Q: Many consider you a leader in fetal surgery, nationally and globally. What drew you to Connecticut Children’s? Why open a fetal care center in Hartford, CT, and why now?
A: There were several factors.
First, Connecticut Children’s offers excellent subspecialty care not only in fetal surgery, but in maternal fetal medicine, neonatology, pediatric radiology, genetics, and multiple pediatric surgical subspecialties. These are all required to provide comprehensive prenatal evaluation and postnatal care for expectant moms with high-risk pregnancies.
We are committed to work in an integrated fashion to provide supportive care for both mom and baby while addressing among the most challenging of fetal problems. All of these components are built into the Fetal Care Center at Connecticut Children’s.
Second is our institutional commitment to expanding and innovating. This can be seen in the building of a new patient tower at Connecticut Children’s, the third floor of which will be dedicated to the Fetal Care Center once construction is complete.
Finally, we are grateful to have all the required components to build a full-fledged, comprehensive fetal care center; we recognize that not every tertiary or quaternary children’s hospital has this opportunity.
Q: Why is it sometimes better to operate on a baby before it is born?
A: Babies are the most vulnerable of patients. It is always preferable to treat babies after they are born, but the reality is many of the unborn babies I treat are diagnosed with life-threatening conditions—in the womb. By the time they are born, care and treatment become extremely difficult, if at all possible. Often, there can be ongoing organ injury or developmental abnormalities which are no longer fixable.
We want families to have the best possible outcomes and their babies to lead healthy, fulfilling lives. When you operate on a baby in the womb, you’re changing the course of the condition to prevent the baby dying in utero or developing irreversible complications from that condition. We no longer see the uterus as a barrier to treating the unborn patient, but rather the world’s best incubator that allows the baby to heal and develop more normally once they have been treated.
Q: How do you work with families who are facing the uncertainty that comes with a high-risk pregnancy?
A: Everyone involved in the Fetal Care Center appreciates how stressful being diagnosed with a fetal anomaly can be. The best way of helping these families is to help them understand the condition, what effect it can have on the baby’s development and the options to treat the condition either before or after they are born. Often, this approach provides the family comfort and a sense of control of events in an otherwise frightening situation.
Before any surgery or intervention, we sit down with the parents and explain what their baby is facing, the risks, and the options for the paths forward for the most positive outcome possible—from pregnancy through delivery, and beyond.
Our families, however, have done their research on their babies’ conditions and are very well informed, so oftentimes they then enter what may feel like a period of grief and we can help them in coming to terms with the challenges their baby may be facing. Families need and deserve the care and support a place like Connecticut Children’s offers, and we’re pleased to meet those needs the best we can.
>Related: Experts You May Meet if You Have a High-Risk Pregnancy
Q: What makes the Fetal Care Center at Connecticut Children’s different than other fetal care centers across the nation?
A: Something unique offered at the Fetal Care Center at Connecticut Children’s is a comprehensive, customized, integrated one-day evaluation with a full panel of experts—all at one location. My colleagues and I want to make the experience as easy as possible to help families fully understand their baby’s condition and having all of their questions addressed.
Additionally, moms who need fetal surgery can expect the expertise of a team who only focuses on fetal and neonatal surgery. We call this vertically integrated care: from the time of prenatal diagnosis, throughout pregnancy, at the delivery, through the NICU course and long-term follow up, the same team continues to care for you and your baby. I truly believe this team approach leads to better outcomes.
Q: Please tell us a bit more about the comprehensive, one-day evaluation at the Fetal Care Center at Connecticut Children’s. What can families expect?
A: Every patient is unique, so this can vary, but here’s an example:
Upon arrival, moms are greeted by their personal Fetal Care Coordinator—who will be their main source of support and a liaison, not only throughout their time here, but for the remainder of the pregnancy and after delivery.
The first priority is examining the baby in order to fully understand the problem. We examine fetal patients through the use of ultrasound, fetal echocardiograms and fetal MRI. We often learn different aspects of the baby’s condition from each imaging modality and obtain a more comprehensive understanding by integrating the findings.
All of the imaging is reviewed by the entire team of subspecialists which at a minimum includes fetal surgery, maternal fetal medicine, neonatology, radiology, and other pediatric subspecialists as indicated by the baby’s condition. This team then synthesizes the assessment of the baby’s condition and explains the specific fetal diagnosis, the implications for the pregnancy, treatment options before and after delivery, anticipated neonatal course and long-term prognosis.
Q: Fast-forward 5, 10, maybe 15 years. What do you envision for the future of fetal care?
A: I believe that we will see continued expansion of the indications for fetal intervention with new approaches to curing genetic conditions before birth with fetal cellular therapy and fetal gene therapy. We are working on placenta gene therapy to treat severe fetal growth restriction (IUGR) a leading cause of perinatal morbidity and mortality.
Q: What’s the most rewarding part of your job?
A: I often hear from parents and their kids who are now going off to college—and whom I operated on 20 years ago. It’s rewarding to see these lives blossom when life might not have been possible. The greatest satisfaction of my career is the privilege of having touched the lives of these families.
Q: What does Beyond Imagination mean to you?
A: As George Bernard Shaw said, “Some men see the world as it is and ask why, I see the world as it might be and ask why not?”
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Meet Dr. Crombleholme
The Fetal Care Center at Connecticut Children’s is led by Timothy M. Crombleholme, MD, one of the world’s most experienced fetal surgeons. Dr. Crombleholme is a pioneer in fetal surgery with decades of experience in fetoscopic surgery, open fetal surgery, image-guided fetal intervention, and EXIT procedures.
Dr. Crombleholme is a nationally recognized authority in the treatment of congenital diaphragmatic hernia (CDH), myelomeningocele (MMC), twin-twin transfusion syndrome (TTTS), congenital pulmonary airway malformation (CPAM) and sacrococcygeal teratoma (SCT), among many others.
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