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CC BY 4.0 · Avicenna J Med 2023; 13(01): 035-042
DOI: 10.1055/s-0042-1760434
Original Article

The Feasibility of Telemedicine in the Implementation and Management of Therapeutic Hypothermia for Infants with Neonatal Hypoxic-Ischemic Encephalopathy in a Resource-Limited Country

Adnan Hadid
1   Department of Pediatric, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2   Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
,
Taher S. AL-Shantout
3   Department of Pediatric, Ohud Hospital, MOH, Madinah, Saudi Arabia
4   Neonatal Intensive Care Unit, Ohud Hospital, MOH, Madinah, Saudi Arabia
,
Rayan S. Terkawi 
5   Department of Pediatrics, Hamad General Hospital, Doha, Qatar
6   Department of Pediatrics, Sidra Medicine, Doha, Qatar
,
Baraa M. Aldbes
7   Department of Pediatrics, Maternity and Children Hospital, Najran, Saudi Arabia
,
Manal M. Zahran
8   Department of Pediatrics, EL-Ekhaa Hospital, Syrian Expatriate Medical Association, Idlib, Syria
,
Fadia A. Alsatouf
8   Department of Pediatrics, EL-Ekhaa Hospital, Syrian Expatriate Medical Association, Idlib, Syria
,
Hani Najjar
9   Department of Pediatrics, Aladan Hospital, Hadiya, Kuwait
,
MHD Hassan Mughrabieh
10   Syrian Expatriate Medical Association (SEMA), Gaziantep, Turkey
,
Nour A. Alhadid
11   College of medicine, Alfaisal University, Riyadh, Saudi Arabia
,
Khalid Altirkawi
1   Department of Pediatric, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2   Neonatal Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
› Author Affiliations
Funding This study received no fund.
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Abstract

Background Telemedicine is widely used in neonatal services in developed countries, though its outcomes in low- and middle-income countries are controversial. Lack of expertise and/or facilities, however, has limited its use in developing countries and around areas of military conflicts. We aim to study the implementation and management of therapeutic hypothermia (TH) in infants with hypoxic-ischemic encephalopathy (HIE) with the help of telemedicine in a resource-limited country.

Methodology This is a retrospective study, evaluating patients who received TH, guided by telemedicine, through a mobile app (Telegram), an application that allows sharing and archiving of information with other beneficial features. We assessed the feasibility of utilizing telemedicine in guiding the application of TH to infants affected with HIE in the North-West of Syria between July 2020 and July 2021. Feasibility was measured by parameters related to the time gaps between initiation of consultation and treatment and clinical short-term outcomes.

Results Out of 5,545 newborn infants delivered during the study period, 22 patients were eligible for TH guided by telemedicine. Patients were referred for consultation at a median (interquartile range [IQR]) of 137 (35–165) minutes of life. A median (IQR) of 12 (3–18) minutes elapsed between the call for a consultation and the consultant response and a median (IQR) of 30 (0–42) minutes elapsed between seeking the consultation and the initiation of cooling therapy. Eighteen patients completed cooling for 72 hours. The patients' temperatures were within the target range (33–34°C) most of the time (84.1%).

Conclusion Telemedicine is a feasible method to guide the implementation TH for HIE in resource-limited areas. The short-term success rate is relatively high; however, further studies with a larger population are needed to confirm these findings.

Keywords

hypoxic-ischemic encephalopathy - therapeutic hypothermia - cooling therapy - NICU - telemedicine

Ethics Approval and Consent to Participate

The Institutional Review Board (IRB) of the Syrian Expatriate Medical Association (SEMA) has approved the study with an exemption from obtaining anything other than general consent for treatment upon hospitalization. The IRB study number is (2020–02). Families consented at the time of cooling initiation. Data were collected from the patients' files and was reviewed by two doctors. All methods were performed in accordance with the Declaration of Helsinki.


Consent for Publication

Not applicable.


Availability of Data and Materials

As per the local institutional regulations, data are not publicly available, but to be provided upon request from the corresponding author for research purposes in deidentified form.


Authors' Contributions

MZ and FA collected the data. KA and AH contributed to data processing and analysis. AH prepared [Fig. 1]. All authors participated in the discussions and drew the conclusions as well as manuscript the article and agreed on the contents.


Competing Interests

Authors have no competing interest to disclose.


Authors' Information (Optional)

Not applicable.




Publication History

Article published online:
23 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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