Neonatal Tele-echocardiography
in the NICU
Ana Maria López, MD, MPH
Medical Director Arizona Telemedicine Program
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ATP Network
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Tucson ATP Team
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In Partnership
University Medical Center - Tucson
Yuma Regional Medical Center
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YUMA AZ ATP
TUCSON AZ ATP
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Demographic Data of Neonates in NICU - Yuma
• Age – Neonatal ( < 2 days) = 4 – Infants ( > 2 days) = 14 • Ethnicity – Hispanic = 12 – Caucasian = 3 – African American = 2 – Native American = 1
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Diverse Ethnic Backgrounds
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Insurance Coverage
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AHCCCS = 13 Blue Cross = 2 HMO = 2 Tricare = 1
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Echocardiography
• Uses very high frequency sound or ultrasound ( 2- 15 MHz) • Visualizes details of heart anatomy • Uses probe with transducer • Two-dimensional echocardiography; probe emits a sequence of pulses in different directions & provides information by returning echoes • Apex of pie represents the point nearest to the probe & rest of picture represents a composite of depth information
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Technology
Yuma
• Philips 5500 or 7500 model echo machine • Videoconferencing: dual screen Tandberg Intern-2 unit via a video S-cable. • IP connection: via a T1 line on the ATP's private network.
Tucson
• Videoconferencing: Tandberg 6000 Standard bandwidth for clinical consultations is 768 Kbps. • Same hook up (Store-forward & Real-time echo studies)
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Real-Time vs Store-Forward
• Real-time & Store-forward echo studies = 2 cases • Real-time connection = 16 cases • Yuma used real-time and storeforward to have a tape to be locally reviewed
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Reasons for Consult
• Murmur = 7 • Respiratory distress = 5 • Infant of diabetic mother = 3 • Respiratory distress & diabetic mother =2 • Premature infant = 1
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Definitive Diagnoses
• • • • • Atrial level shunt = 1 Patent foramen ovale = 5 Septal and left ventricular hypertrophy =1 Ventricular septal defect = 2 Double left ventricle with malposition of the great arteries = 1 • Patent ductus arteriosus with bidirectional shunting = 1
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Probable Diagnoses
• Atrial septal defects = 2
• Atrial septal defect or patent foramen ovale=1
• Coarctation of the aorta =1
• Patent foramen ovale vs. atrial septal defect =3
• Atrial level shunt = 2
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Recommendations
• • • • • • Immediate transferred to UMC = 1 Follow up in 1 month = 1 Follow up in 1-2 months = 1 Follow up in 2-3 months = 1 Follow up in 3-4 months = 1 Follow up in 1 year = 1
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ATP Team
Phyllis Webster – ATP Case Coordinator Ronald Weinstein MD – ATP Director Ricardo Samson MD- Chief Ped. Cardiology Elizabeth Krupinski PhD – Associate Director, Evaluation UMC • Brent Barber MD – Cardiologist UMC
• Richard Donnerstein MD – Cardiologist UMC • Daniela Lax MD– Cardiologist UMC
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• Gregory Warda MD – Neonatologist Yuma • Kim Maryniak – Director NICU Yuma
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