Children's Hospitals Today - Spring 2018 - 22

FEATURE / FETAL CARE

From prenatal care to beyond delivery
At the Colorado Fetal Care Center at Children's Hospital
Colorado, mother and baby can be treated under one roof with
a spectrum of maternal, perinatal and pediatric care services.
The hospital offers an array of treatments, including open
fetal surgery, fetoscopy and ex utero intrapartum treatment
procedures. From fetal diagnosis through discharge from the
NICU or cardiac intensive care unit to pediatric subspecialty
care, Children's Colorado provides a
continuum of care for patients.
Fetal surgeries
During mom's first appointment,
at Children's
Colorado
she meets with the care team: pedisince 2010
atric/fetal radiology, maternal-fetal
medicine, fetal surgery, genetics,
fetal cardiology, psychology, neonatology and all relevant post-natal pediatric providers.
The hospital's fetal care center brings this team together to
streamline the process for patients, while ensuring a responsive and comprehensive care plan is in place. With a focus on
each child's long-term quality of life, the care model also integrates with the hospital's pediatric subspecialty programs.
When it's time for delivery, the maternal fetal care center
has a 10-bed labor, delivery and postpartum unit located
within Children's Colorado, so babies with complex needs
can be transported just down the hall to the Level 4 NICU or
the cardiac ICU immediately after birth. The maternal care
unit is staffed with in-house obstetric hospitalists, anesthetic
and obstetric nurses. Support from a psychologist and social
work case management is also available.
As the hub of the largest neonatal network across the
region, the Colorado Fetal Care Center has cared for highrisk fetuses since 2010 and performed more than 1,200 fetal

surgeries. The center also leads research initiatives such as
3D printing and bioengineering solutions for fetoscopic myelomeningocele repair and fetoscopic tracheal occlusion for
congenital diaphragmatic hernia.
Establishing the fetal program required a partnership between adult and pediatric providers. The Colorado Fetal Care
Center is located at Children's Colorado, so a key to success
was integrating adult providers into the pediatric environment. When developing this program, the Children's Colorado
team worked to design an environment that would best serve
this patient population. The Colorado Fetal Care Center has an
outpatient clinic, 24/7 labor, delivery and postpartum unit, a
fetal intervention suite and one delivery operating room.
Building the program required financial investment and
buy-in from leadership at Children's Colorado and UCHealth,
Children's Colorado's adult partner. Formalizing the agreement
between the entities was critical for success and includes a
provider-based joint operating agreement. Shared governance
between UCHealth and Children's Colorado unifies program
leadership, integrates clinical care, research and education and
creates economic alignment based on contribution margin.

Downstream effects on other service lines

Developing a fetal program will have effects on an organization's neonatal service line. Since the inception of the program
at Children's Colorado, NICU discharges have increased 30
percent, and fetal cardiology volume has more than doubled.
The fetal patients born in the Colorado Fetal Care Center are
very complex and have affected the length of stay in the NICU
and cardiac ICU. The numbers of neonatal surgeries have also
grown in parallel to neonatal discharges.

Continuum of care for high-risk pregnancies
Children's Minnesota is a children's health system with 428
beds in the heart of Minneapolis and St. Paul. Neonatology
fills a significant portion of those inpatient beds-194 beds
and nearly 55,000 patient days. In 2008, two physicians recognized an opportunity to enhance the continuum of care
and solidify the perinatal-neonatal connection, so they took
the lead on developing a fetal care program from the ground
up. Today, Children's Minnesota operates the Midwest Fetal
Care Center (MWFCC), one of the more high-volume centers,
in partnership with adult-focused provider Allina Health.
The MWFCC team offers laser ablation therapy, surgical procedures and care coordination for all complex prenatal diagnoses. In 2016, the center added open fetal surgery to its list of services, performing its first myelomeningocele that year. In one

CHILDREN'S HOSPITAL S TODAY Spring 2018

year, the team completed five successful cases with growth to
10 cases a year. The group also conducts research on congenital
lung malformations, congenital diaphragmatic hernia, twin-totwin transfusion syndrome and
single ventricle cardiac disease.
Myelomeningocele
The organization's multidiscases in year one
ciplinary
approach to fetal care
at Children's
Minnesota
started with training, detailed
strategic planning and programmatic investment. This allowed the team and services to grow; there are now two pediatric surgeons and three perinatal specialists who participate in
open cases and laser ablations, as well as dedicated colleagues
across disciplines who specialize in advancing fetal care.

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