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Cardiology to Fetal Care to Adulthood: Delivering Collaborative Expert Care
Babies with complex congenital (from birth) heart conditions need special care. The Fetal Heart Program at Children’s Health? offers that care even before babies are born. Learn more about the expert care and accurate diagnoses at the nation’s first elite certified fetal cardiac monitoring program.
Featured Speaker:
Learn more about Dr. Laird
Penn Laird, MD
Penn Laird II, M.D. received his medical degree at the University of Texas Southwestern Medical School. He completed his residency in pediatrics and his fellowship in pediatric cardiology at Baylor College of Medicine/Texas Children’s Hospital.Learn more about Dr. Laird
Transcription:
Caitlin Whyte: Welcome. You're listening to Pediatric Insights: Advances and innovations with Children's Health. I'm your host, Caitlin Whyte. Joining us today is Dr. Penn Laird, a cardiologist at Pediatric Heart Specialists, which is a Children's Health Care network partner. We will be discussing babies with complex congenital heart conditions. The expert care offered at the Fetal Heart Program at Children's Health offers that care even before babies are born, as well as after.
Dr. Laird, can you explain how you deliver expert care to expectant moms?
Dr. Penn Laird: Yes. Well, I'm a pediatric cardiologist, which simply means that I take care of children with heart problems. The vast majority of what we take care of are congenital heart defects. So these are birth defects of the heart, minor issues to very severe life-threatening problems. They're the most common type of birth defects. They happen in about one out of every 150 children. So our job is to take care of these patients with congenital heart defects and ensure that they have the best possible outcomes and help them lead as normal lives as possible.
Over the past 30 years or so, it's become increasingly possible to diagnose many of these major heart problems in the womb before a baby is born. So a good portion of our practice now focuses on what we call fetal diagnosis. So in other words, we're doing everything possible to identify and manage these heart issues even before the baby is born.
Caitlin Whyte: So how do patients find their way to delivery and the Fetal Heart Program at Children's Health?
Dr. Penn Laird: Well, most patients are referred in to the Fetal Heart Program at Children's Health, either from their obstetrician or a maternal fetal specialist. These women are seeing an obstetrician at regular intervals and they usually end up getting a screening ultrasound somewhere around 20 weeks gestation. So if the obstetrician at that point sees something concerning, then they may refer the patient to us or onto a maternal field specialist for confirmation. Then, if the maternal fetal specialist confirms that there is a heart problem, then they'll send the patient along to us to get seen.
The second way that patients may find their way to the Fetal Heart Program is that a number of may come in for a second opinion. Maybe they've seen another cardiologist in another city or even state, but they've heard about the Fetal Heart Program at Children's Health and they decided to come here to tap into our expertise. So both direct referrals as well as second opinions are the most common way that patients find their way here.
Caitlin Whyte: So tell us a bit more about your process in making a diagnosis.
Dr. Penn Laird: So when we see a patient that's referred in, we end up doing what's called a fetal echocardiogram. So this is a detailed ultrasound examination of the baby's heart. So we look in depth at all the different anatomical features of the heart, as well as a number of different functional aspects of the heart and cardiovascular system.
So basically, we're trying to look and identify all four chambers of the heart. We're looking at the position of the heart and the chest. We're looking at the four valves, the arteries of the heart. We're looking at the walls of the heart, making sure that there's no holes. The arteries are positioned correctly, all the valves are functioning normally. And then functionally, we're looking at the heart muscle itself, making sure that it's squeezing normally, making sure that the blood flow is proper. And then we're also looking at the heartbeat, making sure that the heart's not excessively fast or excessively slow, et cetera.
So we take all this information and then process it into an accurate diagnosis for the family. You know, the usual study may take 30 to 45 minutes, but sometimes if it's, you know, very complex, maybe up to an hour and a half or two hours. So it just depends on how complicated things are. But that's generally the process of making a diagnosis in these patients.
Caitlin Whyte: Now, how do you ensure the best possible outcomes for mother and baby?
Dr. Penn Laird: So our ultimate goal is to do everything that we can to achieve the best possible outcome for the family. So the steps that we go through include, number one, making sure that we've made an accurate diagnosis and then, number two, sitting down and formulating a plan with the family. And the plan may include things like, you know, in utero medication therapy or referring them onto additional specialists, such as a heart surgeon or a genetic counselor or a neurodevelopmental specialist.
