When newborns with complex cardiac defects are transported to another hospital immediately after birth for perinatal intervention, the baby and mother are separated, heightening anxiety levels for the whole family. At the Cincinnati Fetal Care Center, more of these babies are going to be delivered onsite, reducing the stress produced by transports.
The Fetal Heart Program within the Cincinnati Fetal Care Center brings together three groups to manage these high-risk infants. Experts from the Fetal Care Center partner with the Heart Institute and Perinatal Institute at Cincinnati Children’s to determine in advance the best plan of care for babies who have been diagnosed prenatally with a complex heart anomaly.
The babies that are extremely high-risk and will require a cardiac intervention immediately after birth are already being delivered within Cincinnati Children’s. Now, newborns needing a less urgent intervention, one that occurs prior to discharge home from the hospital but not immediately after birth, may also be delivered here.
“Delivery at Cincinnati Children’s allows the specialists with the knowledge of how to care for these babies to have everything accessible to them here,” explains Allison Divanovic, MD, the Fetal Heart Program’s associate director. “We will also be able to react more quickly. Even though we try to be as precise as possible ahead of time, sometimes babies can be sicker than we predict. This will allow us to escalate care faster when needed.”
The Cincinnati Fetal Care Center is a collaboration of three hospitals—Cincinnati Children’s, Good Samaritan Hospital and University of Cincinnati Medical Center. Typically the deliveries for most babies with heart defects have taken place at Good Samaritan or UC. The three medical centers work closely together on a daily basis, so all patient cases are discussed ahead of time, and decisions are made jointly based on what’s best for the baby and mother. Now the team can offer delivery within the Fetal Care Center for the sickest babies facing complex congenital heart defects including, hypoplastic left heart syndrome, coarctation of the aorta, transposition of the great arteries, truncus arteriosus, tricuspid atresia, and others.
“Our goal is to maximize the chances for these babies, minimize the problems of immediate stress with transport, and keep mothers and babies together as much as we can,” says Foong-Yen Lim, MD, surgical director of the Cincinnati Fetal Care Center.
To get those results, the Fetal Care Center, Heart Institute and Perinatal Institute must work together seamlessly. “This is a well-integrated team of specialists,” says Paul Kingma, MD, PhD, the Fetal Care Center’s neonatal director. “It takes a team that’s really knowledgeable about the case and about complex deliveries in general to be able to discern the difference between a heart problem in a newborn and a normal newborn problem. Our collaboration and experience gives us that level of understanding.” Furthermore, Kingma points out, when these experts have spent a good deal of time with the family, it allows for trust to build between families and caregivers and fosters collaboration on a postnatal care plan that is right for the individual family. “The family’s wishes are of utmost importance,” Kingma says.
Planning ahead also allows for critical conversations to occur among team members. “We have the ability to discuss as a group what concerns each party may have especially if there is another birth defect involved,” Divanovic says. “What is the optimal timing for delivery and which defect will need to be addressed first? Those are the types of discussions that this collaboration fosters.”
The decision to perform more deliveries within the Fetal Care Center is based on research. Prior research involving infants with hypoplastic left heart syndrome has demonstrated decreased risk for mortality in those infants born closer to their surgical center.
Families a Part of the Team
This teamwork is crucial because these babies are so complex. Says Lim, “It’s important that they get the appropriate comprehensive care with all providers on the same page, and that they have a streamlined birth plan and postnatal management so the outcomes can be as good as we expect them to be.” Lim echoes Kingma’s thoughts above, emphasizing that this cohesive collaboration extends to the families as well. “Keeping moms and these high-risk babies together is even more important for communication and getting guidance from the family on how to proceed.”