Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And we have a panel for you today to highlight the breadth of services available at the Fetal Care Center at Weill Cornell Medicine.

Joining me is Dr. Jessica Scholl. She's a Co-Director of the Fetal Care Center at Weill Cornell Medicine, an Assistant Professor of Clinical Obstetrics and Gynecology at Weill Cornell Medical College-Cornell University, and an Assistant Attending Obstetrician Gynecologist at New York-Presbyterian Hospital Weill Cornell Medical Center; and Dr. Ericalyn Kasdorf, she's Co-Director of the Fetal Care Center, an Associate Attending Pediatrician at New York-Presbyterian Hospital Weill Cornell Medical Center, and an Associate Professor of Clinical Pediatrics at Weill Cornell Medical College, Cornell University.

Doctors, thank you so much for joining us today. And Dr. Scholl, I'd like to start with you. What are the most common disorders that women come to you both with that would encourage someone to even consider a consultation at the Fetal Care Center.

Dr. Jessica Scholl: So, a family can be seen at the Fetal Care Center really if there is any suspicion of a fetal birth defect or maybe a genetic abnormality that might require some sort of additional care for the newborn after birth. We also encourage consultations if there's a concern for poor fetal growth, something that we refer to as growth restriction, or a high chance of a preterm delivery when the infant might need a neonatal ICU stay. If there's the potential for any care or tests or studies needed beyond all routine well newborn care, a Fetal Care Center consult is encouraged just so that the family can discuss next steps of care once the baby is born.

Melanie Cole, MS: So doctors, this is really such a great topic because it's important for couples to hear about these services. So Dr. Scholl, why don't you go over for us the breadth of services offered to parents and families at the Fetal Care Center? Tell us about some of those services.

Dr. Jessica Scholl: So, we really offer multidisciplinary services for pregnancies that are going to require special fetal care during either the prenatal period or after delivery. From the initial referral, patients will be prepared to hear from our Fetal Care team, who will be in touch with the patient, gather all the information, and schedule all the appropriate consults for the families. And these consults might consist of detailed ultrasounds and imaging studies. They might consist of consults with high-risk obstetricians or even pediatric subspecialists. And so, we really feel that providing this type of coordinated care during the prenatal period, parents and families can really best prepare for the care of their baby.

Dr. Ericalyn Kasdorf: I'd like to chime in that we also have a level IV neonatal intensive care unit, which means we can provide the highest level of medical care for newborns and extremely premature infants. Our NICU has a dedicated MRI and an operating room actually within the unit so our patients don't have to travel far for further imaging or procedures they need done. And the rooms within the NICU are private, so this really allows a quiet and healing environment for families to spend time with their newborns. Parents can visit their babies any time of day, seven days a week, so it's really an open place for parents to be able to see their baby.

Melanie Cole, MS: Thank you, Dr. Kasdorf, for telling us about that. And Dr. Scholl, speak about prenatal diagnostic services available.

Dr. Jessica Scholl: In terms of genetic prenatal diagnosis, we offer something called chorionic villus sampling, which many may know by the term CVS, and amniocentesis here in our ultrasound unit. For any patients that choose to undergo these procedures, which are really to test the fetal genetics, families can meet with prenatal genetic counselors to talk about the specific tests that are available really depending on the clinical situation.

And then after they undergo the procedure, if we were to discover any abnormality, we would arrange a consult with our team of medical geneticists to discuss the implications of that diagnosis on the baby with the families. And then in terms of diagnosing birth defects, we mainly do this by prenatal ultrasound. We have a very large ultrasound unit here with a team of sonographers who are amazing, and they are really skilled at evaluating patients with complex fetal conditions. So if any condition is suspected at the time of a prenatal ultrasound, a high-risk obstetrician or someone called a Maternal-Fetal Medicine doctor would be there to evaluate and discuss the diagnosis with the families. And then, they could arrange any potential followup testing that is needed, such as a fetal echocardiogram or an MRI, all of which we have available here.

Dr. Ericalyn Kasdorf: And what I'll add is that what is really unique to our program is that patients are meeting specialists along the way and reviewing these studies at each step, but we will often get together as a multidisciplinary team with the patient. So, this may mean we have a meeting where the radiologist will review the MRI with physicians and care providers and the family. Maternal-Fetal Medicine may discuss the timing and mode of delivery. And neonatologists, who are specialists in taking care of babies and other pediatric subspecialists, will review treatment options and plans for the baby after delivery.

Melanie Cole, MS: Thank you both for that. And Dr. Kasdorf, speak about the support families need emotionally and psychologically throughout their journey, because this is so scary. Whether you're pregnant or you've had your baby, this is the kind of thing that parents really need that extra support for. So, can you please speak about how you all help the families with the situation that they're going through and how do you involve them in the decision-making process once you realize what's going on.

Dr. Ericalyn Kasdorf: Absolutely. We feel fortunate to work with such a great support group within the hospital. So first to answer your question about the decision-making process, we really try to get a sense of the family's understanding of their baby's diagnosis and prognosis, and we try to align with them to provide care tailored to their baby and their family. Often parents come to the appointment really knowledgeable. They may have done their own research and have specific concerns they want to address up front. And then, we always make sure to get through any remaining questions they have. And we make sure that they know we're available through this journey to answer new concerns and questions as they come up.

