A Retrospective Review of the Fetal Health Center at Children’s Mercy

Today the FHC is led by Timothy L. Bennett, MD, FACOG, Medical Director of The Fetal Health Center, and Emanuel “Mike” Vlastos MD, FACOG, FAAFP, Medical Director of Fetal Therapy, supported by close collaboration with Howard Kilbride, MD, Associate Chair, Department of Pediatrics, and Steve Olsen, MD, Division Director, Neonatology.

Designing a New Multidisciplinary Model for Care

Creating a labor and delivery unit inside of a freestanding children’s hospital was a novel undertaking at the time and remains rather unique today. Fetuses with identified prenatal complications can be safely delivered near the specialty care they will need without delay, while remaining close to the mother and family. Today the expert pediatric care at Children’s Mercy serves as a regional resource for obstetrical providers and families who are coping with fetal developmental differences.

The Importance of the Integrated Consultation 

The cornerstone of care in the FHC has always been an individualized plan customized for each patient that covers prenatal care, delivery and neonatal care for mother and baby. Mothers first undergo advanced diagnostic procedures at the FHC, such as amniocentesis, fetal echocardiograms and diagnostic ultrasound. Once a diagnosis is identified, the family participates in an integrated consultation — a meeting with a variety of specialized health care providers who collaborate to form a comprehensive plan of care.

The integrated consultation gives the family a forum to better understand the nature of the fetal condition and the various treatment options, with the goal to provide the most optimal outcome. Together the family and care team agree to a unified plan to address the anticipated pregnancy and newborn needs, as well as postpartum needs for the mother.

Conditions Managed by The Fetal Health Center 

Conditions requiring specialized delivery services:

• Congenital diaphragmatic hernia
• Congenital lung conditions
• Duodenal atresia
• Esophageal atresia and tracheoesophageal fistula
• Gastroschisis
• Hydrocephalus
• Intestinal atresia
• Omphalocele
• Spina bifida
• Twin-to-twin transfusion syndrome
• Central nervous system abnormalities
• Congenital heart defects
• Cystic adenomatoid malformation
• Cystic hygroma/cervical teratoma
• Growth restriction
• Hydrothorax
• Neural tube defects
• Skeletal dysplasia

Conditions requiring fetal intervention:

• Airway obstruction
• Amniotic bands
• Fetal anemia and thrombocytopenia
• Lower urinary tract obstruction (LUTO) and other urologic abnormalities
• Neck masses
• Sacrococcygeal teratoma (SCT) and other fetal neoplasms
• Twin-reversed arterial perfusion (TRAP) sequence
• Spina bifida myelomeningocele repair

Deliveries in The Fetal Health Center 

When a condition requires immediate intervention at birth, delivery in the FHC Special Care Delivery Unit is the best option for both mother and baby. The FHC offers comprehensive, high-risk obstetrical services, including 24/7 in-house obstetricians, OB anesthesia and MFM consultations. The advanced neonatal services begin in the delivery room, and subsequent intensive care is provided by a team of surgical and medical subspecialists. All care is provided with an emphasis on family-centered care.

Unique FHC simulation scenarios for obstetrical and neonatal complications offer ongoing multidisciplinary and intradisciplinary teamwork experiences. If an unusual case is anticipated, such as conjoined twins or the need for an ex utero intrapartum treatment (EXIT) procedure, extensive prenatal planning and simulations are conducted. The team regularly participates in these types of simulations to ensure readiness for any possible delivery scenario.

Collaboration Within the Hospital 

The FHC also works closely with neonatal and pediatric subspecialists, such as cardiologists, general surgeons, neurosurgeons, neurologists, nephrologists, colorectal surgeons, urologists, plastic surgeons, genetic counselors, radiologists, palliative care physicians and more. With more than 750 subspecialists at Children’s Mercy, a pediatric subspecialist is available for consultation on any potential prenatal condition. Even if the full extent of the condition is unknown, the FHC is able to have the right resources ready to act when the baby is born. With advance notice and planning, the FHC can make sure the right team, including subspecialists, is in the delivery room, allowing Children’s Mercy to care for the most complex patients, with higher survival rates. These additional subspecialists continue to work with the neonatologists to ensure the best care of the neonate and provide all options to families from birth through young adulthood.

Expanding the Scope of Care to Include Fetal Interventions 

In 2017, Dr. Vlastos joined the Fetal Health Center and expanded the capabilities of the fetal surgery program to care for babies with the highest acuity. Before joining Children’s Mercy, Dr. Vlastos led a fetal health institute for eight years. In addition, he has spent more than 30 years focused on the health of mothers and babies. He is committed to teaching others how to care for complex prenatal conditions.

Dr. Vlastos shares his learnings broadly, traveling across the US and around the globe to assist on cases and demonstrate surgical techniques for in utero procedures such as meningomyelocele.

Outcomes

To date, the FHC team has performed 16 meningomyelocele repairs. The average gestational age at time of repair is 25.4 weeks, and the average gestational age at time of delivery is 35.79 weeks. As a result of the in utero repairs, only one of the 16 babies delivered at Children’s Mercy thus far has required a shunt, versus 40% requiring shunts reported in the published literature. In addition, 45 procedures for twin-to-twin transfusion syndrome have been performed.

Additional studies are underway to better understand outcomes for certain conditions. Tracking outcomes can be challenging due to the broad range of variables. The FHC, however, is continuing to advance its ability to define outcomes. For example, the team is reviewing congenital heart defect outcomes for patients delivered at Children’s Mercy vs. delivery at other hospitals. The team is also reviewing outcomes for patients with serious renal conditions, such as absent kidneys or dysplastic kidneys. Until recently, these conditions have been universally fatal, but today some babies are surviving, thanks to intense interventions.

The multidisciplinary study team hopes to gain a better understanding of other fetal interventions that may improve survival rates in these patients, while also considering related ethical issues.

Continuing the Evolution of Care in The FHC Through Research 

The Children’s Research Institute at Children’s Mercy is building a pediatric data repository to facilitate research and novel treatments for genetic conditions. Called Genomic Answers for Kids, the study aims to collect genomic data and health information for 30,000 children and their biological family members, creating a database of nearly 100,000 genomes. The FHC and Neonatology are active participants already contributing to the firstof-its-kind pediatric research study.

In 2018, the Hall Family Foundation and the Sunderland Foundation announced a combined donation of $150 million to launch construction and recruitment for the $200 million nine-story glass tower. The 375,000-square-foot structure will be divided between wet-lab space and drylab space. Encased in glass, the building will be transparent from wall to wall, with colored windows highlighting genome sequences discovered at Children’s Mercy. Studies conducted at the Children’s Mercy Research Institute are driving innovation in the FHC and neonatology. This integrated research environment breaks down boundaries between science and medicine. Here physicians, scientists, academic colleagues and philanthropic partners are collaborating to change the future for children. Research areas include genomics, precision therapeutics, immunotherapy and health outcomes, among many others.

Learn More About the Elizabeth J. Ferrell Fetal Health Center

Timothy L. Bennett, MD,

FACOG, Medical Director of The Fetal Health Center

tlbennett@cmh.edu

(816) 234-9337

Emanuel “Mike” Vlastos, MD, FACOG, FAAFP,

Medical Director of Fetal Therapy

evlastos@cmh.edu

(816) 302-8505

Howard Kilbride, MD,

Associate Chair, Department of Pediatrics

hkilbride@cmh.edu

(816) 234-3596

Steve Olsen, MD,

Division Director, Neonatology

slolsen@cmh.edu

(816) 234-3596

For consults, admissions or transport call: 1 (800) GO MERCY / 1 (800) 466 3729.