Tele-NICU to the rescue

The team at Grand Itasca worked to coordinate an ambulance or helicopter to transport Jessica to Duluth so her baby could receive the necessary care it would need as a preterm baby. Grand Itasca typically transfers preterm babies to facilities with neonatal intensive care units (NICU), but due to the ongoing the ongoing snowstorm, there was no emergency transportation available in time within a 40-mile radius. The medical team needed to bring Jessica in for a c-section and prepared to deliver the pre-term baby. Part of this process included using the hospital’s new Tele-NICU program. 

According to a press release from Grand Itasca, the Tele-NICU program is, “a mobile video conferencing device that allows care teams encountering complex situations to virtually connect with neonatologists at M Health Fairview Masonic Children’s Hospital who are specialized in handling complex and high-risk birth. The technology allows care teams to share the patient’s vital signs and close-up, high quality video of the delivery room in real time.”

The Grand Itasca medical team worked with Dr. Ellen Diego, neonatologist at M Health Fairview Masonic Children’s Hospital, as the expert on the Tele-NICU call for Teddy’s birth. Dr. Katy Johnson performed the c-section. Then the team of doctors and nurses resuscitated and stabilized Teddy until he was safely transferred up to Duluth for further care. 

Jessica shared that she was not able to hold Teddy after he was born because she had COVID. She saw him through a curtain until five days later when it was safe for her to be with him. 

“It was really hard,” Jessica said. “I knew he was safe and being taken care of, but it was still hard.”

Dr. Tim Pehl was one of the doctors that scrubbed in to help with Teddy’s birth. He said their team had all been through the training with the Tele-NICU program when Grand Itasca got the system six-weeks before Teddy’s birth. Prior to that time, doctors performing high risk deliveries would first work to stabilize the baby and then call another NICU doctor on the phone with other questions. 

“It’s using telemedicine to have another physician with a lot more experience and training for these rare situations where pretty much we were forced into doing the delivery,” Dr. Pehl said. 

Dr. Pehl noted that delivering babies in a rural area can be stressful because of situations such as this. He estimated that Grand Itasca delivers about one baby a day and while the majority of babies do not require this kind of intensive care, this new program helps ease some concerns should the situation arise. 

“It’s a way to deliver extremely critical care in an area, in a way that we normally wouldn’t be able to do that,” Pehl stated. 

Dr. Diego practices clinically at M Health Fairview Masonic Children’s Hospital, but also does academic work in global neonatology in sub saharan Africa. 

She explained her work focuses on, “working to improve care delivery around the time of birth for neonates who are born in a similar situation to Teddy where they don’t have access to the type of medical care they need to sustain life.”

Much of Dr. Diego’s work utilizes telemedicine. She received training on the Tele-NICU system when she started working at M Health Fairview Masonic Children’s Hospital. 

“What we’ve learned with telehealth with resource limited settings is babies who are born extremely premature like Teddy ( babies who are born at a very low birth weight like Teddy was) actually have a higher risk of death and a higher risk of what we call severe morbidity—so chronic illness related to an event at birth if they are not at a care center which is equipped to care for these patients,” Dr. Diego shared. 

Dr. Diego sees this Tele-NICU program as a way to help close barriers to health care in resource limited areas as it allows doctors to not just be verbally present, but able to see what is happening. 

Dr. Diego also explained the most important way they support babies born this early is by first helping their breathing either through a breathing tube or positive pressure device. Babies born this early often do not have lungs mature enough to support life. 

“I was able to help them assess Teddy to see that he was breathing on his own wonderfully which made our resuscitation job much easier. So they were able to support his breathing with that positive pressure device.” said Dr. Diego. 

The next steps included focusing on keeping Teddy’s body temperature up and getting IV access for medicine, fluids and glucose. 

“I really want to just applaud and congratulate the medical team who was at Grand Itasca that night,” stated Dr. Diego. She added, “It can be incredibly nerve racking and really scary as a provider. And the team there was amazing. They were so quick to respond. They were incredibly receptive to feedback on how things were going. They really helped me by articulating what was going on.”

After two weeks and three days in the NICU in Duluth, Teddy was able to finally go home with his parents Jessica and Adam on Dec. 30. The best way to start off a new year together as a family. Since coming home, Jessica said Teddy has been a really good baby and only fusses when he’s hungry. 

“The biggest thing I can say is expressing my gratitude for the Grand Rapids team and everything they did,” Jessica commented. She added, “They were all great, down to the nurses and everything.”