Making an Impact

MFM + NICU Two departments collaborate for best outcomes

Jude Mathien, three years old, greets a visitor at his Trumbull, Conn., home with a very important announcement.  “We have a ball that lights up! And two cats! And a rat! And lots of games!” he shouts gleefully, and then races away to produce all these treasures.

His mother, Julia, watches for a moment, then says, “Sometimes I wonder if they have the wrong kid.” Energetic Jude just doesn’t seem like a child with a rare, complicated congenital heart condition.  But he is scampering around today with his sister, Ella, 6, because of the coordination between Yale-New Haven’s Maternal-Fetal Medicine (MFM) department and the Neonatal Intensive Care Unit (NICU) at Yale-New Haven Children’s Hospital.

The story began back in early 2010, when pregnant Julia and husband Chris went for a routine ultrasound at Norwalk Hospital, where they had planned to have their baby delivered. They were directed to the YNHH MFM department, however, when the ultrasound showed that something was wrong with the fetus’s heart. “We were in shock,” says Chris. “Just completely numb.”

Joshua Copel, MD, an attending physician at YNHH and professor of Obstetrics, Gynecology, and Reproductive Sciences and of Pediatrics, Yale School of Medicine, diagnosed tetralogy of Fallot, which involves four heart malformations: a large ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy and an overriding aorta.  He referred the couple to Bevin Weeks, MD, co-director, YNHH Fetal Cardiovascular Center.  “It was amazing how we didn’t have to do a thing.  As soon as we came to YNHH, the staff took over.  They answered all our questions and set up all the appointments. All we had to do was show up,” says Julia.

The MFM department and the NICU worked together to develop a plan for delivery and post natal care. “Fetuses with this particular defect do fine in utero, because they are getting oxygen through the umbilical cord. It’s after they are delivered that the trouble begins,” explains Mark Mercurio, MD, a NICU physician.

“I described what the heart looked like, how we manage those kids pre-operatively, their surgery and how we take care of them post-operatively andthen long-term,” says Dr. Weeks.

On August 2, 2010, Jude’s birth was attended by both MFM and NICU. Jude was whisked away to the NICU, where he remained for six days.  During that time, Dr. Mercurio and Dr. Weeks assessed his oxygen levels and lung function.  “The coordination between MFM and NICU wasseamless,” says Chris.

Julia recalls, “The NICU staff was amazing. We had Ella at home, so we couldn’t stay in the NICU all the time. I would pump milk and the nurses would feed Jude. We could call at 3 a.m. to ask how our baby was doing, and someone would always answer. It was hugely comforting.”  

When the staff was satisfied that Jude would survive on his own until corrective surgery could bedone, he was sent home. Dr. Weeks stayed in close contact to monitor whether Jude was maintaining adequate blood flow to his lungs. Seven weeks later, Jude underwent surgery to repair the defects.

Although Jude will need future surgical procedures as he grows, his prognosis now is bright.  Julia says, “I asked Dr. Weeks point blank, ‘Is my kid going to grow up?’ She answered that she expected Jude to be going to the adult congenital heart defect clinic for routine checkups long after she is retired and firmly planted on a beach.