NEONATAL INTENSIVE CARE UNIT:
in Yuma’s Newborn ICU
Yuma Regional Medical Center has one of the top-ranked neonatal ICUs in Arizona. One reason is the
Arizona Telemedicine Program, which helps the hospital fulfill its promise of “care close to home.”
eonatologist Greg Warda, MD, arrived at
Yuma Regional Medical Center 15 years ago
as the hospital’s only neonatologist and medical
director of its neonatal intensive care unit (ICU).
Back then, Dr. Warda’s most urgent challenge
was determining when a sick baby could remain
in the Yuma hospital or needed to be transported
to a larger hospital where multiple specialists
could oversee the baby’s care.
If a baby showed signs of congenital heart
disease, for example, diagnosing the problem
could take hours, even days. An echocardiogram
would have to be done, but the hospital lacked
technicians trained to do an “echo” on a
newborn. That sometimes meant the study had
to be repeated. In any case, the echocardiogram
– either on paper or DVD – would have to be
shipped to Tucson or Phoenix or San Diego to be
read by a pediatric cardiologist.
It could take a week or 10 days to get a final
For the parents of the newborn, it was an
agonizing process, often compounded by the
need to transport their baby to a larger hospital
200 or more miles away. Families often were
split apart. The father likely had to stay in Yuma
to work. If the mother had a C-section, she
might have to stay behind as well. And even if
she could go, there was the problem of lodging,
and being able to afford it.
“There were just all kinds of issues, for us and
for the parents,” Dr. Warda recalls. “Fortunately,
a lot of that has changed.”
The change came in 2006, – when Yuma
Regional Medical Center signed a new contract
with the Arizona Telemedicine Program.
That linked Dr. Warda and his team at Yuma
Regional – which, since 2009, includes Nedal
Machhor MD, the hospital’s second full-time
neonatologist – to the pediatric cardiologists
and other specialists at The University of Arizona
Medical Center in Tucson.
Instead of having to ship a DVD, the
echocardiogram can now be transmitted over
the broadband telemedicine network. In most
cases, Dr. Warda gets a definitive diagnosis
almost immediately, or within the same day.
“We’ve had a number of cases where we
would hear a (heart) murmur on a baby who
was otherwise fine, only to find out that the
baby had to be transported immediately,” Dr.
Warda says. “And if we hadn’t been able to do
that echo via telemedicine, we would have let
the baby go home, and the baby would have
come back to us in heart failure or, worse, the
baby could have died.
“Telemedicine has saved so many babies.”
Dr. Daniela Lax heads the University of
Arizona Health Network’s tele-echo program,
which includes her and four other pediatric
cardiologists. Another huge benefit of
telemedicine, Dr. Lax says, is that the pediatric
cardiologist is often available to view the
echocardiogram while the technician is doing
“That allows us to coach the technician, to tell
them if we need a closer look, for example, and
the result is that they are now very well trained
to do excellent studies,” Dr. Lax says.
Each week, Dr. Lax’s group consults on four or
five Yuma pediatric echocardiograms, she says.
The doctors also spend a day and a half each
month in Yuma, following up on babies and
children who were born with heart disease or
While most of the cases referred to Dr. Lax and
her colleagues involve newborns, the doctors
see patients as old as 18, or older if the patient
was born with congenital heart disease.
This collaborative effort resulted in the
publication of a seminal article authored by
Dr. Lax, Dr. Warda and colleagues. Published
in 2012 in Telemedicine and e-Health, the
leading telemedicine journal, it confirmed
that neonatal echocardiograms viewed and
interpreted via telemedicine are as accurate as
echocardiograms recorded and shipped to the
interpreting physician in another city. And both
are “indispensable in the remote diagnosis of
congenital heart disease.”
Dr. Warda expects telemedicine will continue to
play a vital role in his newborn ICU, especially as
the technology continues to evolve.
“I can’t say eno ՝