Jude Crino

Ultrasound and fetal diagnosis of perinatal infection.

Prenatal ultrasound can aid the clinician in evaluation of the patient with a suspected in utero TORCH infection, particularly toxoplasmosis, syphilis, and CMV. Demonstration of characteristic ultrasound findings in the high risk patient has a high predictive value for fetal infection and also may have prognostic significance. The sonologist should understand the limitations of ultrasound, discuss them with the patient, and document the discussion in the medical record. Patients should be counseled that ultrasound is not a sensitive test for fetal infection and that a normal fetal anatomy survey cannot predict a favorable outcome. In the low-risk patient, fetal infection should be considered when multiple organ system anomalies, fetal growth restriction, placental enlargement, or abnormalities of amniotic fluid volume are demonstrated.

Fetal Anatomic and Functional Echocardiography A 5-Year Review

Objective. To assess the concordance of fetal and postnatal echocardiography when congenital heart disease is suspected prenatally. Methods. The perinatology and pediatric cardiology ultrasound databases were searched for fetal echocardiograms obtained between June 1995 and June 2000. All cases with abnormal fetal echocardiographic findings in which postnatal echocardiography was performed were included. A perinatologist, pediatric cardiologist, or both interpreted all fetal echocardiograms; a pediatric cardiologist interpreted all postnatal echocardiograms. The fetal and postnatal echocardiograms were compared for the presence of 25 specific components. The κ statistic was calculated to evaluate concordance between fetal and postnatal studies. Positive and negative predictive values for fetal studies were calculated under the assumption that the postnatal study yielded the correct diagnosis. Results. Sixty‐five patients were included. Congenital heart disease ranged from an isolated atrial septal defect to complex disease. Images adequately showed all 25 components in more than 85% of the fetal studies. Concordance between fetal and postnatal echocardiograms was excellent (κ > 0.75) for 20 of the 25 components evaluated. Four of the remaining 5 components had fair concordance (κ = 0.4–0.75) between fetal and postnatal studies. Structural abnormalities without excellent concordance included partial anomalous pulmonary venous return, secundum atrial septal defects, and heart malposition. Concordance between fetal and postnatal right and left ventricular function was fair; however, differences may have been due to physiologic changes that occurred after birth rather than to inferior diagnostic accuracy of fetal echocardiography. Conclusions. Fetal echocardiography is an extremely useful and accurate clinical tool for prenatal and postnatal evaluation of congenital heart disease.

Isolated prenatal choroid plexus cysts do not affect child development.

To examine the effect of isolated prenatal choroid plexus cysts (CPCs) on child cognitive, behavioral, motor, and autonomic development at 18 months of age.

Ex utero intrapartum treatment procedure for management of congenital high airway obstruction syndrome in a vertex/breech twin gestation

Congenital high airway obstruction syndrome (CHAOS) is one indication for the ex utero intrapartum treatment (EXIT), which is used to secure the fetal airway, while fetal oxygenation is maintained by uteroplacental circulation. We report a successful EXIT procedure in a twin gestation in which one child had CHAOS while the other was a healthy child without any congenital abnormalities. After version of Twin B to allow for delivery of Twin A, Twin B underwent airway evaluation and tracheostomy for laryngeal atresia prior to delivery.

Maternal Sirolimus Therapy for Fetal Cardiac Rhabdomyomas

Maternal Sirolimus for Fetal Cardiac Rhabdomyomas Cardiac rhabdomyomas were diagnosed in a fetus at 21 weeks of gestation by means of echocardiography; probable tuberous sclerosis complex was diagnosed by association. The mother received sirolimus, with considerable regression of the cardiac tumors in utero.

Prenatal ABO/RHD Genotyping: A New Paradigm to Allow for Fresh Whole Blood for Cardiopulmonary Bypass in the Immediate Newborn Period

Compared to standard component therapy, fresh whole blood (FWB) offers potential benefits to neonates undergoing cardiopulmonary bypass (CPB) in the context of open cardiac surgery: decreased blood loss and subsequent risk of volume overload, improved coagulation status, higher platelet counts during and following CPB, circumvention of limited vascular access, and significantly reduced donor exposures. Obtaining FWB, however, entails 2–5 days of preparation, which often precludes its availability for neonates requiring CPB in the immediate newborn period. Using a multidisciplinary approach and molecular ABO/RHD genotyping on amniotic fluid, we developed a protocol to allow procurement of FWB for timed delivery followed by open cardiac surgery. Eligible subjects include patients undergoing genetic amniocentesis following the diagnosis of a fetal cardiac anomaly likely to require open surgical repair in the initial days after birth. This protocol has been successfully implemented following prenatal diagnosis of severe fetal cardiac anomalies. Taking advantage of the prenatal time period and the ability to perform fetal blood typing prenatally using molecular genotyping makes possible a new paradigm for the availability of FWB for CPB to improve perioperative, short-term, and long-term outcomes in a population comprised of some of the smallest and sickest patients who will undergo CPB.

Ultrasound Findings Associated with Antepartum Viral Infection

This article reviews the sonographic manifestations of fetal infection and the role of ultrasound in the evaluation of the fetus at risk for congenital infection. Several ultrasound findings have been associated with in utero fetal infections. For the patient with a known or suspected fetal infection, sonographic identification of characteristic abnormalities can provide useful information for counseling and perinatal management. Demonstration of such findings in the low-risk patient may serve to identify the fetus with a previously unsuspected infection. The clinician should understand the limitations of ultrasound in the prenatal diagnosis of congenital infection and discuss them with the patient.

Extracorporeal fetal support: a new animal model with preservation of the placenta.

BACKGROUND Previous models of support for premature sheep fetuses have consisted of cesarean delivery followed by catheterization of umbilical or central vessels and support with extracorporeal membrane oxygenation (ECMO). The limitations of these models have been insufficient blood flow, significant fetal edema, and hemorrhage related to anticoagulation. METHODS We performed a gravid hysterectomy on 13 ewes between 135 and 145days gestational age. The uterine vessels were cannulated bilaterally and circulatory support was provided via ECMO. Successful transition was defined as maintenance of fetal heart rate for 30minutes after establishing full extracorporeal support. Circuit flow was titrated to maintain mixed venous oxygen saturation (SvO2) of 70-75%. RESULTS Seven experiments were successfully transitioned to ECMO, with an average survival time of 2hours 9minutes. The longest recorded time from cannulation to death was 6hours 14minutes. By delivering a circuit flow of up to 2120ml/min, all but one of the transitioned uteri were maintained within the desired SvO2 range. CONCLUSION We report a novel animal model of fetal ECMO support that preserves the placenta, mitigates the effects of heparin, and allows for increased circuit flow compared to prior techniques. This approach may provide insight into a technique for future studies of fetal physiology.