Remote telemedical interpretation of neonatal echocardiograms: impact on clinical management in primary care setting

OBJECTIVE The purpose of this study was to evaluate the utility of telemedical echocardiographically assisted neonatal cardiovascular evaluation in primary care setting. BACKGROUND Neonates with congenital heart disease are frequently born far from pediatric subspecialty centers and can be clinically unstable at presentation. Recent advances in telecommunication technology have made it possible to transmit echocardiographic images over long distances. This technology may be beneficial to newborns with heart defects who are born in primary care centers. METHODS retrospective review of all telemedical echocardiograms obtained from neonates (aged 1 day to 30 days) was performed. telemedical link was created using T-1 transmission line and standard voice telephone line between the Mayo Clinic, Rochester, Minnesot (pediatric cardiology site), and the Altru Clinic, Grand Forks, North Dakot (primary care site), which is general pediatric practice 400 miles from Rochester. Neonates with possible cardiac disorders were identified by the general pediatricians, who then requested telemedical echocardiography. RESULTS The 133 neonates had 161 T-1 echocardiograms. Median patient age was two days (range, one day to 29 days). One hundred thirty-two of 133 initial echocardiograms (99%) were obtained because of urgent indications. Transmitted images provided adequate diagnostic information in all patients. Seventy-nine neonates (59%) had change in medical management or required cardiology follow-up. An immediate change in management occurred in 32 patients (24%), including seven in whom emergency transfer was either arranged or avoided. CONCLUSIONS Telemedical echocardiography provides accurate diagnostic dat in neonates. Rapid telediagnosis facilitates appropriate care of sick neonates with possible congenital heart disease in the primary care setting. Unnecessary long-distance transfers can be avoided with this technology.