When concerns about COVID-19 spiked in mid-March, Stephen G. Miller, MD, a pediatric cardiologist and director of Duke Fetal Cardiac Imaging, accelerated a planned telehealth roll-out to offer remote ultrasound interpretation and counseling for parents preparing for potential cardiac complications at birth.
Coordinated with the telehealth roll-out across Duke Health, the program was launched to help patients who are normally evaluated by Duke pediatric cardiologists during bi-monthly visits to a Wilmington maternal-fetal medicine clinic three hours from Duke’s Durham clinic.
Secure transmission of ultrasound images, along with remote video consultation, allowed Miller and colleagues to review images from anatomic ultrasound evaluations performed routinely on fetuses as early as 17- to 18 weeks by maternal and fetal medicine specialists at the Wilmington clinic. In complex cases, families were asked to come to Duke for more detailed imaging customized for prenatal cardiac assessment.
As of late May, Miller and his team had performed 14 telehealth consults, with four more scheduled through the first week of June. With one exception, Miller says, the consults took place on the day of the initial ultrasound or the next day. “It’s not quite like being together face-to-face, but the video consultation allows us to communicate results and discuss the implications quickly following a diagnosis. They don’t have to wait until our specialists come back to the clinic,” Miller says. “After our discussion about the diagnosis and the risks, we can also send emails offering detailed diagrams and education materials.”
Parents express relief following the consults and are grateful to receive information quickly, Miller says. “We are able to provide immediate feedback based on the imaging. It’s effective in getting information quickly to anxious parents.”
Demand for fetal imaging increasing rapidly
Demand for the Duke fetal imaging program has increased rapidly. Since 2011-12, when 800 to 900 scans were performed, the number has nearly doubled: about 1,600 were performed in 2019. Partnerships with regional obstetricians and improving sophistication in the use of the scans has helped increase detection of abnormalities, Miller says. Of the 1,600 consults, about 15% identify abnormalities, and 110 of the babies were delivered at Duke because of diagnosed complex heart disease.
Telehealth is just one of the innovations introduced by the fetal care team. A novel parental bonding program allows a baby born with a congenital cardiac condition to spend time with the parents after birth, even permitting breast feeding when possible. Families hold and care for their newborn if there is no risk to the infant—another key part of the program’s focus on helping and counseling parents. New research suggests that bonding time may help improve the child’s overall growth and health, Miller says.
To ensure the safety of the newborn, the entire care team— including prenatal nurse coordinators, obstetricians, pediatric cardiologists, intensive care physicians, and delivery specialists—collaborate to develop detailed plans for each baby to monitor risk factors and prepare for urgent care if needed.
Comprehensive planning and preparation reflect the program’s focus on the patient, Miller says. Each month, the team convenes a multispecialty review involving all specialties—obstetrics, genetics, neonatology, surgery and others as needed—to review the details of each baby that will be delivered in the month ahead.
“We also work with parents and local maternal and family health teams to determine birthing plans that cover the last few weeks of the pregnancy,” Miller says.