Expanding Care for Infants with Neurologic Injury

The need for early intervention is critical when newborns experience a brain injury or are born with a congenital neurologic condition. At Cincinnati Children’s, fetal and neonatal neurologists collaborate with specialists throughout the medical center to diagnose and treat these conditions as early as possible in the child’s life.

The neonatal neurology program recently expanded from three specialists to four – the physician team now includes Mark Schapiro, MD, Cameron Thomas, MD, MS, Marissa Vawter-Lee, MD and Charu Venkatesan, MD, PhD. These fetal and neonatal neurologists provide consultation services for the acute management of neurological disorders at the Cincinnati Children’s newborn intensive care unit (NICU) and the city of Cincinnati’s two other Level III NICUs. In addition, they provide off-site neonatal consultation and electroencephalogram monitoring for a Level III NICU in Dayton. This telemedicine program, established in 2015, is one of the first of its kind in the United States.

The physicians also are part of the prenatal evaluation team at the Cincinnati Fetal Center at Cincinnati Children’s. Continuing advancements in sequencing technology for fetal magnetic resonance imaging provide increasingly detailed analysis and allow greater diagnostic certainty at earlier gestational ages. As a result, physicians can more often offer accurate diagnostic and prognostic information regarding neurologic conditions during pregnancy, rather than discovering them after delivery.

Long-term follow up for neurologic concerns The fetal and neonatal neurology team saw over 900 patients in outpatient clinics last year, an increase of 30 percent compared to the year before. These clinics include:

• A neonatal neurology clinic, where the specialists provide follow-up after a fetal consultation, and long-term follow up for babies who were discharged from the NICU and need care for neurological problems (not other complex medical issues).
• A multidisciplinary clinic for infants with a clinical concern for seizures after discharge from a NICU. Most of these infants experienced hypoxic brain injury perinatally and were treated with therapeutic hypothermia; others have unexplained encephalopathy. This clinic provides comprehensive follow-up care from a team that includes a fetal and neonatal neurologist, neonatologist, speech therapist, occupational therapist, registered dietitian and social worker. By providing consistent care over the long term, the team is able to identify risk factors for poor neurologic development and areas where targeted interventions may improve patient outcomes.

Clinic appointments are available at the hospital’s main campus, Liberty campus (located between Cincinnati and Dayton) and two satellite locations. Most often, by the age of three, patients are transitioned to general neurology clinics for long-term care.

The physician team also participates in clinical research to improve outcomes for children born with neurologic deficits. “Several of our studies involves looking at specific diagnostic findings on fetal imaging and finding ways to screen those populations for developmental outcomes,” Thomas says. “Also, we recently joined a multisite, Patient-Centered Outcomes Research Institute-funded national study looking at patients who had neonatal seizures. The goal is to see whether we can stratify their future risk of epilepsy, anticipate developmental outcomes and better understand how the child’s condition affects the family.”

2018 Neurosurgery Conference for Advanced Practice Providers

The Cincinnati Children's Division of Neurosurgery will host its fifth annual Advanced Practice Provider Neurosurgery Conference April 19-20, 2018, at the medical center. The conference will feature presentations by faculty and advanced practice providers, who will share cutting-edge practices within pediatric neurosurgery.

To learn more, contact Allie.Mains@cchmc.org.