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Introduction: Comprehensive prenatal care of congenital heart disease (CHD) relies on a multi-disciplinary approach that includes timely prenatal counseling and individualized care plans for the pregnancy, delivery and neonatal period. With the COVID-19 pandemic our fetal therapy clinic (FTC) approach to patient care was altered to accommodate restrictions, including the use of telehealth visits. We investigated whether counseling and access to care for fetal patients with CHD was negatively impacted by COVID-19. Hypothesis: Fetuses with CHD would experience a delay in timing of diagnosis and referral; parents would receive a shorter counseling session during the COVID-19 pandemic. Methods: Retrospective chart review of all fetal cardiology patients seen in our multidisciplinary FTC both before (5/1/19-12/31-19) and during the COVID-19 pandemic (5/1/20-12/31/20). Data collected included gestational age (GA) at referral, GA at first fetal echo, use of telehealth, total time counseled, number of sub-specialty consults, and total number of fetal cardiology visits. Results: A comparable number of dyads were seen before and during the pandemic (Table 1). GA at initial diagnosis was similar, but GA at referral and first visit was earlier during the pandemic. Additionally, families seen during the pandemic had longer counselling across all disciplines with significant differences in pediatric cardiology and neonatology. There was no difference in total number of consults or access to care based on insurance. Conclusions: While prenatal counseling and referral to FTC is multifaceted, we demonstrated that COVID-19 and alterations in care delivery did not in fact lead to delays in referrals for patients across a large geographical catchment. Moreover, with telemedicine we were able to ensure our families continued to receive multidisciplinary care and families were able to spend more time with our care team developing comprehensive individualized plans.

Background Moderately premature infants, defined here as those born between 30 0/7 and 34 6/7 weeks gestation, comprise 3.9% of all births in the United States and 32% of all preterm births. While long-term outcomes for these infants are better than for less mature infants, morbidity and mortality are still substantially increased in comparison to infants born at term. There is an added survival benefit resulting from birth at a tertiary neonatal care center, and although many of these infants require tertiary level care, delivery at lower level hospitals and subsequent neonatal transfer are still common. Objective Our primary aim was to determine the impact of maternal characteristics and antenatal medical management on the early neonatal course of the moderately premature infant. The secondary aim was to create a clinical prediction rule to determine which infants require intubation and mechanical ventilation in the first 24 hours of life. Such a prediction rule could inform the decision to transfer maternal-fetal patients prior to delivery to a facility with a Level III Neonatal Intensive Care Unit (NICU), where optimal care could be provided without the requirement for a neonatal transfer. Methods Data for this analysis came from the cohort of infants in the Moderately Premature Infant Project (MPIP) database, a multi-center cohort study of 850 infants born at gestational age 30 0/7 to 34 6/7 weeks, who were discharged home alive. We built a logistic regression model to identify maternal characteristics associated with need for tertiary care, as measured by administration of surfactant. Using statistically significant covariates from this model, we then created a numerical decision rule to predict need for tertiary care. Results In multivariate modeling, 4 factors were associated with reduction in the need for tertiary care, including, surfactant administration, including non-White race (OR=0.5, [0.3, 0.7], older gestational age, female gender (OR=0.6 [0.4, 0.8]) and use of antenatal corticosteroids (OR=0.5, [0.3, 0.8]). The clinical prediction rule to discriminate between infants who received surfactant, versus those who did not, had an area under the curve of 0.77 [0.73, 0.8]. Conclusions Four antenatal risk factors are associated with a requirement for Level III NICU care as defined by the need for surfactant administration. Future analyses will examine a broader spectrum of antenatal characteristics and revalidate the prediction rule in an independent cohort.