Fetal Centers and the Role of the Neonatologist in Complex Fetal Care

Abstract

As prenatal imaging and genetic diagnostic techniques developed, clinicians knew earlier and with greater accuracy of the extent and severity of fetal anomalies. This, coupled with an acute awareness of high rates of death or devastating neonatal morbidities in some cases, drove efforts to create innovative fetal interventions. However, with advances in neonatal quaternary care, infants with even the most complex congenital anomalies now have a substantially greater chance of survival. But many still require highly coordinated intensive care from the moment of delivery, have lengthy and complicated hospitalizations, and need ongoing complex care and services. Therefore, a new vision of complex fetal medicine must evolve, actively integrating robust multidisciplinary involvement in collaborative counseling, planning, and management. The clinical arc visualized for complex fetal patients should shift toward a comprehensive continuum of care concept-extending from fetal life, through neonatal intensive care, to childhood. The neonatologist plays a critical role in bridging this trajectory, coordinating complex processes to a smooth delivery and neonatal plan, counseling and preparing expectant mothers, and integrating many components of subspecialty input for families and other fetal team members. Neonatologists' engagement and perspective can substantively inform the clinical and strategic direction for fetal centers.

Two sides of the same coin – an interview study of Swedish obstetricians’ experiences using ultrasound in pregnancy management

“…Along with the development of fetal treatment and postnatal care there has been an increased involvement of paediatricians in consulting pregnant women concerning prenatal decisions [ 32 ]. A multidisciplinary approach to both prenatal diagnostics, pregnancy management and counselling pregnant women regarding management, has also been suggested to enhance pregnancy outcome [ 33 ]. Although pregnant women ask the obstetrician to “do anything possible” to enhance fetal outcome and are strongly motivated to participate in treatment to enhance the fetus condition as our results suggest, this does not relieve the obstetricians from their responsibility to safeguard the woman’s health and autonomy.…”

Implementation of trauma-informed care strategies in a comprehensive maternal–fetal care center.

“…Written patient education materials in other languages are also provided when indicated. Current literature (Davis et al, 2014) supports collaboration with subspecialists at the time of the initial consultation (e.g., neonatology, surgery, anesthesia) as this approach supports continuity of care for the family and decreases diagnostic uncertainty. If the option of fetal surgery/intervention is discussed and parents choose to proceed, or in the setting of an ongoing pregnancy with a poor prognosis, the MFM physician can incorporate the embedded psychosocial support services to provide a full spectrum of care.…”