b'REACHING BABIES BEFORE THEY REACH Important hurdles had to be overcome to establish the program. Putting telemedicine on wheels requires light, mobile equipment that doesnt delay transport teams. The technology THE NICU:for both the NICU team and Transport nurses has to be extremely user-friendly. And Launching one of the Nations First Neonatal TeleTransport Programs TeleTransport equipment has to transmit clear video, audio and telemetry data from medical When neonates and infants are ill, time is of the essence. Thats why Childrens Healthdevices without interruption, even as connectivity fluctuates in rural and urban areas and Childrens Medical Center Dallas in collaboration with UT Southwestern recently became one ofinside hospitals. the nations first hospitals to launch a neonatal TeleTransport program, enabling our experts toTo solve these puzzles, the transport team is equipped with a cellular-enabled tablet, routers in evaluate patients and guide their care, even when they are miles away. ambulances to provide Wi-Fi hotspots and software that is simple and intuitive.Using TeleTransport, UT Southwestern neonatologists with expertise in Level IV neonatalThe platform was designed so that, no matter what needs to be done, the nurses and doctors care can work with the Transport team at the outside hospital to assess the patient and theircan get to the solution with the smallest number of clicks, says Eric McKenney, I.S. architect at imaging and test results; speak with the referring doctors and parents; and help optimizeChildrens Health. the babys condition before transport. Importantly, the virtual connection continues duringPILOTING TELETRANSPORT.transport where the physicians can monitor the patients in real-time and provide minute-by-minute care to keep them as stable as possible.To pilot the project, the Transport team was educated to use the equipment and incorporate it into their teamwork and their emergency procedures. Early cases showed the difference that TeleTransport allows us to bring Level IV expertise to the patients bedside at the earliestthe remote connection could make.possible moment, says Dr. Rashmin Savani. Thats going to help more babies survive and thrive, and our experience building the program could be informative to other hospitals whoThe first baby to benefit from TeleTransport had an initial blood gas that was near death, want to create one of their own.relates Dr. Savani. The pH was 6.89, and CO2 was unrecordably high. TAILORING TECHNOLOGY FOR THE MOBILE NICU. He visually assessed the baby, watched the monitors relaying the babys vital signs and collaborated with the Transport team to change ventilator settings and administer medications Dr. Vedanta Dariya has observed the ever-growing need for technology in NICU care. He including blood pressure support and nitric oxideto stabilize the babys critical condition. recalls one recent case where a critically ill newborn with huge pneumothoraces was being resuscitated at a freestanding ER and then transported to Childrens Health.I was able to do almost exactly what I would have done if I was there physically, and when the baby showed up in our NICU four or five hours later, the blood gas was pH 7.40 and PCO2 42, I stayed on the phone with the Transport team for about 45 minutes, says Dr. Dariya. Andboth completely in the normal range, says Dr. Savani. All the interventions that were made every one of those minutes I was thinking, If I could look at this baby, I wouldnt need to haveduring the transport improved the babys physiological condition, and the babys life was saved.the transport team telling me whats happening while theyre trying to resuscitate the baby.TeleTransport also allows the physicians and the Transport team to meet the parents virtually. The Transport team can engage with the family so that they can understand the specialty Dr. Rashmin Savani discusses a TeleTransportcare being provided and also meet our physicians who are caring for their baby early in the case after the first successful transfer.process, says Scotti Floyd, Director of Transport Services at Childrens Health.With the first baby TeleTransported, Dr. Savani was able to counsel the parents as to thecritical nature of the babys condition and keep them updated about the progress being made.If parents are able to meet the neonatologist and team virtually before transport, says Kristin Carlton, Program Director for Telespecialty and Clinical Outreach, when they arrive at Childrens Health, they see familiar faces, adding some level of comfort to a very stressful time.JUMPSTARTING THERAPEUTIC COOLING.TeleTransport allows Level IV care to start before the babies reach the NICU. One important example is therapeutic hypothermia for babies with hypoxic-ischemic encephalopathy.When babies have been severely depressed at birth and deprived of oxygen or blood flow to the brain, their brain is at risk, says Lina Chalak, M.D., neonatologist, Director of the Neonatal NeuroNICU Program and Professor at UT Southwestern. Hypothermia is the only treatment currently shown to reduce death or disability but only if the encephalopathy is recognized immediately and treatment is initiated in the first six hours after birththe sooner, the better.'