Fetal Cardiac Program Pivots to Adapt to COVID-19 Environment

January 11, 2021

For families expecting a child with a cardiac abnormality, the Fetal and Neonatal Cardiology Program at Lurie Children's offers expert diagnosis, comprehensive counseling and perinatal management.

COVID-19 has required adjustments in how the medical community provides care and is especially challenging for a fetal cardiac program due to the time-sensitive nature and multidisciplinary approach needed to provide the appropriate counseling and care.

“In an increasingly stressful time, expectant families of a child diagnosed with a cardiac issue still deserve seamless access to care,” said Sheetal Patel, MD, MSCI, director of Lurie Children’s Fetal Cardiology Program. “Our team has worked hard to modify our workflow so we can continue to provide our full-scale services.”

Diagnostic Consultation

The team, which includes specialists from Lurie Children’s Heart Center and The Chicago institute for Fetal Health, provides specialized ultrasound imaging of the heart during pregnancy and performs more than 2,000 fetal echocardiograms per year at multiple locations in the Chicagoland area with a diagnostic accuracy that exceeds 95%.

At the beginning of the COVID-19 pandemic, the team worked closely with maternal fetal medicine (MFM) and obstetrician (OB) colleagues to carefully determine which patients needed a fetal echocardiogram. To reduce the risk of COVID-19 exposure for expectant mothers, the fetal cardiac team collaborated with OB and MFM teams to review cardiac images obtained during the level 2 ultrasound. If those limited images were reassuring, an immediate fetal echocardiogram was deferred. However, when confident in safety measures and other risk mitigation techniques, the program gradually opened access to all patients and resumed cardiology consultation based on standard indications and guidelines.

For mothers who are not suspected to have COVID-19 or are asymptomatic, the team follows vigorous safety protocols put in place by the hospital’s Infection Prevention and Control team. With the growing number of cases in the Chicago area and for mothers who have an urgent need for a fetal cardiac evaluation, Lurie Children’s also implemented a High Consequence Infectious Disease (HCID) clinic specific to mothers who are COVID positive. With the help of this clinic, the program is able to fully accommodate any mother who needs to be seen and facilitate fetal echocardiograms and cardiology consultations. This process ensures the patient’s safety as well as the safety of the care team around them, while still providing the necessary diagnostic consultation in a timely manner.

Multidisciplinary Approach  

If significant cardiac abnormalities are identified on prenatal screening, the program typically offers a comprehensive in-person consultation with a multidisciplinary team of experts – often including, but not limited to, a cardiologist, cardiac surgeon, cardiac critical care specialist and neonatologist. The team discusses and coordinates the best treatment plan for the child soon after birth and may review anticipated procedures, expected length of stay and anticipated surgical results.

Other team members are included as needed in the comprehensive consultation unique to each fetal diagnosis, such as specialists from the NICU-Cardiac Neurodevelopmental Program (NCNP): Early Childhood Clinic, Cardiomyopathy and Heart Transplant Program, Electrophysiology Program and other non-cardiac anomaly specialists. Support staff, such as social workers and care coordinators, are also involved to ensure that all aspects of a family’s needs are met.

When in-person consultations became a challenge during the pandemic, the fetal team began incorporating telemedicine into their operations while preserving the multidisciplinary aspect of fetal care. Referring programs started to provide fetal echocardiogram images via Cloud-based services, allowing the Lurie Children’s team to provide virtual consultations to patients both locally and in other states across the country. These telemedicine appointments range from one provider within the program to the full team depending on patient needs. Being able to share fetal images and cardiac diagrams on the screen preserves the ability to use tools that help explain the cardiac diagnosis to parents. A video telemedicine consultation also allows patients to stay within their home environment, reduces risk of exposure to COVID-19 and offers the patient the ability to have other members of their support system nearby.

While consultations previously included an in-person tour of the Regenstein Cardiac Care Unit (CCU), the team now shares a virtual tour so families are still able to become familiar with the facility. The team also provides other video resources for expectant families, including an educational series on breastfeeding children with congenital heart disease and an introduction to the Interstage Home Monitoring Program

Post-Natal Care

To improve the transfer process to Lurie Children’s cardiac care unit for newborns with critical congenital heart disease, the program relies on their “Code Rainbow” initiative to improve the communication between the teams, reduce the overall transfer time, and allow for early preparation for timely cardiac intervention needed for survival of these newborns.

During COVID-19, the team continues to safely offer highly specialized and individualized delivery and transfer plans for each fetus according to their cardiac diagnosis. The program’s partner maternal hospitals perform a COVID-19 test for any mothers admitted for labor and delivery within 72 hours prior to her admission. If the test is negative, the team proceeds with the typical “rainbow” workflow. However, if a mother is COVID-positive and the infant is in need of urgent transfer due to a complex congenital heart defects, the team takes all standard precautions that are required in transferring a patient under investigation for possible COVID-19.

Lurie Children’s Fetal Cardiology Program team provides services at 6 locations around the metropolitan Chicago area. Learn more at luriechildrens.org/fetalcardiology.