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Distance Shouldn't Be a Barrier to Care: Telemedicine in the NICU

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Distance Shouldn't Be a Barrier to Care: Telemedicine in the NICU

Neonatal Intensive Care Unit physicians Jamie Limjoco (left) and Andrea CarberryMadison, Wisconsin - Since May 2014, doctors in American Family Children's Hospital's Neonatal Intensive Care Unit (NICU) have been using video technology similar to Facetime to make quick, accurate diagnoses of very sick newborns.

The NICU is one of two Level IV units in the state, meaning its patient roster includes babies with severe medical problems who often need surgery or some type of dramatic intervention in the hours and days immediately following their births.

Time is of the essence when deciding on treatment plans, and by integrating video into physician-to-physician correspondence, NICU staff is able to make quick decisions based in part on the visual cues a phone call could not provide.

Jamie Limjoco, MD, the NICU's medical director, says the service is particularly useful when working with C.H.E.T.A., the Children's Hospital's emergency transport team.

"Our transport team picks up babies from all different places in Wisconsin," she says. "They have the video program on their iPad, so they can go to any facility in the state and show me the video of the baby. I can see what the baby looks like and talk to the physician at the other hospital."

All Dr. Limjoco needs is her smart phone with the HIPAA-compliant Vidyo application fully installed. The application automatically determines the correct video resolution based on the user's device, guaranteeing Dr. Limjoco and her NICU colleagues a crystal-clear shot of the young patient they are diagnosing from afar.

That's important, says Dr. Limjoco, because when caring for sick newborns, a picture is worth the veritable 1,000 words.

"People can describe a baby in respiratory distress or in shock or sepsis, but when you actually see it, it's totally different," Dr. Limjoco says. "Baby seizures don't look like our seizures. They can be very subtle. Someone who is not used to taking care of neonates might think a baby looks totally fine, but as a neonatologist, I can see something's wrong."

And if that something wrong requires quick medical intervention, time that may have been devoted to delivering the child to the Children's Hospital can be saved and devoted to treatment, thanks to the immediacy of video.

Dr. Limjoco uses hypoxic-ischemic encephalopathy (HIE), a kind of brain injury caused by a lack of oxygen to the brain that can result severe cognitive and developmental delays that can accompany seemingly routine, full-term births, as an example.

"These are totally normal babies, or so we think," Dr. Limjoco says. "But at the time of the delivery, something goes crazy and the baby doesn't get enough oxygen to the brain. It can be devastating."

Decreasing the baby's body temperature has proven an effective treatment for HIE, but the cooling has to begin within six hours of birth, often leaving little time for transport. But with the visual confirmation video affords, Dr. Limjoco says, "I can see something's wrong. For that child, we can turn off the warmers and stop with the blankets. For those types of time-sensitive things, video has been really helpful."

Video can also ease the mind of a mother who not only has to deal with the worry of having a newborn in the NICU but also has endured a birth difficult enough to keep her in the hospital where her child was born.

"A lot of times (with babies admitted to the NICU), the moms have been take for emergency C-section, so they'll have to stay in the hospital for at least five days," Dr. Limjoco says. "They really want to come to the Children's Hospital to be with their babies, and some do so at the expense of their own health."

But a mother's recovery can be aided by incorporating her into daily rounds, when the baby's health care team discusses the baby's progress, and letting her see – rather than just hear about – her child's feeding and care routines.

"We can video the mom in and she can be there during rounds and see her baby, and that's been a great experience for them. They still feel like they're part of the team," Dr. Limjoco says. "With video I've been able to say, "Look! Your baby looks great! You can take care of yourself.' That's been a plus."

This type of efficient, effective use of telemedicine will be a prominent facet of any discussion about the future of the care UW Health provides, says UW Hospital and Clinics telehealth coordinator Bree McGrath. She envisions a day when MyChart users can log into their accounts and conduct video consultations with their physicians, and has also spoken with Dr. Limjoco about the benefits of video in American Family Children's Hospital's Emergency Department.

"I mentioned it to Bree and she was like, ‘OK, one thing at a time,'" Dr. Limjoco says with a laugh.

"Those are the next step with the technology," McGrath says. "Distance shouldn't be a barrier for good care."


Date Published: 04/06/2015