Caring for High Risk Cyanotic Infants During a Global Pandemic: A Single Center Experience with COVID-19 and the Use of Telemedicine for Interstage Home Monitoring

Background: Pediatric single ventricle patients have seen dramatic improvements in outcomes over the past several decades. This is largely attributed to the development of home monitoring programs for interstage patients – cyanotic infants who are at highest risk. In today’s current COVID-19 pandemic, the use of telemedicine has allowed providers to care for these patients and support their families effectively while minimizing the risk of COVID-19 exposure. This is particularly important in this fragile patient population for whom infection with a respiratory virus could prove life threatening.

Methods: Our single center study reviewed the charts of 9 patients followed by our single ventricle team through 11 months of the COVID-19 pandemic in the United States from March 1, 2020 to January 31, 2021. We reviewed the charts of cyanotic infants who were either single ventricle patients following stage 1 palliation or two ventricle patients who underwent a palliative procedure and were awaiting complete two ventricle repair. All patients discharged from the hospital and enrolled in our digital home monitoring program were included. Records were retrospectively reviewed for total number of outpatient visits (in-person versus telemedicine), adverse events, unplanned hospital readmissions, and unplanned procedures. These results were then compared to pre-pandemic data from 2018-2019.

Results: Nine infants were followed for a total of 58 months during the COVID-19 pandemic. This cohort was compared to the 9 infants followed for total of 70 months from 2018-2019. During the pandemic there were 2.8 in-person visits for every 1 telemedicine visit. Patients were seen in-person on average every 6 weeks compared to every 2-3 weeks pre-pandemic. Our results demonstrated zero adverse events with the use of telemedicine compared to 1 adverse event (cerebral vascular accident) during the 2 prior years. There were a total of 16 unplanned readmissions pre-pandemic compared to 8 during the pandemic (50% decrease). Three unplanned procedures were performed pre-pandemic compared to 1 during our study period. One patient was diagnosed with acute COVID-19 infection and managed conservatively via telemedicine with full recovery.

Conclusion: To our knowledge, this is the only case series reporting on the use of telemedicine during the COVID-19 pandemic in the high risk cyanotic infant population. Our center utilized telemedicine effectively with a decrease in adverse events, unplanned procedures, and unplanned admissions. Telemedicine visits allowed for identification of issues requiring hospital readmission including feeding difficulties, poor weight gain, and decreased oxygen saturations as well as conservative management of one patient with COVID-19. Thus, telemedicine may continue to be an integral part of the management of high risk cyanotic infants who are enrolled in our high risk infant home monitoring program, including monitoring of interstage single ventricle patients. This is especially true as the COVID-19 pandemic persists.