Delivering at a hospital that doesn’t have the capacity to address some of these really important things then mandates the baby be transported. That can be critical time and can sometimes make the difference between life and death.
St. Louis (Vocus) April 23, 2010
A combination of medical expertise, technology and geography will converge as Barnes-Jewish Hospital, St. Louis Children’s Hospital and Washington University School of Medicine launch in April a new “Fetal Care Center” for the care and management of high-risk mothers and births.
Expanding upon the comprehensive maternity center at Barnes-Jewish Hospital, the geographically adjacent neonatal intensive care unit (NICU) at St. Louis Children’s Hospital, and medical and surgical services from Washington University, the Fetal Care Center targets the nearly 10,000 babies born annually in Missouri and the surrounding eight states who have serious medical conditions requiring specialized care.
The Fetal Care Center is the only center in the Midwest offering advanced fetal diagnosis, fetal surgical interventions and newborn medicine all on one medical campus.
“We don’t think a mother-to-be should wait for answers,” says Anthony Odibo, MD, co-director of the Fetal Care Center and associate professor of obstetrics and gynecology at Washington University. “That’s why we’ve designed our program to provide results, develop a plan -- even begin treatment, if necessary -- right on the spot.”
Having both mother and baby on one campus is an important consideration as many similar fetal centers around the country have separate locations that can be miles away for delivery and subsequent newborn care. In this case, the Fetal Care Center has both Barnes-Jewish Hospital and St. Louis Children’s Hospital adjacent to each other. According to surgical director, Brad Warner, MD, the value of geography can’t be underestimated when a baby is high risk.
“Delivering at a hospital that doesn’t have the capacity to address some of these really important things then mandates the baby be transported from one facility to another,” says Dr. Warner. “That can be critical time and can sometimes make the difference between life and death.”
Just as important, according to the multidisciplinary team at the center, is the emotional experience for moms and their families. That means special considerations such as convenient scheduling of appointments, a personal nurse advocate, and a comprehensive end-of-day physician conference to summarize test results and make team recommendations.
Typically, when doctors suspect a fetus has a complication, developing a treatment plan can require multiple appointments with multiple specialists to understand the challenges. The goal of the Fetal Care Center is to provide mothers with the opportunity to have all necessary tests done at one time and place, and provide answers and options before the end of the day.
For babies like five-month-old Benjamin Hubble, who has congenital diaphragmatic hernia (CDH), this care is essential. CDH occurs when the diaphragm does not fully form and allows abdominal organs to enter the chest cavity. One in every 2,000 babies in the U. S. is born with CDH, nearly half of whom don’t live to see their first birthday.
“The setup was amazing,” says Kelly Hubble, Benjamin’s mom. “They had me deliver at Barnes-Jewish and the Children’s Hospital NICU team was right there in the OR. They took over and did a fabulous job getting him over to Children’s safely to where he could get more stabilized.”
According to Dr. Odibo, such stabilization is possible through the most advanced technical and surgical options available at the Fetal Care Center.
“We have one of the largest ultrasound departments in the country and are known internationally for our research in ultrasound techniques,” says Dr. Odibo.
The Fetal Care Center will specialize in surgical treatment, both in-utero and after delivery, to correct many of the most complicated prenatal diagnoses including congenital heart defects, Twin-Twin transfusion syndrome (identical twins receive unequal bloodflow and nutrition from the placenta), gastroschisis (intestines and other organs form outside the fetus), omphalocele (intestines and other organs form outside the fetal abdomen, through the umbilical cord), and congenital diaphragmatic hernia.
When the need for surgery is a possibility, it’s important families know in advance, so they can make arrangements to deliver at Barnes-Jewish Hospital, begin learning about the baby’s condition, tour the NICU at St. Louis Children’s Hospital and in many cases, even begin treatment before delivery.
The Hubbles knew their diagnosis in advance. Their nurse coordinator arranged all of their appointments in one day, including fetal MRI, surgical consultation, echo-cardiogram and a tour of the NICU. She escorted them between appointments, and remained with them for their entire patient experience.
“It was a very long day,” says David Hubble. It culminated with an end-of-day consultation where every specialist they’d met with got together to discuss test results, answer their questions and develop a plan for baby Benjamin.
“The end-of-day consult gives parents an opportunity to cut to the chase,” explains F. Sessions Cole, MD, Fetal Care Center co-director. “At the end of the day the really important questions get addressed: When is the baby going to be ready to be delivered? What specialists are going to be available and at what time? What are the likely complications? What’s my baby’s long-term prognosis?”
Baby Benjamin faced many complications after being born. He spent three weeks on a heart-lung bypass machine, had seven surgeries and spent a total of four months in the NICU. Today, he is home with his family, gaining weight and thriving.
“The day that he was finally not the sickest kid in the NICU, that was a pretty good day,” says David Hubble.
“Statistically he shouldn’t be here several times. They did an amazing job taking care of him in the best possible way,” says Kelly Hubble. “He’s our miracle.”
For more information about the Fetal Care Center, call 866.867.3626 or visit http://www.FetalCare.org .