With the opening of the Elizabeth J. Ferrell Fetal Health Center, Children’s Mercy Kansas City became one of only a few children’s hospitals in the country to offer comprehensive care, including on-site delivery, for babies with fetal anomalies.
This allows mothers, families and newborns to remain in the same hospital regardless of the complexity of the newborn’s medical condition with access to the region’s only Level IV neonatal intensive care unit.
Tim Bennett, MD, a Professor and Vice Chairman of the Department of Obstetrics and Gynecology of the University of Missouri – Kansas City School of Medicine, is here to discuss comprehensive care, including on-site delivery, for babies with fetal anomalies.
Fetal Health: Advancing Outcomes for High Risk Infants
Featured Speaker:
Learn more about Dr. Timothy L. Bennett
Tim Bennett, MD
Dr. Timothy L. Bennett is Professor and Vice Chairman of the Department of Obstetrics and Gynecology of the University of Missouri – Kansas City School of Medicine. He is a board-certified Maternal-Fetal subspecialist and practices at Children’s Mercy Kansas City and Truman Medical Center. Dr. Bennett is Co-Director of the Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy. He received his Bachelor of Science degree in Mathematics and Computer Science from the University of Kansas. He is a graduate of University of Kansas School of Medicine and attended OB/GYN residency training at Indiana University Hospitals, Indianapolis, and his fellowship training at Wake Forest University in Winston-Salem, North Carolina.Learn more about Dr. Timothy L. Bennett
Transcription:
Fetal Health: Advancing Outcomes for High Risk Infants
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is “Fetal Health: Advancing Outcomes for High Risk Infants.” My guest is Dr. Tim Bennett. Dr. Bennett is Professor and Vice Chairman of the department of Obstetrics and Gynecology at the University of Missouri, Kansas City School of Medicine. He is a board certified maternal fetal subspecialist and practices at Children’s Mercy in Kansas City and Truman Medical Center. Dr. Bennett is Director of the Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy. Dr. Bennett, welcome to the show.
Dr. Tim Bennett (Guest): Well, thank you very much for having me.
Dr. Smith: So, as the Director of the Fetal Health Center at Children’s Mercy. Tell us why there is a need for this type of center.
Dr. Bennett: What we’re about is to try to help physicians and providers in the community when they’re dealing with complicated pregnancies, specifically babies that are identified as having birth defects. Trying to help them, number one, make a diagnosis and then to further that by giving them the opportunity to deliver in a center where the baby can immediately receive the care that it needs-- whether it’s medical or surgical. The model in the past has been to deliver babies with, say, a birth defect, identify the problems after birth and then scramble and send the baby off to another center where they can take care of the baby. The problem with that is that you delay the treatment of the baby and also you separate the family, specifically the mom who has just delivered, from the baby who is now at a different hospital. We try to combine the services so that we can do all of that in one place.
Dr. Smith: When you combine the services like that, what’s the ultimate benefit to the patient – both mom and baby?
Dr. Bennett: Sure. Well, the benefit to the mother is that, again, she can be recovering from her delivery and still be close to her baby because in the older model, again, the baby would be transferred to another hospital. She then has to try to get discharged from the hospital earlier than she normally would. So now, we can have her continue her postpartum recovery and still be there for decision making regarding the baby and also just to be near the baby. As far as the baby, some of the advantages are really obvious and that is you don’t take any time at all to treat the baby. If there is a surgical problem that needs to be taken care of, our surgeons are ready. They can operate on the baby immediately. The baby doesn’t have that period of time where a condition may worsen while we’re waiting for getting ready for surgery or whatever.
Dr. Smith: So, in terms of advancing outcomes for high risk infants and this type of center, what have been the results? What had you seen so far? Are we making some headway with advancing outcomes?
Dr. Bennett: I think that we definitely can say that we are. There are a few centers like ours. At Children’s Mercy here in Kansas City, we’re one of a few centers where there is actually a children’s hospital that has a small delivery unit. So there are a few other centers like this one, the one being most notable in Philadelphia. There is data to show that these babies just simply do better. Their survival is higher and the morbidities that are associated with the condition are lower. So there is still ongoing research, particularly in our institution, to really define that in more critical ways but I think that the early data would strongly suggest that this is an advantage.
Dr. Smith: Can you describe for the listeners maybe a little bit more specifically how the center actually works – starting prenatally and all the way through the infant care?
