Telemedicine Expansion and New Services in the UPMC Newborn Medicine Program

While the COVID-19 pandemic has forced a shift to and greater reliance on telemedicine or remote visits in order to keep patient care flowing as normally as possible, the UPMC Newborn Medicine Program has an extensive history using the platform to reach distant patients across UPMC’s wide geographic territory. 

Abeer Azzuqa, MD, associate professor of Pediatrics, is the director of neonatal telemedicine services for the UPMC Newborn Medicine Program and coordinates its services and new initiatives.

Telefeeding Program with UPMC Hamot

Developed and piloted in 2020, and launched as an official program in early 2021, a telemedicine feeding program consult service was initiated between the multidisciplinary feeding program of the UPMC Newborn Medicine and the neonatal intensive care unit (NICU) at UPMC Hamot in Erie, Pennsylvania. 

Dr. Azzuqa collaborated with the leadership team of the multidisciplinary feeding program (Arcangela Lattari Balest, MD, a neonatologist and feeding specialist, Sheryl Rosen, MA, CCC-SLP, dysphagia lead at UPMC Children’s, and UPMC Children’s coordinator of occupational therapy services, Kim Kubistek, OTD, OTR/L ) and UPMC Hamot to bring telemedicine feeding consults for the program to its NICU staff and patients in Erie.

The multidisciplinary feeding program within the UPMC Newborn Medicine program and its NICUs is largely based on the concept and precepts of infant-driven or cue-based feeding. Its multidisciplinary nature brings together physicians, nursing, occupational therapy, speech-language pathology, and other disciplines to tackle the challenges associated with feeding difficulties in fragile NICU patients.

"UPMC Hamot delivers about 2,300 babies each year. Since our pilot began and the official program launched this year, we have been conducting one to three feeding consults a month with our colleagues in Erie. The multidisciplinary feeding program brings neonatal feeding expertise, critical support, and skills in dealing with complex feeding issues in neonates. Being able to do so through telemedicine to distant patients allows us to seamlessly help care for these infants with no disruption in their local care or the need to transfer the infant and separate them from their family support system," says Dr. Azzuqa.

Prenatal Telemedicine Visits for Patients With Fetal Anomalies

Once the full extent of the COVID-19 pandemic became visible, health care organizations of all variety made adaptations to continue patient care through one means or another. Telemedicine has been a crucial component of this care. One particularly vulnerable group of patients in need of uninterrupted medical care are expectant mothers whose unborn baby has been diagnosed with a fetal anomaly. The specialized care needed for these patients is time-sensitive and complex. 

To provide remote access to the specialized services of the Center for Advanced Fetal Diagnostics (CAFD) at UPMC Magee, Dr. Azzuqa and colleagues quickly implemented telemedicine consults for patients in the early parts of the COVID-19 pandemic in 2020. The CAFD consults with more than 250 patients each year, all with complex fetal conditions and many who are a significant geographical distance from the Center's hub in Pittsburgh.

"Our initial experience has been positive, but certainly not perfect. Even with some technical issues, we saw zero missed appointments, which is very positive. We have some challenges to work out, and whether or not loosened telemedicine guidelines from regulatory bodies remain in effect after we end the COVID-19 pandemic is an unknown, but we are confident that our initial experience points toward a longer-term use of telemedicine for these cases, and at the same time serving as a foundation for continued services. Moreover, future use of this program may serve as a valuable tool to address disparities and improve access to prenatal and neonatal services," says Dr. Azzuqa. 

For more information about the prenatal telemedicine visits for patients with fetal anomalies, please see the commentary published in the Journal of Perinatology under the following reference: 

Bishop CE, Jackson LE, Vats KR, Azzuqa AA. Prenatal Neonatology Telemedicine Consultation for Patients With Fetal Anomalies During the COVID-19 Pandemic Era: Rapid Implementation and Lessons Learned. J Perinatology. 2020. doi.org/10.1038/s41372-020-00787-9.

More About Dr. Azzuqa

Abeer Azzuqa, MD, is an associate professor of Pediatrics at the University of Pittsburgh School of Medicine. She serves as the medical director of the Neonatal Intensive Care Unit at UPMC Children’s Hospital of Pittsburgh. In addition to her role as director of neonatal telemedicine services, she also serves as the UPMC Advanced Practice Provider Neonatal Fellowship Program's medical director.