine in guiding the application of TH to infants affected with HIE in the North-West of Syria between July 2020 and July 2021. Feasibility was measured by parameters related to the time gaps between initiation of consultation and treatment and clinical short-term outcomes. Results Out of 5,545 newborn infants delivered during the study period, 22 patients were eligible for TH guided by telemedicine. Patients were referred for consultation at a median (interquartile range [IQR]) of 137 (35–165) minutes of life. A median (IQR) of 12 (3–18) minutes elapsed between the call for a consultation and the consultant response and a median (IQR) of 30 (0–42) minutes elapsed between seeking the consultation and the initiation of cooling therapy. Eighteen patients completed cooling for 72 hours. The patients' temperatures were within the target range (33–34°C) most of the time (84.1%). Conclusion Telemedicine is a feasible method to guide the implementation TH for HIE in resource-limited areas. The short-term success rate is relatively high; however, further studies with a larger population are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

The Feasibility of Telemedicine in the Implementation and Management of Therapeutic Hypothermia for Infants with Neonatal Hypoxic-Ischemic Encephalopathy in a Resource-Limited Country

Hadid

AL-Shantout²,

Terkawi

et al. 2023

Avicenna J Med

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“…Remote-mentored echocardiography is reported to increase diagnostic accuracy to above 90%, only missing minor CHD, typically clinically insignificant ventricular septal defects, or mild pulmonary valvular stenosis. Previous publications all report an excellent ability to identify CCHD by remote mentoring [3][4][5][6][7]. Newborns need transportation for echocardiography to obtain a diagnosis in centers without remote consultation services or in-house pediatric cardiologists.…”

Section: Introductionmentioning

confidence: 99%

Real-Time Remote-Mentored Echocardiography in Management of Newborns with Critical Congenital Heart Defects

Solvin,

Diab,

Elle

et al. 2023

CHD

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Background: The management of suspected critical congenital heart defects (CCHD) relies on timely echocardiographic diagnosis. The availability of experienced echocardiographers is limited or even non-existent in many hospitals with obstetric units. This study evaluates remote-mentored echocardiography performed by physicians without experience in imaging of congenital heart defects (CHD). Methods: The setup included a pediatric cardiologist in a separate room, guiding a physician without experience in echocardiographic imaging of CHD in the examination of a symptomatic newborn. This remote-mentoring pair was blinded to the diagnosis of the newborn and presented with a simplified patient history. The echocardiographic images were streamed to the laptop of the mentor, along with a webcam feed showing the probe position. The task was to identify CCHD in need of immediate transfer to a pediatric cardiac surgical center. The result was compared to the previously completed echocardiographic report and the clinical decision of the patient-responsible pediatric cardiologist. Results: During 17 months, 15 newborns were recruited. All six newborns with CCHD were correctly labeled by the remotementoring pair. One newborn with Tetralogy of Fallot was erroneously labeled as needing immediate transfer. Eight newborns without CCHD were correctly labeled. Conclusions: Remote-mentored echocardiography performed by examiners without experience in imaging CHD identified all newborns with CCHD in need of immediate transfer for specialist care. The setup shows promising results for improving the management of CCHD in hospitals without continuous pediatric cardiology service. KEYWORDSRemote-mentoring; echocardiography; telemedicine; congenital heart defect Abbreviations CHD Congenital heart defect CCHD Critical congenital heart defect CoA Coarctation of the aorta This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Additionally, tele-echocardiography with remote interpretation can be an effective option for determining which neonates require urgent transfer to tertiary care centers. This service can be provided in real time or using store-forward mechanisms [ 58 , 59 ]. Real-time tele-echocardiography also has the advantage of providing training to community ultra-sonographers.…”

Section: Introductionmentioning

confidence: 99%

“…A recently conducted study showed the feasibility of tele-echocardiography for congenital heart disease (CHD) screening in a Level II NICU. These authors demonstrated that tele-echocardiography can be safe and effective in CHD screening and can prevent unnecessary transfer of infants to regional level III/IV NICUs, thus saving on transfer costs [ 59 ]. Feasibility of remote cardiac intensive care unit rounds, especially in the international setting, is beginning to be studied [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Telemedicine across the continuum of neonatal-perinatal care

Chuo

Makkar

Machut

et al. 2022

Seminars in Fetal and Neonatal Medicine

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Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System

Cited by 12 publications

References 28 publications

The Feasibility of Telemedicine in the Implementation and Management of Therapeutic Hypothermia for Infants with Neonatal Hypoxic-Ischemic Encephalopathy in a Resource-Limited Country

The Feasibility of Telemedicine in the Implementation and Management of Therapeutic Hypothermia for Infants with Neonatal Hypoxic-Ischemic Encephalopathy in a Resource-Limited Country

Real-Time Remote-Mentored Echocardiography in Management of Newborns with Critical Congenital Heart Defects

Telemedicine across the continuum of neonatal-perinatal care

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