The other big step that we take to make sure that that the baby and mother had the best possible outcome is to prepare for the baby's delivery and immediate postnatal course. So sometimes this can be very straightforward if the baby has been diagnosed with just a relatively minor issue, then many instances, we don't need to do anything special. The baby can be delivered at the local community hospital. But if it's a more serious, complicated problem that may need immediate resuscitation or say surgical intervention immediately after birth, then in many instances, we have to rearrange for delivery at a hospital that's equipped to handle these complex issues and then prepare for immediate delivery to Children's Health after the baby's born.
But no matter what, at every step along the path, our goal is to make sure that the family is informed and communicated with and has a full understanding of things and feels comfortable with the plan. We also do everything we can to make sure the referring obstetrician and maternal fetal specialist are involved in the planning process.
Caitlin Whyte: And when we're on the other end of that process, what is the course of care after the baby's born?
Dr. Penn Laird: A lot of it depends on the significance of the heart problems that the baby's been diagnosed with. If it's just a minor heart problem, then that baby in many instances, doesn't need any specialized care at all. They just need confirmation of the diagnosis after they're born and then routine baby care. More significant problems though, they're often very involved. So we've arranged for the neonatologists to be present at the delivery of the baby. The baby's resuscitated and immediately transferred to the neonatal intensive care unit.
Oftentimes intravenous lines have to be placed in the baby. Medications may need to be started. And then we're arranging for immediate transport to the cardiac intensive care unit at Children's Medical Center. And once the baby arrives there, then depending on the baby's status, there may be a need for immediate interventional procedures or even surgery.
So that generally summarizes the care of the baby. Again, it's dependent largely on the diagnosis that we've made.
Caitlin Whyte: Great. Dr. Laird, a lot of good information here. Is there anything else you'd like to share?
Dr. Penn Laird: One thing I wanted to share is that in this day and age, babies with even the most serious of heart problems can be treated and have very good outcomes. I mean, we've seen an incredible improvement in the treatment and management of these types of babies over the last 40 years. And in this day and age, you know, many of these children can go on to lead very normal, healthy lives. They can attend school, play sports and do things like that. So I think it's really important to encourage families in this regard.
I know that it can be devastating to a family to get a serious diagnosis of a heart problem in an unborn child. But with the right care, the right preparation, these babies can ultimately have really excellent outcomes.
Caitlin Whyte: Well, thank you so much for joining us today, doctor, and for all the work you do. And as always thank you for listening to Pediatric Insights. You can find more information at childrens.com/fetalheart.
I'm your host, Caitlin Whyte. Stay well.
Caitlin Whyte: Welcome. You're listening to Pediatric Insights: Advances and innovations with Children's Health. I'm your host, Caitlin Whyte. Joining us today is Dr. Penn Laird, a cardiologist at Pediatric Heart Specialists, which is a Children's Health Care network partner. We will be discussing babies with complex congenital heart conditions. The expert care offered at the Fetal Heart Program at Children's Health offers that care even before babies are born, as well as after.
Dr. Laird, can you explain how you deliver expert care to expectant moms?
Dr. Penn Laird: Yes. Well, I'm a pediatric cardiologist, which simply means that I take care of children with heart problems. The vast majority of what we take care of are congenital heart defects. So these are birth defects of the heart, minor issues to very severe life-threatening problems. They're the most common type of birth defects. They happen in about one out of every 150 children. So our job is to take care of these patients with congenital heart defects and ensure that they have the best possible outcomes and help them lead as normal lives as possible.
Over the past 30 years or so, it's become increasingly possible to diagnose many of these major heart problems in the womb before a baby is born. So a good portion of our practice now focuses on what we call fetal diagnosis. So in other words, we're doing everything possible to identify and manage these heart issues even before the baby is born.
Caitlin Whyte: So how do patients find their way to delivery and the Fetal Heart Program at Children's Health?
Dr. Penn Laird: Well, most patients are referred in to the Fetal Heart Program at Children's Health, either from their obstetrician or a maternal fetal specialist. These women are seeing an obstetrician at regular intervals and they usually end up getting a screening ultrasound somewhere around 20 weeks gestation. So if the obstetrician at that point sees something concerning, then they may refer the patient to us or onto a maternal field specialist for confirmation. Then, if the maternal fetal specialist confirms that there is a heart problem, then they'll send the patient along to us to get seen.
