Primary Children’s expands NICU care using telehealth, keeps infants closer to home

SALT LAKE CITY — Until about nine months ago, Utah infants in the neonatal intensive care unit who needed neurological care were typically transported to Primary Children’s Hospital.

Now, remote technology has allowed this neurological care to happen remotely so babies can stay at NICUs close to their parents while getting care from Primary Children’s in a first-of-its-kind program in the state.

Dr. Betsy Ostrander, a pediatric neurologist with University of Utah Health and Primary Children’s Hospital, said this service is currently only available at six Utah NICUs and one in Montana — with which Primary Children’s has a standing relationship. She said hospital officials hope to expand it so every infant in Utah who needs the expertise of a neurologist has access to the program, as well as infants in neighboring states, eventually.

“The Neuro NICU telehealth service allows caregivers at other hospitals to quickly contact neurologists at Primary Children’s when they have questions about the infant’s wellbeing. It helps us quickly assess the patient’s needs, support the clinical team and patient family, and make a smoother transition if the patient needs to be transferred to Primary Children’s for additional care,” she said.

The program allows for the same continuous seizure monitoring provided at Primary Children’s to take place at other NICUs. Ostrander said the program will help expand the knowledge of doctors and nurses in other hospitals as they help treat patients.

She said the program allows providers to share brain imaging and other evaluations to facilitate discussion, and guides local medical teams on specific helpful maneuvers.

Ostrander also said Primary Children’s hopes to expand the program to facilitate telehealth appointments with families after their infants have been released from the NICU. She said using telehealth programs keeps costs lower, and reduces the need for transportation of patients when it is complicated or expensive.

The neurology NICU at Primary Children’s was established in 2016, combining neurosurgical, NICU and neurologist expertise. Ostrander said officials quickly realized that many children across Utah would benefit from the care provided, which led to the development of this telehealth program.

In addition to directing the program, Ostrander consults patient families — providing evaluations via bedside video and conversations with the family. Because of the remote nature, extended family can join the conversations and ask questions in real-time, as relaying information can be traumatizing for parents.

“Families have expressed a tremendous amount of appreciation for this service and for being able to see the neurologist who’s supporting their local medical team,” Ostrander said.

Patient families previously at Primary Children’s would talk to doctors at other NICUs on the phone, but the new option is a big improvement. She said they have received an “overwhelmingly positive” response from families.

“The parents can see me. I can support the medical team. The family can feel like they are getting all the expertise they need at the bedside to help maximize their child’s outcome,” she said.

In some instances time is of the essence. Ostrander said when babies have impaired breathing or poor blood flow at birth they need therapeutic hypothermia — full body cooling — within six hours. She said transporting an infant in that time period can be tricky, but with telehealth the hospital can make this service available to a child in Billings, Montana.

If surgical intervention is needed, transportation to Primary Children’s is often still the best option, and Ostrander said babies may be transported for continuous medication or seizures — but this will only be about 25% of cases.

“Most babies are going to be able to stay in their home NICU, with the parents there … close to their support environment,” she said.

Ostrander said this will also help open beds at Primary Children’s to infants who need them most, since no deliveries happen at the hospital. The NICU is used only for infants who need specialized care and those transported from other hospitals.

Primary Children’s emergency room already uses telehealth to help bring its expertise with children to other Intermountain emergency room facilities in Utah and Idaho.