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Published in CenterView on January 24, 2011

Center gives 'best possible chance' at life

By Jack Mazurak

In fixing heart defects, abdominal wall malformations, tumors and a range of other issues in the youngest of babies, a new multidisciplinary center at UMMC offers in-depth procedures previously unavailable in Mississippi, helping keep patients close to home.

In the year since the University Center for Fetal Medicine's inception, its team members have evaluated and delivered more than 200 babies, many of them with complex birth defects that would otherwise have had to seek care in Cincinnati, Ohio, Philadelphia, Pa., San Francisco, Calif. or other far-flung cities.

"There's nothing more terrifying than being an expectant parent and finding out your baby has something wrong. Unfortunately, many care providers do not have the experience or resources to provide an accurate diagnosis, prognostic information or management options to these families," said Dr. Kenneth Liechty, associate professor of pediatric surgery and center director.

"UMMC and Batson Children's Hospital now offer a multidisciplinary center to provide the highest level of fetal medicine to these patients. Ultimately, we don't want families from Mississippi to have to go outside the state for care."

Fetal medicine staff include, front row from left, Dr. James Bofill, Dr. Jennifer Shores and Dr. Kenneth Liechty, and back row from left, Dr. Christopher Friedrich, Holly Zimmerman, Dr. Rick Boyte, B. J. Mize and Jackie Carrillo.
Fetal medicine staff include, front row from left, Dr. James Bofill, Dr. Jennifer Shores and Dr. Kenneth Liechty, and back row from left, Dr. Christopher Friedrich, Holly Zimmerman, Dr. Rick Boyte, B. J. Mize and Jackie Carrillo.

In 15 percent of pregnancies, the fetus will have something wrong, ranging from a simple skin tag to major developmental disorders that involve multiple organ systems and require surgery and months of intensive care. Some of these patients even require surgery before birth or special delivery procedures.

Sending mothers out of state for highly technical care heaps expense on families, insurers and, when the patient doesn't carry private insurance, the state of Mississippi. Liechty, who came to UMMC in 2009 from Pennsylvania, was a member of the Center for Fetal Diagnosis and Treatment at Children's Hospital of Philadelphia.

"At CHOP I cared for several Mississippi moms who relocated to Philadelphia for care," he said.

The chance to start a center in Mississippi and bring a new level of specialized fetal and neonatal care to the South played heavily into Liechty's decision to move.

"I was a fellow when (CHOP) set up its fetal center and was involved from the beginning. So I learned a lot about how a center for fetal medicine should work."

Some expecting families live hours away and coming to UMMC multiple times for consultation, imaging, diagnosis and discussion of treatments just isn't possible and relocation isn't an option for them.

"In one day they can come here and get an answer rather than being referred to several different specialists on several different days," Liechty said. "The center coordinates these appointments into one day and at one central location.

"Patient access is important because you don't want them driving in three times when they're hours away."

Liechty and the center's other members worked to make the moms' experience smooth and efficient. Much of that relies on B. J. Mize, nurse manager and center coordinator, who organizes visits for each mom. And that's no simple feat, considering the center's reliance on multiple departments, divisions and specialists.

The center's team approach spans perhaps the greatest number of departments and specialists of any UMMC center. The multiple disciplines represented include obstetrics and gynecology, pediatric surgery, pediatric cardiology, the Pediatric Intensive Care Unit, the Neonatal Intensive Care Unit, radiology, social work, maternal-fetal medicine, genetics and genetic counseling.

"Most of the care is postnatal, but when you're a pregnant mom and you hear your baby has a problem, you want to know what options exist," Liechty said.

As the center grows, Liechty plans to offer fetal interventional procedures - operations that can correct abnormalities before the baby is delivered.

When dealing with some of the most difficult issues and high-risk pregnancies, some babies don't make it. It's why palliative care specialists keep a caring hand in the center, too.

"We give them the best possible chance at life. Without the procedures we offer and that level of care, many wouldn't have had a chance at all," Liechty said.

Pediatric cardiologist Dr. Jennifer Shores said the Center for Fetal Medicine centralized the care available in many existing specialties.

"The pieces of the puzzle were there already," she said. "The fetal center helps pull them together under the same roof.

"Bringing together so many specialties and sub-specialties is significant."

Shores, who also trained at CHOP, said the center gives doctors a whole-patient view.

"Because it's multidisciplinary, it allows us to take better care of the patient as a whole. It unifies care for patients," said Shores, director of UMMC's Fetal Heart Program. "I have the input of so many specialists, techs, nurses and physicians, I can give better care than in a vacuum where I'm looking at just the heart."

Personally, through her involvement in the center, Shores is seeing a larger number of patients with multi-organ system involvement as well as congenital heart defects.

"Previously, fetal heart patients would be diagnosed here, born here, then transported elsewhere for surgery," she said. "Now we offer that surgery here with Dr. Jorge Salazar. It's expanded my practice to include more surgical and post operative care of neonates.

"As we move into more of the fetal interventional procedures, I'll be more involved in monitoring and the close follow-up that fetal heart patients need."

Renovations to provide a home for the center in the former antenatal diagnostic unit on the ground floor of the Winfred L. Wiser Hospital for Women and Infants should be complete by March. They include a dedicated entrance, remodeled rooms, new ultrasound and fetal echo-cardiogram machines and two waiting rooms: one for short waits, the other an all-day room.

In its first year, the center's physicians have treated patients from all over central Mississippi. But in the future, Liechty wants to recruit patents from the five surrounding states - including the Florida panhandle - and to add about 50 patients annually, working up to 600-800 patients a year.

Some of the developmental complications the center handles include: