By Sheila Dwyer, Body1 Staff
All parents face challenges when they bring a newborn home from the hospital. Nightly feedings, erratic sleep patterns, and inconsolable crying fits suddenly become part of everyday life. For parents of very low birth weight (VLBW) babies – babies who weigh less than 3.5 pounds at birth – health problems may emerge on a daily basis.
Parents of VLBW babies are forced to be quick studies in monitoring sleep apnea, performing cardiopulmonary resuscitation, and determining their baby’s complex needs. Due to the increased survival rate of VLBW babies over the past 20 years, many neonatal intensive care units (NICUs) allow for early discharge. Parents are happy to see their baby out of the NICU, but are overwhelmed by having to provide such specialized care.
Health care professionals evaluate each case individually, but they recommend early discharge for healthier VLBW babies to keep hospital costs low. Every year, two to four billion dollars is spent on care of low birth weight babies; much of this money is not reimbursed to the hospital. As a result, health care workers have developed a system in which parents and hospitals can work together to monitor a child’s care before and after discharge, keeping down future hospital costs.
Doctors from Beth Israel Deaconess Medical Center and the Center for Clinical Computing at Harvard Medical School in Boston have developed a telemedicine intervention that provides support to families of high-risk newborns through their hospitalization and discharge. In the evaluation process that took place in Boston, doctors used few criteria for inclusion in the study. This selection process allowed for a realistically diverse group of families to participate, which reflects the cross-section of families with VLBW babies.
Three days after the birth of a VLBW baby, the hospital introduces the family to the telemedicine system. The three-day grace period gives the family an opportunity to adjust to the emotional issues associated with a VLBW baby and to acclimate to the NICU staff and environment. This technology helps parents understand the large volume of unfamiliar knowledge, terminology, and rules presented to them after the baby is discharged from the hospital.
This telemedicine system, Baby CareLink, incorporates the World Wide Web into its structure. The hospital creates a secure Web site for every VLBW baby in the study that includes recent photos, vital statistics, feeding plan, progress chart, and doctor names. Each baby’s family is equipped with a Pentium-class computer that includes a 3.5 inch floppy disk drive, a 12x CD-ROM drive, a SoundBlaster 16-bit card capability, speakers, a 17 inch color monitor, a camera, and a videoconferencing board. In addition, the hospital provides fixed educational content via CD-ROM or hard drive files before installation.
The Baby CareLink system is multi-faceted. While the infant is still in the NICU, doctors can make sure that the entire family knows about the VLBW baby’s situation. NICU staff distributes instructional material to the parents and provides information about the hospital and the baby to other children in the family via a child-friendly Web site. Through videoconferencing and chat groups, families that are unable to visit can see a video image or photos of their baby. This viewing is especially helpful for families that live far away, and for those who have to work long hours. They can access the baby’s latest medical information anytime.
From a high-risk baby, parents become accustomed to having 24-hour child care; therefore, taking the baby home can result in high anxiety. Often parents feel overwhelmed by information and intense responsibility. After the VLBW baby is discharged, the families can access vital medical information from their secured Web site. In case of emergency or concern, parents can contact the NICU staff electronically; physicians can view the baby using the video link.
Physicians project that these systems will get babies home with their families sooner and reduce costs associated with VLBW babies.
References:
www.tatrc.org/
www.aafp.org/afp/980501ap/trachten.html
courses.washington.edu/hubio516/98Summaries/Prematurity.htm
