When a baby is born, a hospital’s delivery team knows almost immediately if something is wrong – a blue face, a concerning rash, the absence of a healthy screech. For some rural facilities lacking specialized staff and equipment, the question is how to keep the newborn healthy until help from a bigger hospital arrives.
At the UC Davis Center for Health and Technology, telehealth experts are determined to deliver virtual care, especially emergency neonatal care, to remote facilities across Northern California. The Pediatric Emergency Assistance to Newborns Using telehealth, or PEANUT program, started this summer and is providing a handful of rural nurseries with access to lifesaving consultations and training via web-based video.
The general telehealth program, established at Sacramento’s UC Davis Medical Center in 1996, aims to provide health care over a distance, minimizing cost and travel time for patients in remote areas. Most often, this means establishing a live audio/visual feed with a Davis specialist who can provide guidance on tough cases. The hospital has conducted more than 38,000 telehealth consultations since its inception, but over the past year has put a strong emphasis on improving newborn care.
While most hospitals have the equipment and training necessary for immediate infant resuscitation, many do not have neonatal intensive-care units or other supplies necessary for follow-up care, such as miniature ventilators or intravenous fluid formulated for premature babies, said Dr. Mark Underwood, chief of pediatric neonatology for the UC Davis Health System.
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Stocking those items and hiring physicians trained to use them cost more than many small hospitals can afford, especially when they might deliver a premature or otherwise at-risk baby only once or twice a year, Underwood said. Establishing a virtual connection with a neonatologist can help small staffs determine if they need to transfer a baby to a larger facility for higher-level care, and what steps should be taken to improve the baby’s health while waiting for transport.
Hospitals in the PEANUT program that do not have designated telemedicine equipment receive a specialized mobile unit with a high-resolution camera, as well as funding for a telemedicine coordinator on their end and 24/7 support from UC Davis technological specialists. There are nine rotating neonatologists in the Davis neonatal intensive-care unit, at least one of whom is available for a video consult at any hour.
From his Sacramento office, Underwood can look through the telehealth equipment into the referring nursery to see and hear a struggling baby and can speak directly to hospital staff and family. Underwood can control the referring doctor’s camera, zooming in on the patient or a monitor as needed.
“At first it’s a little bit unnerving, from the standpoint of feeling like you just want to reach through the camera and touch the baby,” he said. “If I’m trying to talk to a physician or evaluate a baby and all I’ve got is the phone, you feel like you’ve got an incomplete picture. With this, I feel much more confident in making a diagnosis.”
At Ukiah Valley Medical Center, which joined the PEANUT program in October, the staff delivers about 825 babies a year in its nursery and does not have any neonatologists, said Casey Ford, director of perinatal services for the hospital. Pediatricians there have used telehealth resources twice, both times for help diagnosing a concerning rash on a newborn.
In one of those cases, Underwood was able to determine a course of action that allowed the baby to stay in Ukiah, rather than be moved to to a better equipped nursery more than an hour away. Dr. Shaista Parveen, a Ukiah pediatrician, said she was happy to not have to send the patient away for a consultation, as doing so can be distressing for the mother.
“That was really helpful, because they could actually look at the baby rather than us trying to describe it to them,” she said. “That makes us feel like we have some support from these institutions. Their expertise is very appreciated.”
PEANUT is expected to help an additional 100 newborns this year and an additional 120 during each of the three-year program’s subsequent years. The program is funded by the federal Health Resources and Services Administration and is in place at three hospitals, with two more in the works.
The program was not in place when JoLea Urrutia delivered her son prematurely at Mercy Medical Center Redding in 2012. Baby Trenton was taken to UC Davis Medical Center, nearly three hours away, where he stayed for the next three months. Even after he was discharged, Urrutia continued to go to Sacramento a few times a month, sometimes driving several hours for just a 15-minute appointment.
In July 2012, Urrutia was told Trenton needed an in-depth hearing test, but she was given the option to do it remotely via telemedicine with a UC Davis audiologist. Urrutia took Trenton into the local Mercy hospital, where a UCD audiologist administered the screening remotely.
The audiologist “thoroughly explained each testing – it felt like we were in the same room with her,” Urrutia said. “If it saves me another trip, it’s great ... I wish they would do that with more of our smaller appointments.”
UC Davis Medical Center provides telehealth consultations to 105 remote institutions throughout the state in 30 clinical specialties. It is used most commonly for dermatology, psychiatry, orthopedics and endocrinology.
Dr. James Marcin, director of pediatric telemedicine for the center, said he hopes to eventually use the technology for at-home chronic disease management, which would allow children with conditions such as asthma or diabetes to log their vitals and check in with specialists from a distance.
“This is an improvement on the current system,” he said. “I’m very excited about the use of technologies, and people using their phones and iPads to better themselves. It’s our goal to give every kid access to that in California. We want them to have the best care possible.”
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