Pediatric neurology participation in a fetal diagnostic service.
Fetal neurologic consultations were provided to 166 maternal-fetal pairs over a 5-year period. Consultations were initiated during the second trimester in 46% (74/166) of pairs. Fifty-percent (83/166) of these consultations involved brain malformations, of which 55% (46/83) were also associated with other organ abnormalities. Brain malformations principally consisted of encephalocele, dorsal neural tube defects, holoprosencephaly, schizencephaly, cerebellar dysgenesis, and ventriculomegaly. Non-central nervous system organ system anomalies were observed in another 50% (83/166), in decreasing order of occurrence-cardiac, renal, gastrointestinal, pulmonary, in utero growth restriction, and hydrops fetalis. Outcome data on 128 children included survival at delivery for 86/128 or 67.2%, termination in 16/128 (12.5%), stillborn 6/128 (4.7%), and postnatal deaths in 20/128 (15.6%). Maternal medical histories were abnormal for 65% of women. Placental pathology was abnormal in 80% (72/102) of available specimens, consisting of both chronic and acute lesions. Postnatal diagnoses were obtained in 128 neonates; 64% (82/128) remained the same diagnosis, 28.1% (36/128) had a worse or improved diagnosis, and 10/128 (7.8%) were normal. Pediatric neurologists can provide useful fetal consultations early during gestation, and must consider multiple organ diagnoses and maternal-placental diseases. Postnatal diagnoses may be different from the fetal diagnoses which will influence continuity of care for the child at older ages.
Scher
Mark S
MS
Department of Pediatrics, Division of Pediatric Neurology, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
Kidder
Brenda M
BM
Shah
Dinesh
D
Bangert
Barbara A
BA
Judge
Nancy E
NE
D000293:Adolescent; D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007231:Infant, Newborn; D009422:Nervous System Diseases / Q000000981:diagnostic imaging*; D009462:Neurology / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods*