Well, I returned from my Labor Day break to a very hectic day on Labor and Delivery and a bevy of great questions and comments from our readers. So many of these touch on important issues of general concern that it is worthwhile presenting them as a post so that other readers can benefit from the responses...
I had a late preterm baby almost 4 months ago now. It was my first pregnancy, I was over 35, and developed high blood pressure. I don't think I realized the seriousness of delivering at 35 weeks until it was all over....believe me, I did not want to go early, but everything happened so quickly that I was stunned. My daughter was in the NICU in a major US hospital for 5 weeks, and came home on her due date...we still have cardiac and respiratory issues that we need to follow up on for her, but she appears to be a happy and relatively healthy 4 month old now.
She has doubled her weight since she has come home with us. I am afraid to see the costs associated with her NICU stay-it is scary to see hom many children enter the world and spend their first days weeks or months in a NICU. The census in the NICU our daughter was in hit 60 for weeks at a time. I am grateful that the technology exists to help our children, but also troubled by the number of newborns that need it.
To Anonymous Aug 31: Thank you for sharing your story. I know that you did not expect a response, but I also know many other readers will benefit from your comments and, perhaps, learn from your experience. It is hard enough when someone needs to be delivered early, as was your case, and still has a baby with complications of prematurity. But, we need to be super vigilant as patients and providers that we don't place a baby in the NICU as the result of a delivery that was unnecessary, performed early by miscaclculation of gestational age, or done for convenience as are at least 30% of 'late preterm' births. It is very important to understand that not all babies born at 34-38 weeks will do just fine. I am glad your daughter graduated from the NICU successfully (just having to stay that long in the hospital is a risky proposition in this day and age!)and I certainly hope she does well in the long-term. Again, thanks for reading and for sharing. Dr T
Anonymous has left a new comment on your post "Fetal Cystic Hygromas in First Trimester": Dr, My husband and I went for an NT scan yesteday in Boston. The ultrasound tech and the doctor both measured out 7mm of fluid in our baby's neck. We met with the genetic counselor, and she informed us that based on everything, we have a 50% chance of there being a chromosomal issue, and 50% of there being nothing wrong. The heart has been strong since my first ultrasound at 8 weeks, and the doctor remarked at how the heart seemed to be functioning properly. I am scheduled for a CVS on Tuesday. I guess my question is - have there been children who have been diagnosed with an excess amount of fluid on the neck, and have gone on to be delivered healthy with no issues? I know the risks and I know that it's hard to be certain. My husband and I are trying to deal with this as honestly as possible, and we know what we will do if the prognosis from the CVS proves to be dire. Thanks! Jessica
To Jessica Sept 1: Did you have the NT done for any special reason, i.e., maternal age or previous pregnancy or family history of chromosomal problems, or simply as a routine study? Unfortunately, you do have at least a 50% chance of a baby with a chromosomal problem and/or a congenital heart abnormality. The prognosis for either of these problems will depend on the final diagnoses.
I am glad you are having the CVS done. That will answer the chromosomal question in most instances. However, even if this returns normal, your doctors might recommend that the baby have another study done during pregnancy or after birth to evaluate the possibility of mosaicism (two or more populations of cells, some chromosomally normal and some not. This will be especially important if any physical abnormalities are found. Also, the baby should have a very careful evaluation of its heart by 18-20 weeks, preferably, by a specialist in Maternal-Fetal Medicine, Pediatric Cardiology, or Radiology who has experience with the in utero diagnosis of congenital heart defects. The risk of a baby with a heart defect under these circumstances is proportional to the degree of NT width.
But the final answer to your question is this: YES, some babies with widened nuchal translucencies in first trimester end up being perfectly normal and with no apparent consequence of their 'abnormal' NT measurement. So, best of luck to you and your husband! Thanks for reading and please let me know how things turn out. I will be pulling for you guys - all three of you. Dr T