Published on in CHOP News
December 29, 2009 — More than 240 babies born in 2009 in the Garbose Family Special Delivery Unit (SDU) at The Children’s Hospital of Philadelphia are ringing in 2010 with their joyful families. Families from 24 states traveled to Children’s Hospital for expert prenatal, delivery and postnatal care for their babies.
“This state-of-the-art, one-of-a-kind Special Delivery Unit provides the most personalized, comprehensive care for these families before, during and after birth,” said N. Scott Adzick, MD, surgeon-in-chief at The Children’s Hospital of Philadelphia and medical director of the Center for Fetal Diagnosis and Treatment (CFDT). “These truly remarkable babies were prenatally diagnosed with life-threatening birth defects that required a team of specialists to closely monitor the mother and baby during the course of the pregnancy and a plan for the highly specialized neonatal, surgical or cardiac care needed at birth.”
Approximately one in every 33 babies born is diagnosed with a birth defect. However, there is a large spectrum of severity of birth defects and only life-threatening birth defects require the services offered in the Special Delivery Unit at Children’s Hospital.
Forty-four percent of the babies born this year in the SDU had congenital heart defects while the remainder had non-cardiac defects such as congenital diaphragmatic hernia, an abdominal wall defect or a tumor on their lungs, backside or neck. These babies are fragile at birth; many have tiny, underdeveloped lungs and require expert care by a team of subspecialists devoted to providing care to newborns with birth defects.
First comprehensive obstetrical unit in a pediatric hospital
Opened in 2008, the SDU is the world’s first comprehensive obstetrical unit within a pediatric hospital for mothers carrying a fetus with a known birth defect. Prenatal and delivery services are contained within the same unit. Patients are cared for by a dedicated team of obstetricians, maternal fetal medicine specialists, pediatric surgeons, fetal cardiologists, neonatologists, anesthesiologists, radiologists, sonographers, nurse-midwives, nurses and social workers.
Unlike centers where mothers give birth and recover in one hospital while their critically ill newborns are transferred to a specialized pediatric facility, the SDU allows the mother and baby to stay in the same hospital with a multidisciplinary team of experts caring for both the mother and the baby.
Patients are first introduced to the Center for Fetal Diagnosis and Treatment or the Fetal Heart Program during an outpatient evaluation. During the initial evaluation, mothers receive a series of tests in a single day — a high-resolution ultrasound, an ultrafast fetal MRI and an echocardiogram. After the images are evaluated, the team meets with the family to discuss the diagnosis and treatment options and to devise a care plan. If the baby will require immediate critical care upon birth, the family is enrolled in the SDU program.
“The uniqueness of the SDU goes beyond the convenience of having the mother and baby together in a pediatric hospital,” said Lori J. Howell, RN, MS, executive director of the Center for Fetal Diagnosis and Treatment. “The unit staff strives to optimize and individualize the birth experience for mothers and normalize their delivery experience as much as possible during a difficult and technically challenging time for the baby.”
A team approach for both mother and baby
Patients are followed by the team throughout the pregnancy, and it is the familiar members of the mother’s prenatal care team who also deliver the baby. After the birth, the SDU team immediately brings the family together, and encourages parents to be with their new babies as soon as possible — they will even provide some of the mother’s postpartum care in the intensive care units where the babies are receiving care. Families are able to stay together, which helps to make a difficult time a little easier.
After delivery in the SDU, babies are treated immediately in the Harriet and Ronald Lassin Newborn/Infant Intensive Care Unit (N/IICU) or the Evelyn and Daniel M. Tabas Cardiac Intensive Care Unit (CICU) while the mother recovers in the same hospital.
Families from California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia all received care in the Special Delivery Unit at Children’s Hospital this year.
As one of only a few centers of its kind in the world, the Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia offers a wide range of comprehensive fetal surgery services that support patients from the prenatal evaluation stage through infant follow-up care.
The Center was established in 1995 and has received more than 10,000 referrals from all 50 states and 46 countries. The Center has performed more than 630 fetal surgery operations. Among those are major open fetal surgical procedures for birth defects such as spina bifida and less invasive fetoscopic or ultrasound guided surgeries for conditions such as twin-twin transfusion syndrome.
Multidisciplinary coordinated special delivery approaches for babies that require surgical interventions while still on maternal-placental life support (EXIT delivery) or immediate cardiovascular evaluation and open heart versus less invasive surgery for major congenital heart disease (IMPACT delivery) are also offered.