title: A telemedicine network for remote paediatric cardiology services in north-east Brazil.
abstract: OBJECTIVE
  Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries.
  
  
  METHODS
  In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries.
  
  
  METHODS
  Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children.
  
  
  RESULTS
  From 2012 to 2014, 73,751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality.
  
  
  CONCLUSIONS
  Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Sandra da Silva
authors.initials: Sda S
authors.lastname: Mattos
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Sheila Maria Vieira
authors.initials: SM
authors.lastname: Hazin
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Cláudio Teixeira
authors.initials: CT
authors.lastname: Regis
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Juliana Sousa
authors.initials: JS
authors.lastname: Soares de Araújo
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Fernanda Cruz de Lira
authors.initials: FC
authors.lastname: Albuquerque
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Lúcia Roberta Didier Nunes
authors.initials: LR
authors.lastname: Moser
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Thamine de Paula
authors.initials: Tde P
authors.lastname: Hatem
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Carolina Paim
authors.initials: CP
authors.lastname: Gomes de Freitas
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Felipe Alves
authors.initials: FA
authors.lastname: Mourato
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Thiago Ribeiro
authors.initials: TR
authors.lastname: Tavares
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Renata Grigório Silva
authors.initials: RG
authors.lastname: Gomes
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Rossana
authors.initials: R
authors.lastname: Severi
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Cícera Rocha
authors.initials: CR
authors.lastname: Santos
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Jailson
authors.initials: J
authors.lastname: Ferreira da Silva
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Juliana Landim
authors.initials: JL
authors.lastname: Rezende
authors.affiliation: Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil .
authors.forename: Paulo Coelho
authors.initials: PC
authors.lastname: Vieira
authors.affiliation: Laboratório de Imunopatologia Keiso Asami, Universidade Federal de Pernambuco, Recife, Brazil .
authors.forename: José Luiz
authors.initials: JL
authors.lastname: de Lima Filho
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002309:Cardiology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007373:Interinstitutional Relations; D020407:Internet; D007400:Interprofessional Relations; D008297:Male; D010372:Pediatrics; D019035:Rural Health Services; D017216:Telemedicine / Q000379:methods*