Summarize clinical characteristics, correlation of prenatal and postnatal diagnosis, and postnatal outcomes of patients referred to determine how fetal neurology consultation can influence neonatal care.

Fetal neurology consultations are limited to tertiary care centers that have resources available to evaluate this unique patient population. As more centers are developing their fetal-neonatal collaborative programs, there is limited information available that describes the experiences learned from preceding institutions and their impact on perinatal outcomes.

We performed retrospective electronic chart review of fetal consults from April 2009 to August 2019 at Nationwide Children’s Hospital. Maternal-fetal pairs were examined for their demographics and other available data, disposition after delivery, interventions, and follow-up neonatal recommendations.

Of the 174 maternal-fetal neurology consults placed, 125 were completed. The median gestational age (GA) at prenatal MRI was 26.7 weeks prior to a referral at 26.5 weeks. Average GA at consultation was 30.7 weeks. Of the 126 anticipated fetuses, 5 experienced fetal demise, 7 underwent elective termination, and 10 died postnatally. The majority were admitted to the neonatal intensive care unit (NICU), however only 31% required supportive intervention for feeding, breathing, or hydrocephalus at discharge. Ten neonates had seizures during their NICU stay.  

Accuracy of prenatal diagnoses was analyzed on the 95 babies that had a pre- and postnatal MRI brain with an overall 69% agreement (Cohen’s kappa: 0.62, 95% CI: 0.5, 0.73). The most common prenatal malformations involved midline anomalies (39%), posterior fossa abnormalities (21%), and ventriculomegaly (14%). In comparison, postnatal imaging revealed the most common malformations involved midline anomalies (32%), posterior fossa (17%), and neuronal migration disorder (14%). Fetal consult recommendations for postnatal studies were followed in most patients (66%). 

Establishing a multidisciplinary fetal clinic can provide timely counseling to families and curate a standardized protocol for efficient management of the fetus and neonate.