Dr. Bennett: Sure. So, typically, what would happen is that a pregnant women would be managed by her local obstetrician or practitioner and they would identify that there was something out of the ordinary. They may have a very clear diagnosis or they may not be sure and they just simply say, “Something looks funny.” They would refer the patient to us really to help make a more precise diagnosis. That is our first job: to examine the fetus, provide the imaging--ultrasound, fetal MRI, echocardiogram, whatever they need--and we would help define that diagnosis. So, once they have that then we sit down with the family--the mother, the partner and then any other family members--and we really do a multidisciplinary consultation. So, we’ll have them sit with a neonatologist, a genetics counselor, a social worker, a pediatric surgeon, if necessary, a cardiovascular surgeon, if necessary, a cardiologist, an internal fetal doctor--a variety of people. They sit around a table and review the case with the family and tell them what we think is going on, what we think the likely outcomes are going to be and what we can do to help with the baby. So, the next step is that consultation. That information goes back to her referring doctor. A decision is made collaboratively where would be the best place for the baby to deliver. In the more serious situations, the patient is usually expressing a desire to come back and deliver with us at our center. Then, we begin that preparation. So, the mother meets our obstetrical team. She can delivery vaginally, many times. Sometimes a Cesarean section is required but we plan the delivery. And in that planning, we obviously have our neonatal team and our surgical teams with the appropriate subspecialists that are needed. They’re ready to go. So, when the baby is born everyone is alerted. We’re there in the delivery room together. Baby gets immediate assessments, immediate care. Then, we move forward to the post-partum care where we take care of mom make sure she’s healthy; that she’s stable from the delivery process. Then, we take care of that baby and do the necessary things that are needed for them.
Dr. Smith: So, the center at Children’s Mercy, is this going to become a model, you think, for other hospitals throughout the country?
Dr. Bennett: Absolutely. We weren’t the first, by any means but on the other hand, we are certainly in the mix of this type of development. This is catching on in centers across the country. This is the model, I think, that is beginning to emerge as being the best model for, again, really a small population of obstetrical cases. If you look at the number of birth defects that occur in pregnancies, it’s about 2-3% of all pregnant women will deliver a baby with a birth defect and about a third of those – roughly 1% – of the total number of deliveries would really have a problem that really would require our services. So, it still is a fairly small number but in those cases there is no doubt that this is becoming the model which is emerging to improve the fetal condition.
Dr. Smith: It’s obvious that Children’s Mercy provides many consultation for patients that don’t actually deliver at Children’s Mercy. What types of cases do deliver at Children’s Mercy?
Dr. Bennett: The general guideline is if a baby is going to require significant urgent care right after delivery – if we can anticipate that--then that is a patient that would very likely deliver with us. For example, if a baby is born with a cleft lip or even a cleft palate that’s not an urgent or emergent problem and those are cases that don’t generally deliver with us. But, on the other hand, if the baby were to have a congenital diaphragmatic hernia, where we know the contents of the abdomen is herniated into the chest and has caused significant lung hypoplasia, this is a baby that is going to have immediate hypoxia, immediate need for aggressive resuscitation and surgery. That’s a baby that really will definitely benefit from a center like ours.
Dr. Smith: Dr. Bennett, I want to thank you for coming on to the show and for all of the great work that you’re doing at Children’s Mercy. You’re listening to Transformational Pediatrics with Children’s Mercy, Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I am Dr. Michael Smith. Have a great day.
Fetal Health: Advancing Outcomes for High Risk Infants
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is “Fetal Health: Advancing Outcomes for High Risk Infants.” My guest is Dr. Tim Bennett. Dr. Bennett is Professor and Vice Chairman of the department of Obstetrics and Gynecology at the University of Missouri, Kansas City School of Medicine. He is a board certified maternal fetal subspecialist and practices at Children’s Mercy in Kansas City and Truman Medical Center. Dr. Bennett is Director of the Elizabeth J. Ferrell Fetal Health Center at Children’s Mercy. Dr. Bennett, welcome to the show.
Dr. Tim Bennett (Guest): Well, thank you very much for having me.
Dr. Smith: So, as the Director of the Fetal Health Center at Children’s Mercy. Tell us why there is a need for this type of center.
Dr. Bennett: What we’re about is to try to help physicians and providers in the community when they’re dealing with complicated pregnancies, specifically babies that are identified as having birth defects. Trying to help them, number one, make a diagnosis and then to further that by giving them the opportunity to deliver in a center where the baby can immediately receive the care that it needs-- whether it’s medical or surgical. The model in the past has been to deliver babies with, say, a birth defect, identify the problems after birth and then scramble and send the baby off to another center where they can take care of the baby. The problem with that is that you delay the treatment of the baby and also you separate the family, specifically the mom who has just delivered, from the baby who is now at a different hospital. We try to combine the services so that we can do all of that in one place.
Dr. Smith: When you combine the services like that, what’s the ultimate benefit to the patient – both mom and baby?
