A perinatal cardiology network review: The Nemours Children's health system approach in the state of Florida

Background: Congenital heart disease occurs in approximately 1% of all live births and accounts for 30–50% of all infant mortality due to congenital malformations. Infant mortality related to congenital heart disease has significantly decreased over the last 20–30 years due to improvement in surgical procedures, introduction of interventional procedures, and more accurate ultrasonic and advanced imaging diagnostic studies. With the multifactorial improvement in mortality outcomes, it is difficult to demonstrate a survival benefit for infants based on prenatal diagnosis of congenital heart disease alone. However, prenatal diagnosis of congenital heart disease is associated with significant improvement in postnatal morbidity including reduced duration of mechanical ventilation, length of hospital stay, end organ dysfunction, and improvement in neurodevelopmental outcomes. Additionally, there is still considerable variation in mortality outcomes across races and geographical locations within the United States with increased mortality associated with increased distance from top pediatric cardiac surgical centers. Aim of Review: This paper describes a comprehensive perinatal cardiology program model at a stand-alone children's hospital with a referral base that encompasses a large geographical region of the state with variable limitations in access to tertiary care. Key Scientific Concepts of Review: A comprehensive perinatal cardiology program with a multispecialty team of fetal cardiologists, maternal fetal medicine physicians, nurse coordinators, pediatric cardiology subspecialists, and supportive services for patients with wide and diverse community partnerships is an essential component in providing accessible prenatal cardiac care and complex delivery planning regardless of socioeconomic status or geographical location, limiting disparities in care and improving overall outcomes.