Dr. Jessica Scholl: And I would just add that we really consider the parents and families being involved at all levels of this whole process. Our job is really to give them and provide them with the most accurate and evidence-based information about their baby. And then, we offer all the options that are available, and support them in their decisions about what is really best for their families.

Dr. Ericalyn Kasdorf: I'd like to go back then, too, to what happens after delivery, who is available to help support families. One team we rely on heavily is our Child Life team. So, this is a group of specialists who help families navigate discussing these difficult situations, maybe with other children or older siblings at home, and they figure out how to best support their family during this really stressful time.

Once the infant is in the NICU, Child Life also helps families make memories. Just thinking about some families are spending holidays in the hospital, Child Life really helps families find moments joy during what can be a long stay. We have a March of Dimes-sponsored NICU family support coordinator who also is a great support, both before delivery and after. So, she will give daily survival tips to families, where to eat, where is the laundry room, how do you get through day to day living in the NICU. We also have our Komansky Family Advisory Council. This is a group of wonderful parents who have been through a difficult stay potentially in the hospital and can really be a great source of support. So, they have a parent-to-parent peer counseling program where a parent may be matched with a family who went through a similar experience with their baby and can really support them along the way.

And then finally, once a baby is getting ready to go home, if they have medical equipment they may have to use, we have a team who will teach families how to care for a baby through simulation. The parents will show that they're comfortable to leave the hospital with this medical equipment. And this is done with support from many other people, social workers, case managers. It really takes a village to help the baby get out of the NICU safely and so that the family is comfortable.

And finally, we have a neurodevelopmental follow up program where a family will be seen by the neonatologist. We have a nutritionist in this program and occupational and physical therapy. And we follow our babies over the first three years of life and longer so that we can act as an ongoing source of support for the families.

Melanie Cole, MS: Thank you for that, Dr. Kasdorf. And Dr. Scholl, I'd like you to expand a bit on what Dr. Kasdorf was just discussing as far as that multidisciplinary approach. You both represent separate specialties focused on treating patients and families at the Fetal Care Center. Explain why that multidisciplinary team is so important, and as Dr. Kasdorf mentioned, but a few of the people that are involved with these families, tell us how you all work together to ensure that comprehensive care.

Dr. Jessica Scholl: Yes, definitely. So, first, for the patient, we really make every effort to combine all appointments together. So, this might be imaging appointments the same day as their consultative appointments with the subspecialists. And that's really for ease to the patients and their families. We also arrange video visits. And these visits can include the obstetrician, the neonatal ICU doctors, and the pediatric subspecialists who can all be present together to talk to the families about the condition and what to expect next. We hold frequent conferences actually among ourselves, among all the Fetal Care Center providers, to discuss all of our patients individually, and ensure that really all the levels of their care are being addressed as well.

Melanie Cole, MS: I'd love to give you each a chance for a final thought. So Dr. Scholl, starting with you, tell us a little bit about some of the treatment options available to families facing prenatal diagnoses or complications.

Dr. Jessica Scholl: So, the range of options is very wide. For more minor issues, the treatment might include close observation or even a minimally invasive procedure for the newborn after delivery. For more complex diagnoses though, this might include fetal procedures such as potentially an intrauterine blood transfusion or a stent placement done during the pregnancy, or it might even include medications given to the mother to stabilize the condition so that patients can deliver their baby at or near full term.

Melanie Cole, MS: Dr. Kasdorf, the same for you, speak just a little bit about some of the treatment options and exciting technology that you have available when families are there at the Fetal Care Center and the baby is born.

Dr. Ericalyn Kasdorf: Absolutely. We have the ability to perform really complex neonatal surgeries, and this could range from anything from major cardiac surgery, urologic surgery or neurosurgery, among many other procedures. We have a really comprehensive craniofacial program where we treat conditions such as cleft lip and palate, for example. We have a multidisciplinary congenital vascular anomalies team, and pediatric surgeons who can provide really wide breadth of surgical interventions, including a laparoscopic approach when feasible. We have a close working relationship with the hospital for special surgery as well, and so we can often refer patients there for findings such as clubfoot. So, we're really fortunate to have access to all of these wonderful surgeons and subspecialists within our system.

Melanie Cole, MS: Dr. Kasdorf, just stick with us for a second and offer parents and families your best advice. Let them know what you would like the key takeaways to be and the best advice as far as consultation and what you offer at the Fetal Care Center at Weill Cornell Medicine.

Dr. Ericalyn Kasdorf: Thank you. I think what really stands us apart is that we know how stressful it can be to receive information that something might not be as you expected during the pregnancy or after. And when we get that call that you need help to be seen, advice, consultation, we'll get you in quickly and we'll really tailor your care so that it's personalized to you and to your baby.

And the collaboration of care you'll see at our center and with our teams is truly unparalleled. We have access to the best obstetricians, neonatologists, and pediatric subspecialists, and we will make sure that your care is coordinated with excellent communication between the teams so that families can really make the best decision in a supportive and compassionate environment.

Melanie Cole, MS: Thank you both so much for joining us and telling us really all about the Fetal Care Center at Weill Cornell Medicine. What great work that you're doing. Thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify, iHeart, and Pandora. And for more health tips, please visit wieillcornell.org and search podcasts. And don't forget to check out Back to Health. We have so many great podcasts there as well. I'm Melanie Cole. Thanks so much for joining us today.

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