Fetal Neurology Practice Survey: Current Practice and the Future Directions - 05/07/23

Doi : 10.1016/j.pediatrneurol.2023.04.016

Tomo Tarui, MD ^a, Charu Venkatesan, MD, PhD ^b, Dawn Gano, MD, MAS ^c, Monica E. Lemmon, MD ^d, Sarah B. Mulkey, MD, PhD ^e,^f, Andrea C. Pardo, MD ^g, Lisa Emrick, MD ^h, Mark Scher, MD ⁱ, Sonika Agarwal, MBBS, MD ^j,^k,^⁎
^a Division of Pediatric Neurology, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
^b Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
^c Department of Neurology & Pediatrics, University of California San Francisco, San Francisco, California
^d Department of Pediatrics and Population Health Sciences, Duke University School of Medicine
^e Prenatal Pediatrics Institute, Children's National Hospital, Washington, District of Columbia
^f Departments of Neurology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
^g Division of Neurology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago Illinois
^h Department of Pediatrics, Neurology and Developmental Neuroscience, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
ⁱ Emeritus Full Professor Pediatrics and Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
^j Division of Neurology & Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^k Division of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

^∗Communications should be addressed to: Dr. Agarwal; Division of Neurology and Pediatrics; Children's Hospital of Philadelphia; 3401 Civic Center Blvd; Philadelphia, PA 19104.Division of Neurology and PediatricsChildren's Hospital of Philadelphia3401 Civic Center BlvdPhiladelphiaPA19104

Abstract

Background

Fetal neurology is a rapidly evolving field. Consultations aim to diagnose, prognosticate, and coordinate prenatal and perinatal management along with other specialists and counsel expectant parents. Practice parameters and guidelines are limited.

Methods

A 48-question online survey was administered to child neurologists. Questions targeted current care practices and perceived priorities for the field.

Results

Representatives from 43 institutions in the United States responded; 83% had prenatal diagnosis centers, and the majority performed on-site neuroimaging. The earliest gestational age for fetal magnetic resonance imaging was variable. Annual consultations ranged from <20 to >100 patients. Fewer than half (n = 17.40%) were subspecialty trained. Most respondents (n = 39.91%) were interested in participating in a collaborative registry and educational initiatives.

Conclusions

The survey highlights heterogeneity in clinical practice. Large multisite and multidisciplinary collaborations are essential to gather data that inform outcomes for fetuses evaluated across institutions through registries as well as creation of guidelines and educational material.

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Keywords : Fetal, Neurology, Practice, Counseling, Prognostic, Fetal MRI, Outcomes, Brain

Plan

Practicing institutions

Fetal neurology consultants

Neuroimaging modalities

Fetal neurological consultations and diagnoses

Genetic testing

Multidisciplinary meetings

Postnatal follow-up

Future collaborations and education

Discussion

Utilization of fetal brain MRI for prognostication is common practice

Heterogeneity of the fetal neurology practice

Gaps in training and education

Conclusions and future directions

	Conflict of interest and source of funding statement: The authors report no conflict of interest or competing financial interests in relation to the work.
	Funding/support: No funding was secured for this study.
	Clinical trial registration (if any): None.
	Author contributions: Dr. Tarui conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Agarwal conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Dr. Agarwal has final responsibility for the decision to submit the manuscript in its final form. Drs. Agarwal and Tarui have full access to the data. Drs. Venkatesan, Gano, Pardo, Mulkey, Lemmon, Emrick, and Scher conceptualized and designed the study and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Vol 145

P. 74-79 - août 2023 Retour au numéro

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Fetal Neurology Practice Survey: Current Practice and the Future Directions - 05/07/23

Abstract

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