Neonatal-Perinatal Health Care Delivery: Practices and Procedures
Neonatal-Perinatal Health Care Delivery 3: Practices: Growth & Nutrition, Potpourri
Sarah B. Mulkey, MD, PhD (she/her/hers)
Fetal-Neonatal Neurologist, Associate Professor Neurology and Pediatrics
Children's National Health System
Washington, District of Columbia, United States
The objective was to understand fetal neurology care delivery across centers in the US.
Design/Methods:
A survey characterizing fetal neurologic care delivery was distributed to practicing child neurologists. The survey was administered by the Fetal Neurology Consortium, which includes representatives from 9 sites across the United States. An online fetal neurology practice questionnaire using a Redcap database was posted to the Child Neurology Society member website in November 2021 and March 2022, inviting members who currently perform fetal neurology consultations. Survey results were summarized using descriptive statistics.
Results:
Representatives from 43 US institutions responded to the survey. Most had a fetal diagnostic center (n=38/43, 88%) and perform fetal ultrasound and MRI studies on site. The annual number of fetal consultations ranged between < 20 for 40% to >100 for 17% of the respondents. About 50% of respondents were subspeciality trained in fetal-neonatal neurology (18) or neurogenetics (7). Earliest gestational age of fetal MRI was between 16-19 weeks in 30% of centers and 20-23 weeks in 30%. Ventriculomegaly, corpus callosal anomalies, absent septum pellucidum, and malformations of posterior fossa or cortical development were the top reasons for consultation. 25% participated in interdisciplinary consultations. Prenatal genetic testing varied between centers. A majority followed neurodevelopment clinically. Most (n=39/43, 91%) were interested in participating in a collaborative national registry for prenatally diagnosed neurological disorders. The top-five priorities for the field were clinical guidelines, long-term follow-up data, fetal imaging, practice improvement, and prenatal counseling technique.
Conclusion(s):
The fetal neurology survey highlighted heterogeneity in practice and need for practice guidelines and education. Interdisciplinary collaborations will be crucial for curriculum and program development, including increasing attention to healthcare disparities. Synergy among different disciplines will improve outcomes and may reduce the burden of neurological diseases with fetal origins across the lifespan.