Am J Perinatol 2014; 31(07): 549-556
DOI: 10.1055/s-0034-1371709
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Alexis S. Davis
1  Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
2  The Center for Fetal and Maternal Health, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
,
Valerie Y. Chock
1  Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
2  The Center for Fetal and Maternal Health, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
,
Susan R. Hintz
1  Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
2  The Center for Fetal and Maternal Health, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
› Author Affiliations
Further Information

Publication History

27 November 2013

13 January 2014

Publication Date:
04 April 2014 (eFirst)

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.