The second way that patients may find their way to the Fetal Heart Program is that a number of may come in for a second opinion. Maybe they've seen another cardiologist in another city or even state, but they've heard about the Fetal Heart Program at Children's Health and they decided to come here to tap into our expertise. So both direct referrals as well as second opinions are the most common way that patients find their way here.
Caitlin Whyte: So tell us a bit more about your process in making a diagnosis.
Dr. Penn Laird: So when we see a patient that's referred in, we end up doing what's called a fetal echocardiogram. So this is a detailed ultrasound examination of the baby's heart. So we look in depth at all the different anatomical features of the heart, as well as a number of different functional aspects of the heart and cardiovascular system.
So basically, we're trying to look and identify all four chambers of the heart. We're looking at the position of the heart and the chest. We're looking at the four valves, the arteries of the heart. We're looking at the walls of the heart, making sure that there's no holes. The arteries are positioned correctly, all the valves are functioning normally. And then functionally, we're looking at the heart muscle itself, making sure that it's squeezing normally, making sure that the blood flow is proper. And then we're also looking at the heartbeat, making sure that the heart's not excessively fast or excessively slow, et cetera.
So we take all this information and then process it into an accurate diagnosis for the family. You know, the usual study may take 30 to 45 minutes, but sometimes if it's, you know, very complex, maybe up to an hour and a half or two hours. So it just depends on how complicated things are. But that's generally the process of making a diagnosis in these patients.
Caitlin Whyte: Now, how do you ensure the best possible outcomes for mother and baby?
Dr. Penn Laird: So our ultimate goal is to do everything that we can to achieve the best possible outcome for the family. So the steps that we go through include, number one, making sure that we've made an accurate diagnosis and then, number two, sitting down and formulating a plan with the family. And the plan may include things like, you know, in utero medication therapy or referring them onto additional specialists, such as a heart surgeon or a genetic counselor or a neurodevelopmental specialist.
The other big step that we take to make sure that that the baby and mother had the best possible outcome is to prepare for the baby's delivery and immediate postnatal course. So sometimes this can be very straightforward if the baby has been diagnosed with just a relatively minor issue, then many instances, we don't need to do anything special. The baby can be delivered at the local community hospital. But if it's a more serious, complicated problem that may need immediate resuscitation or say surgical intervention immediately after birth, then in many instances, we have to rearrange for delivery at a hospital that's equipped to handle these complex issues and then prepare for immediate delivery to Children's Health after the baby's born.
But no matter what, at every step along the path, our goal is to make sure that the family is informed and communicated with and has a full understanding of things and feels comfortable with the plan. We also do everything we can to make sure the referring obstetrician and maternal fetal specialist are involved in the planning process.
Caitlin Whyte: And when we're on the other end of that process, what is the course of care after the baby's born?
Dr. Penn Laird: A lot of it depends on the significance of the heart problems that the baby's been diagnosed with. If it's just a minor heart problem, then that baby in many instances, doesn't need any specialized care at all. They just need confirmation of the diagnosis after they're born and then routine baby care. More significant problems though, they're often very involved. So we've arranged for the neonatologists to be present at the delivery of the baby. The baby's resuscitated and immediately transferred to the neonatal intensive care unit.
Oftentimes intravenous lines have to be placed in the baby. Medications may need to be started. And then we're arranging for immediate transport to the cardiac intensive care unit at Children's Medical Center. And once the baby arrives there, then depending on the baby's status, there may be a need for immediate interventional procedures or even surgery.
So that generally summarizes the care of the baby. Again, it's dependent largely on the diagnosis that we've made.
Caitlin Whyte: Great. Dr. Laird, a lot of good information here. Is there anything else you'd like to share?
Dr. Penn Laird: One thing I wanted to share is that in this day and age, babies with even the most serious of heart problems can be treated and have very good outcomes. I mean, we've seen an incredible improvement in the treatment and management of these types of babies over the last 40 years. And in this day and age, you know, many of these children can go on to lead very normal, healthy lives. They can attend school, play sports and do things like that. So I think it's really important to encourage families in this regard.
I know that it can be devastating to a family to get a serious diagnosis of a heart problem in an unborn child. But with the right care, the right preparation, these babies can ultimately have really excellent outcomes.
Caitlin Whyte: Well, thank you so much for joining us today, doctor, and for all the work you do. And as always thank you for listening to Pediatric Insights. You can find more information at childrens.com/fetalheart.
I'm your host, Caitlin Whyte. Stay well.