Members of the Care Team

  • Pediatric Surgeon – A pediatric surgeon is a physician who has earned an undergraduate degree and completed four years of medical school, five years of residency training in general surgery followed by an additional two years of residency specialization in pediatric surgery. Pediatric surgeons are double board certified in surgery and pediatric surgery.
  • Pediatric Anesthesiologist – An anesthesiologist is a physician who has earned an undergraduate degree and completed four years each of medical school and residency training in the medical specialty of anesthesiology. A pediatric anesthesiologist has additional experience or fellowship training in pediatric anesthesiology and may be board certified in both anesthesiology and pediatric anesthesiology. Additionally, many pediatric anesthesiologists also specialize in cardiac anesthesiology, pain medicine, critical care management or neuroanesthesia.

Conditions Treated

  • Twin-to-Twin-Transfusion Syndrome – Twin-to-twin transfusion syndrome occurs when twins share a single placenta and blood is passed from one twin to the other. In severe cases, one twin receives too much blood while the other twin doesn’t receive enough. If left untreated, there is a high likelihood that neither twin will survive.
  • Myelomeningocele – Myelomeningocele, or spina bifida, is an abnormal opening in the baby’s spinal cord. The opening can cause damage to the baby’s spinal cord, leading to multiple neurologic problems.
  • Low Urinary Tract Obstruction (LUTO) – Low urinary tract obstruction (LUTO) occurs when a baby is unable to pass urine and is most common in boys. When this happens, the baby’s kidneys and lungs can be damaged.
  • Hydrothorax – Hydrothorax occurs when fluid builds up in a baby’s chest. The excess fluid can squeeze the heart, causing a baby to become very sick.
  • Congenital Pulmonary Airway Malformation (CPAM) – Congenital pulmonary airway malformations are abnormal growths of lung tissue that can cause recurrent infections or become a tumor. There are many different types of CPAMs, including:
    • Congenital cystic adenomatoid malformation (CCAM)
    • Bronchopulmonary sequestrations (BPS)
    • Bronchial atresia
    • Congenital lobar emphysema
    • Bronchogenic cyst
  • Congenital Diaphragmatic Hernia – Congenital diaphragmatic hernia is an opening in the muscle that separates the chest cavity from the abdominal cavity. The hole allows organs from the abdomen to push into the chest and squeeze the heart and lungs, making it difficult for a baby to breathe when born.
  • Fetal Neck Mass – Fetal neck mass refers to a tumor on a baby’s neck that can block the windpipe. Babies with this condition may require a very special type of delivery known as an EXIT procedure.

Types of Testing

  • Obstetric Ultrasound (Doppler and 3D) – An obstetric ultrasound, often called a sonogram, is a diagnostic procedure that uses high-frequency sound waves to generate images of the fetus. A Doppler ultrasound is able to measure slight changes in sound wave frequency as they bounce off bones and tissue to generate black and white images of the fetus, while a 3-D ultrasound uses specially designed equipment and software to develop three-dimensional images of the fetus.
  • Amniocentesis – Amniocentesis is a diagnostic test to screen for chromosome abnormalities and inherited disorders. A sample of amniotic fluid is collected through an ultrasound guided needle inserted into the amniotic sac. The amniotic fluid is sent to a laboratory for analysis.
  • Non Invasive Prenatal Screening – Pregnant women have access to a variety of tests to determine a baby’s risk of Down syndrome, Trisomy 18 and open neural tube defects. Some newer testing methods involve only a blood test and an ultrasound, which can be done safely early in the pregnancy. These screenings are minimally invasive and do not pose any identifiable risk to the fetus. However, while they predict the likelihood that a particular condition is present, they do not provide definitive answers. For example, a “positive result” would not necessarily mean that a baby has a health problem, but it shows that the baby is at increased risk. Similarly, a “negative” result would not guarantee that no health problem is present. Other testing methods can provide a more definitive answer for the specific condition being investigated. However, these tests may pose a greater risk to the mother and fetus because often they are more invasive.

Treatment Options

  • Fetoscopic Laser Photocoagulation – Fetoscopic laser photocoagulation is a procedure used to treat twin-to-twin transfusion syndrome. A tiny camera is placed into the uterus to help guide a laser that is used to stop blood flow between the two twins.
  • Amnioreduction – Amnioreduction is a procedure that removes excess fluid resulting from conditions such as twin-to-twin transfusion syndrome, where there is too much fluid around a baby. A small needle is passed through the mother’s uterus and the extra amniotic fluid is removed.
  • Fetal Shunt Placement – Shunts are devices that drain fluid. When an unborn baby has fluid collecting in his or her chest, abdomen or bladder, a fetal shunt can be placed to help drain that fluid.
  • Ex utero Intra-partum Therapy (EXIT Procedure) – EXIT Procedure is a specialized mode of delivery where a baby stays connected to its mother through the placenta while a surgical procedure is performed. As soon as the baby’s surgery is complete, he or she is disconnected from the placenta, completing the delivery. This procedure is most commonly used when a baby has a large tumor on his or her neck that will make it difficult to breathe once born.

Referral Indications

  • Open Fetal Surgery – Open fetal surgery occurs where the mother’s uterus is opened so that surgery can be performed on the baby before he or she is born. When he surgery is done, the uterus is closed with the baby still inside to continue developing.
  • Fetoscopy – Fetoscopy is a type of surgery where a small camera is inserted into the uterus so that surgery can be performed on the developing baby. This procedure is most commonly used to treat twin-to-twin transfusion syndrome.
  • Percutaneous Fetal Surgery – Percutaneous fetal surgery is a type of surgery where small needles are passed through a mother’s stomach, into the uterus, to perform procedures on a developing baby. This procedure is often used to remove fluid from the baby or to place shunts.
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