Diagnosing a congenital anomaly and creating a plan for delivery and postnatal care are multidisciplinary endeavors. Too often, however, the institutional separation between pediatric and adult specialists can prevent physicians and patients from achieving the full benefits of multidisciplinary medicine, leading to siloed and inefficient care.
In June 2021, CHOC, in partnership with UCI Health, opened The Fetal Care Center of Southern California on its main campus in Orange. The center meets the need for advanced, centralized care for all types of congenital and chromosomal anomalies and multiple births in Southern California.
“CHOC and UCI have been affiliated for many years at various levels, including a joint pediatrics residency program and a joint neonatal fellowship program,” says Dr. Kushal Bhakta, board-certified neonatologist and medical director of the neonatal intensive care unit at CHOC. “The Fetal Care Center of Southern California is new, but our collaboration is mature.”
A multispecialty team
The Fetal Care Center brings together neonatologists, pediatric surgeons, maternal-fetal medicine physicians and a wide array of additional specialists to meet with expectant mothers during one all-encompassing visit to the center. The entire team meets regularly in a maternal-fetal care conference to review diagnoses and discuss delivery and intervention plans.
“Bringing all the providers to the Fetal Care Center enhances provider-to-provider communication,” says Dr. Peter Yu, board-certified pediatric general and thoracic surgeon at CHOC and co-medical director of The Fetal Care Center of Southern California. “Nobody operates in a silo. The neurologists know what the cardiologists and cardiac surgeons plan to do, for example, and what they anticipate being problematic. Once every clinician has met with and counseled an expectant mother, they send a multidisciplinary document of their assessment to the referring provider.”
Seamless and comprehensive
A key differentiator of the Fetal Care Center is expectant mothers’ ability to undergo advanced diagnostic testing and meet with every relevant specialist and support care provider in one facility during a single visit. The center’s fetal care coordinators field referrals from obstetricians or other clinicians, as well as patients themselves, and facilitate meetings with the appropriate specialists. The coordinators — an obstetric nurse and a neonatal nurse, respectively — also act as points of contact and informational resources for expectant mothers throughout pregnancy.
During a patient’s visit, she may undergo an ultra-fast fetal MRI to diagnose a suspected fetal anomaly. The images are read by a fetal specialist with board certification in pediatric radiology. Obstetric ultrasound is available to confirm the diagnosis, if necessary. Other services include fetal echocardiograms performed by board-certified fetal cardiologists, genetic counseling, case management and social work.
“We offer a wide variety of interventions, from routine procedures, including amniocentesis, to more complex procedures, such as fetal shunt placement,” Dr. Yu says. “We’re building toward offering the full spectrum of fetal interventions, including open fetal surgery.”
The Fetal Care Center is designed to shepherd patients from diagnosis to delivery and beyond. For many infants, that means transitioning to the high-level NICUs at either UCI or CHOC. The quaternary Level 4 CHOC NICU is home to the West Coast’s only Surgical NICU, leading-edge therapies such as extracorporeal membrane oxygenation, and a unique Small Baby Unit.
“Once a woman has met with the appropriate specialists at the Fetal Care Center based on the fetal diagnosis, we create a plan for delivery and postnatal care,” Dr. Bhakta says. “When the baby is delivered and stabilized by the neonatal team, we take him or her to the NICU, or the baby will undergo immediate surgery, if needed, followed by NICU admission.”
The opening of the Fetal Care Center is the latest demonstration of CHOC’s commitment to caring for babies with complex conditions. Additional plans to help mothers and infants are in the works.
Within three years, CHOC plans to debut a unit dedicated to delivering babies with complex conditions who need immediate care. The unit will feature two fetal operating rooms, an adjoining infant resuscitation room and modern amenities for families. The Fetal Care Center will move into the main hospital building, bringing it immediately adjacent to the NICU and new delivery unit. A boon for clinician collaboration, this centralization will also enhance patient care — as will CHOC’s ongoing endeavor to develop its fetal surgery program.
“We plan to offer the full spectrum of fetal interventions, from less invasive procedures, such as aspiration of fluid, to more complex procedures, such as open fetal surgery for giant tumors and babies who are facing demise,” Dr. Yu says. “We also plan to offer therapy for complicated multiples, such as twin-twin transfusion syndrome.”