title: Telemedicine for genetic and neurologic evaluation in the neonatal intensive care unit.
abstract: OBJECTIVE
  Evaluate whether telemedicine can be used to perform dysmorphology and neurologic examinations in the neonatal intensive care unit (NICU) by determining the examination accuracy, limitations and optimized procedures.
  
  
  METHODS
  Prospective evaluation of NICU patients referred for subspecialty consultation for dysmorphic features (n=10) or encephalopathy (n=10). A physician at bedside (bedside clinician) performed an in-person examination that was viewed in real time by a remote physician (remote consultant). Standardized examinations were recorded and compared. Subsequently, a qualitative approach established technique adjustments and optimization procedures necessary to improve visualization.
  
  
  RESULTS
  Telemedicine examinations identified 81 of 87 (93%) dysmorphology examination abnormalities and 37 of 39 (92%) neurologic examination abnormalities. Optimization of remote consultant visualization required an active bedside clinician assisting in camera and patient adjustments.
  
  
  CONCLUSIONS
  Telemedicine can be used to perform accurately many components of the dysmorphology or neurologic examinations in NICU patients, but physicians must be mindful of specific limitations.
authors.affiliation: 1] Division of Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [2] Section of Clinical Informatics, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Wenger
authors.affiliation: Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gerdes
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Taub
authors.affiliation: 1] Division of Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [2] Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Swarr
authors.affiliation: Division of Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Deardorff
authors.affiliation: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D001927:Brain Diseases / Q000175:diagnosis; D000013:Congenital Abnormalities / Q000175:diagnosis*; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D019114:Remote Consultation