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CASE STUDY

The first-time parents of a healthy two-day-old baby are anxiously awaiting discharge from a community hospital in the upper peninsula of Michigan so they can start their new life. The nurse explains to the parents that the baby must “pass” a few routine tests prior to discharge. This includes a pulse oximetry screening test to rule out critical congenital heart disease. Unexpectedly, the baby's oxygen level is 93%, lower than the acceptable value for discharge. A family practitioner meets with the family and tells them that after following the recommended algorithm, he is not comfortable sending the baby home without a more definitive test to rule out a life-threatening heart problem. The baby needs to have an echocardiogram (ultrasound of heart) performed. The hospital does offer this test in babies, but the cardiologists in the hospital are only qualified to interpret studies in adults. The nearest pediatric cardiologist is 300 miles away and only visits the region one time per month. If this had happened two years ago, the baby would have needed to be transferred via helicopter to a children's hospital hundreds of miles away.

Fortunately, the hospital has an established telemedicine link with a children's hospital. A local sonographer performs the echocardiogram and transmits it immediately to a cloud server. Within 30 minutes of completing the test, a pediatric cardiologist meets the family via live videoconference consultation and tells them their baby's heart is normal and there is nothing to worry about. Had something abnormal been detected, the pediatric cardiologist could have watched the echocardiogram as it was being performed; instructed the sonographer to obtain additional images; made management recommendations to the local physician; and counseled the family about the diagnosis, treatment, and prognosis.

This scenario plays out hundreds of times a day across the United States; congenital heart defects occur in 1% of all children and one-quarter of them are critical. Many additional newborns have findings concerning for a heart defect; as a result echocardiography is requested in approximately 40/1,000 newborns prior to hospital discharge. 1 Many of these infants are born at hospitals that have adult cardiology programs that include echocardiography but don’t have immediate access to onsite pediatric cardiology. Over the last 20 years telemedicine has become the standard of care in this setting, allowing for initiation of lifesaving treatment and urgent transport for babies with critical heart disease and obviating the need for unnecessary transport in cases where congenital heart disease can be excluded.

Telemedicine has changed the practice of pediatric cardiology. Pediatric cardiology is one of the largest users of telemedicine, with multiple modalities, clinical models, and technology (Tables 16-1 and 16-2). In this chapter we will provide an overview of how tele-echocardiography and other modalities of telemedicine are used in pediatric cardiology, with focus on shifting technology and expanding clinical use cases. We will also provide a brief discussion of how the pediatric cardiology literature can be leveraged for ...

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