Transforming Pediatric Critical Care: AI and Telehealth in India

In 2024, a collaborative effort between a global health program and Cloudphysician Healthcare Private Limited in India focused on understanding and improving the tele-ICU model. This marks the third year of residents visiting India to study the model and enhance collaboration as well as underscoring the significance of technology, operational strategies, and partnerships in addressing critical care challenges, particularly during the COVID-19 pandemic. Tele-ICU models contribute to improving patient care, mortality rates, and healthcare delivery in Low- and Middle-Income Countries (LMICs) as well as demonstrating the potential to expand critical care services in remote areas.

India accounts for the highest number of births globally with a neonatal mortality rate of over 20 per 1000 live births, many of which are due to preventable and treatable conditions. Although neonatal outcomes have improved over the past two decades, continued progress in accordance with the Sustainable Development Goals (Target 3.2) has been stifled by inadequate access to neonatal and pediatric critical care personnel, training, and infrastructure, particularly in rural areas.

Tele-NICU services - wherein centralized neonatologists provide real-time consultation to remote bedside providers - have the potential to bridge key resource gaps in India. Drs. Britto, Hilker, Brewster, and Mathias have partnered with Cloudphysician (Banglore, India), a healthcare technology organization whose low-cost tele-ICU platform combines camera-enabled continuous video monitoring, integrated telecommunications software, and 24/7 remote clinical decision support. To date, the impact and acceptability of tele-ICU interventions has been exclusively studied in high income countries and in primarily adult populations. There remains a dearth of literature and a gap in understanding the associated benefits are generalizable in the context of neonates in low resource settings.

Global Health Program funding is supporting a mixed methods study of tele-NICU outcomes, cost-effectiveness, and perceptions in India with Cloudphysician’s existing network of partner sites and operational infrastructure. To understand the clinical impact of tele-ICU coverage, the team is conducting a prospective interventional pre/post trial at six of Cloudphysician's  partner hospitals, chosen to reflect variation in clinical capacity, rurality, and staffing observed in India. Outcomes to be assessed are aligned with World Health Organization standards for newborn care, and encompass overall clinical endpoints, including (but not limited to) mortality, length of stay, and weight trajectory.  As a secondary analysis, the team will assess perceptions and attitudes of bedside physicians and nurses for to understand perceived usefulness, ease of use, and educational value of tele-NICU services.

‍