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Photo: Charles Manley
Mary D’Alton, left, and Lynn Simpson
Mary D’Alton, left, and Lynn Simpson
Expectant parents often approach their first ultrasound anxious that something might be wrong with their baby.
   When Jennifer Loschiavo was 22 weeks pregnant with her first child, the results of the first ultrasound were grim. “I could tell right away there was something wrong, just by looking at the doctor’s face,” says Rick Loschiavo. “They took us into the back room, told us our son had a hole in his diaphragm and that we should consider terminating the pregnancy. Then they sent us home to do some research. It was a rough night.”
   The next day, the couple learned about the Center for Prenatal Pediatrics at CUMC and NewYork-Presbyterian.
   The center is dedicated to helping families when a significant birth defect has been found prenatally. Spearheaded by Mary D’Alton, M.D., the Willard C. Rappleye Professor of Obstetrics and Gynecology and chair of the Department of Obstetrics and Gynecology, the center has now seen more than 800 patients since it opened less than three years ago. It is the only such comprehensive care center in New York City.
   “Our name says it all,” says Lynn Simpson, M.D., medical director of the center and associate professor of obstetrics and gynecology. “The term prenatal pediatrics illustrates the principle that the care of babies with abnormalities begins during the prenatal period and continues after birth with pediatric follow-up.”
   Providing care for such babies usually requires several kinds of specialists, from maternal fetal medicine obstetricians who treat high-risk pregnancies to neonatologists who take care of the babies immediately after birth, to social workers who help the family cope.
   “The unique thing about Columbia is that specialists in all these disciplines collaborate to give the parents an accurate picture of their baby’s medical condition and create the best management plan,” Dr. D’Alton says. “That’s not the case around the country. Many times patients have to contact a variety of specialists, they get a range of prognoses, and then are left to piece together the information on their own. Here, our specialists work together to create a consistent plan, and that optimizes the experience for the parents.”

Broad Expertise
The successful collaboration of center specialists stems from the support of board members: Dr. D’Alton; Dr. Simpson; Richard Polin, M.D., director of neonatology and professor of pediatrics; Charles Stolar, M.D., the Rudolph N. Schullinger Professor of Surgery and Pediatrics; Charles Kleinman, M.D., professor of clinical pediatrics in obstetrics/gynecology and director, pediatric cardiac imaging; and Ronald Wapner, M.D., director, division of maternal fetal medicine and director, perinatal genetics. The board meets regularly to discuss research opportunities, ongoing projects and to consider ways to build upon the center’s reputation for compassionate care and clinical excellence. In addition, a weekly multidisciplinary case conference enables coordination of these complex cases from the prenatal to the postnatal period.
   Doctors at the center confirmed that the Loschiavos’ baby had a diaphragmatic hernia and that parts of his small intestine had migrated into the chest cavity through this opening. With less space to grow, the lungs could not develop properly. The outcome in these cases largely depends on how much lung tissue is able to form.
   “In the two days from the time of the ultrasound to our appointments at the center, we went from despair to cautious optimism,” Mr. Loschiavo says. “Our baby would need surgery after birth to move his intestines back into his abdomen and to close the hole. But his liver was fine, the heart looked good, and there was a good amount of lung.”
   Babies with diaphragmatic hernia can have a difficult time breathing after birth, and the Loschiavos decided to deliver at Sloane Hospital for Women at New York-Presbyterian Hospital, where CUMC has one of the largest teams of high-risk maternal fetal medicine specialists in the nation. “Babies delivered in our new Labor & Delivery Unit on the top floor of the new Morgan-Stanley Children’s Hospital are cared for in our nationally recognized NICU in the same hospital, instead of enduring a long journey from one institution to another,” says Dr. Simpson. “It makes parents feel very comfortable about the postnatal experience.”
   The Loschiavos’ baby – born in April 2006 – had surgery four days after birth and remained in the hospital for a month struggling to gain weight. Other babies born with diaphragmatic hernias often need more help for their weakened lungs than he did. These infants are placed on a type of heart/lung bypass machine that can take the pressure off the lungs for up to three weeks until they are able to function on their own. The machine, called ECMO (for extracorporeal membrane oxygenation) raises the survival rate for babies with diaphragmatic hernia from 50 percent to 85 percent. New York-Presbyterian/Columbia has the only ECMO in New York City.
   Twenty years ago, diaphragmatic hernias were the most common congenital anomalies seen at Columbia. Now about 50 percent of the center’s cases are heart-related. The most striking example of progress in the treatment of congenital heart anomalies is a condition called
Jennifer and Rick Loschiavo with their 10-month-old son
Jennifer and Rick Loschiavo with their 10-month-old son, Richard, who was successfully treated at the Center for Prenatal Pediatrics for a diaphragmatic hernia.
hypoplastic left heart syndrome, in which the left side of the heart is much smaller than the right. “When we used to see these defects, we considered the condition to be lethal. That’s not the case anymore,” Dr. Simpson says. “In 15 years, we have progressed from giving babies with this problem a dismal prognosis, to one where there is hope for a normal life.”
   Though the outlook for children with many congenital anomalies has greatly improved, “nobody knows what the long-term outcome is for children born with many of these conditions. But this is extremely valuable information for parents in thinking about their children’s futures,” Dr. Simpson says.
   The center currently has projects following patients with certain conditions; its goal is to begin tracking its entire patient population. “When parents want to know the long-term outcomes for children born with diaphragmatic hernia or hypoplastic left heart syndrome, we want them to say, ‘Columbia knows,’” Dr. Simpson says.
   As for 10-month-old Richard Loschiavo – he’s thriving. “He’s in the 25th percentile of weight and the 75th percentile in height. I hope he’s going to be a supermodel,” Mr. Loschiavo says. “I don’t know where we’d be without the doctors and nurses at Columbia and NewYork-Presbyterian. We’re very fortunate and very thankful.”

—Susan Conova

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