Dr. Bennett: Sure. Well, the benefit to the mother is that, again, she can be recovering from her delivery and still be close to her baby because in the older model, again, the baby would be transferred to another hospital. She then has to try to get discharged from the hospital earlier than she normally would. So now, we can have her continue her postpartum recovery and still be there for decision making regarding the baby and also just to be near the baby. As far as the baby, some of the advantages are really obvious and that is you don’t take any time at all to treat the baby. If there is a surgical problem that needs to be taken care of, our surgeons are ready. They can operate on the baby immediately. The baby doesn’t have that period of time where a condition may worsen while we’re waiting for getting ready for surgery or whatever.
Dr. Smith: So, in terms of advancing outcomes for high risk infants and this type of center, what have been the results? What had you seen so far? Are we making some headway with advancing outcomes?
Dr. Bennett: I think that we definitely can say that we are. There are a few centers like ours. At Children’s Mercy here in Kansas City, we’re one of a few centers where there is actually a children’s hospital that has a small delivery unit. So there are a few other centers like this one, the one being most notable in Philadelphia. There is data to show that these babies just simply do better. Their survival is higher and the morbidities that are associated with the condition are lower. So there is still ongoing research, particularly in our institution, to really define that in more critical ways but I think that the early data would strongly suggest that this is an advantage.
Dr. Smith: Can you describe for the listeners maybe a little bit more specifically how the center actually works – starting prenatally and all the way through the infant care?
Dr. Bennett: Sure. So, typically, what would happen is that a pregnant women would be managed by her local obstetrician or practitioner and they would identify that there was something out of the ordinary. They may have a very clear diagnosis or they may not be sure and they just simply say, “Something looks funny.” They would refer the patient to us really to help make a more precise diagnosis. That is our first job: to examine the fetus, provide the imaging--ultrasound, fetal MRI, echocardiogram, whatever they need--and we would help define that diagnosis. So, once they have that then we sit down with the family--the mother, the partner and then any other family members--and we really do a multidisciplinary consultation. So, we’ll have them sit with a neonatologist, a genetics counselor, a social worker, a pediatric surgeon, if necessary, a cardiovascular surgeon, if necessary, a cardiologist, an internal fetal doctor--a variety of people. They sit around a table and review the case with the family and tell them what we think is going on, what we think the likely outcomes are going to be and what we can do to help with the baby. So, the next step is that consultation. That information goes back to her referring doctor. A decision is made collaboratively where would be the best place for the baby to deliver. In the more serious situations, the patient is usually expressing a desire to come back and deliver with us at our center. Then, we begin that preparation. So, the mother meets our obstetrical team. She can delivery vaginally, many times. Sometimes a Cesarean section is required but we plan the delivery. And in that planning, we obviously have our neonatal team and our surgical teams with the appropriate subspecialists that are needed. They’re ready to go. So, when the baby is born everyone is alerted. We’re there in the delivery room together. Baby gets immediate assessments, immediate care. Then, we move forward to the post-partum care where we take care of mom make sure she’s healthy; that she’s stable from the delivery process. Then, we take care of that baby and do the necessary things that are needed for them.
Dr. Smith: So, the center at Children’s Mercy, is this going to become a model, you think, for other hospitals throughout the country?
Dr. Bennett: Absolutely. We weren’t the first, by any means but on the other hand, we are certainly in the mix of this type of development. This is catching on in centers across the country. This is the model, I think, that is beginning to emerge as being the best model for, again, really a small population of obstetrical cases. If you look at the number of birth defects that occur in pregnancies, it’s about 2-3% of all pregnant women will deliver a baby with a birth defect and about a third of those – roughly 1% – of the total number of deliveries would really have a problem that really would require our services. So, it still is a fairly small number but in those cases there is no doubt that this is becoming the model which is emerging to improve the fetal condition.
Dr. Smith: It’s obvious that Children’s Mercy provides many consultation for patients that don’t actually deliver at Children’s Mercy. What types of cases do deliver at Children’s Mercy?
Dr. Bennett: The general guideline is if a baby is going to require significant urgent care right after delivery – if we can anticipate that--then that is a patient that would very likely deliver with us. For example, if a baby is born with a cleft lip or even a cleft palate that’s not an urgent or emergent problem and those are cases that don’t generally deliver with us. But, on the other hand, if the baby were to have a congenital diaphragmatic hernia, where we know the contents of the abdomen is herniated into the chest and has caused significant lung hypoplasia, this is a baby that is going to have immediate hypoxia, immediate need for aggressive resuscitation and surgery. That’s a baby that really will definitely benefit from a center like ours.
Dr. Smith: Dr. Bennett, I want to thank you for coming on to the show and for all of the great work that you’re doing at Children’s Mercy. You’re listening to Transformational Pediatrics with Children’s Mercy, Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I am Dr. Michael Smith. Have a great day.