Leveraging Telemedicine to Reduce Disparities in Time to Initiation of Therapeutic Hypothermia in Rural Settings
With more than two-thirds of babies born in Maine born at rural or community hospitals, it becomes critical that these hospitals are equipped to handle challenging deliveries and emergency treatments. Dr. Alexa Craig’s pilot project focused on building the infrastructure community hospitals need to access specialists in minutes rather than hours. Dr. Craig is a Neonatal Neurologist at MaineHealth who specializes in a life-saving treatment called therapeutic hypothermia. During a challenging birth, infants can experience significant brain trauma. The cold can put the brain into a sort of suspended animation where the cascade of effects that hurt the brain doesn’t happen as quickly. However, it’s a complicated procedure that can only be used in very specific circumstances in a tertiary care center, and community hospitals are often out of reach. Dr. Craig’s pilot project reduced the time to consult by putting cameras and telehealth systems right in the community hospitals, reducing the disparity between rural and urban areas in time to consult and treatment. Now, she and her team could be in the room to assess whether an infant needed therapeutic hypothermia regardless of where they were born. Not only did this get the right babies transferred to MaineHealth for the procedure more quickly, it also reduced the number of babies who were separated from their parents and sent to MaineHealth just to learn they did not meet criteria and thus not receive treatment. As a result, the infants who need treatment get it faster, and those who don’t get to stay with their parents and receive the appropriate care right in their community hospital.
Dr. Craig’s project is now funded under a larger COBRE at MaineHealth, where she is focusing on expanding how many infants can be reached via teleconsult as well as assessing the health outcomes of those who didn’t meet criteria for treatment. The team now includes physicians across Maine and Vermont. This project also inspired the launch of a training program to help community hospitals effectively and efficiently resuscitate these infants, as that’s the first step before babies can be treated.
- Coffey, Rachel; Melendi, Misty; Cutler, Anya K.; and Craig, Alexa K. (2022) "Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals and Tertiary Care Centers," Journal of Maine Medical Center: Vol. 4: Iss. 1, Article 7.
- Craig AK, McAllister LM, Evans S, Melendi M. Telemedicine consults to assess neonatal encephalopathy are feasible in the neonatal intensive care unit. J Perinatol (2020). https://doi.org/10.1038/s41372-020-00828-3