TMC PULSE

t m c » p u l s e | a p r i l 2 0 1 9 15 Digital House Calls Telemedicine study shows early benefits for children with medical complexities N athan Lingenfelter was born healthy in July 2012. His life was transformed six weeks later after losing conscious- ness and nearly succumbing to SIDS, or sudden infant death syndrome. "There was no pulse. There was no heartbeat. There was nothing," his mother, Cheryl Lingenfelter, said. A frantic hour crammed with multiple interventions saved his life. "I had to do CPR while my mom called 911," Lingenfelter said. "The paramedics came and did CPR. He was taken to Sugar Land Methodist, where he was revived. It was 20 minutes from when I started CPR. Judging from the brain damage on the MRIs, it was probably over 30 minutes." Now 6, Nathan doesn't walk or talk. He breathes on his own, but requires a ventilator. The loss of oxygen to his brain for half an hour resulted in a severe mental deficiency; developmentally, he functions like an infant three to six months old. But, Nathan's denim blue eyes are animated. At about 50 pounds, he is still light enough for his mother and full-time caretaker to carry—but not for much longer. Not only must Cheryl Lingenfelter change her son's diapers and manage his feeding tube and treatments, but she must also negotiate a never-ending cycle of medical appointments. Those trips require a load of essentials— Nathan's wheelchair, extra diapers, medications, breathing gear and a change of clothes. That's all planned and packed before she loads him into her SUV, drives from their Sugar Land home, unloads, hopes he doesn't acquire an illness in the office, reloads and returns home. But relief has come through friendly medical faces on Cheryl's iPad. For several months, Nathan has been enrolled in a telemedicine study at the UT Physicians High Risk Children's Clinic. because it helps you to determine what to do with the patient," he said. "Sometimes, they call me on the phone and I am not sure if they need to be seen or not. It's a nice tool because I can see with my eyes and determine the next step for them." Mosquera, a pediatrician and pediatric pulmonologist, has led the clinic since its 2010 founding by faculty at UTHealth's McGovern Medical School. He now has 400 patients. The medical team is made up of 11 specialists whose collective expertise covers neurology, genetics, infectious disease, gastroenterology, nephrology and physical medicine and reha- bilitation—comprehensive care for fragile youngsters with medical complexities. "I wanted to avoid fragmenta- tion of care for those patients," said Mosquera, an associate professor of pediatrics at McGovern Medical School. "We wanted to put everyone together at the same time and in the same place." Early on, Mosquera conducted a two-year study examining the medical team approach in the then-outpatient clinic. The results, published in the Journal of the American Medical Association (JAMA) in 2014, said this outpatient team strategy cut costs by $10,000 per child per year and decreased the number of sick children, hospital admissions, intensive care entry and emergency department visits by half. ➟ Can virtual visits improve care? Nathan now can be observed and treated at home through a telemedi- cine app on his mother's tablet. "It's almost like FaceTime, in a way, where we can see each other and I can move it so I can show them what he's doing," Cheryl said. "It's really helpful, especially when it comes to his breathing issues. They can see exactly what I'm talking about." Adding virtual home visits grew out of an ongoing effort to improve services offered by the High Risk Children's Clinic, according to med- ical director Ricardo Mosquera, M.D. "For the physician, it's nice B y C i n d y G e o r g e Left: Nathan Lingenfelter, 6, has a virtual medical appointment with pediatrician Ricardo Mosquera, M.D. Right: Cheryl Lingenfelter holds her son outside their Sugar Land home.

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