Dr. Mark Lewin is division chief of Cardiology, co-director of the Heart Center and director of the Fetal Care and Treatment Center at Seattle Children’s, and chief of Pediatric Cardiology at the University of Washington School of Medicine.

Dr. Bettina Paek and Dr. Martin Walker are co-directors of the new Maternal Fetal Intervention and Surgery Program at Seattle Children’s Fetal Care and Treatment Center. They previously worked together for 16 years in private practice at Eastside Maternal Fetal Medicine at Evergreen Health.

On October 1, Seattle Children’s opened its expanded Fetal Care and Treatment Center. With the addition of Seattle Children’s Maternal Fetal Intervention and Surgery Program, we now offer the only fetal intervention and surgery program in the Pacific Northwest, as well as advanced diagnostic and testing options, dedicated care coordination, the most comprehensive pediatric medical and surgical experts in the region and robust support services. Learn more.

What new developments in fetal therapy can we expect soon at Seattle Children’s?

Dr. Lewin: Having Drs. Paek and Walker here to provide fetal intervention and surgery is a major expansion for us. It opens the door to all kinds of prenatal treatments. We can now offer fetoscopic interventions that are minimally invasive. They allow us to treat some potentially devastating vascular anomalies in twins and a number of conditions that affect individual fetuses, including issues with anemia, bladder malformations and excessive amniotic fluid that can adversely affect the fetus and even cause a newborn to be very ill or die.

Within 6 to 24 months we will offer new procedures that are not now available in the Pacific Northwest. This includes minimally invasive surgery on a fetus with spina bifida (myelomeningocele repair). This is an evolving procedure with long-term implications that aren’t yet known, but we have great hope that their neurodevelopment will be positively impacted.

We’re also planning to offer prenatal repair of congenital diaphragmatic hernia (CDH), a condition with potentially devastating consequences for newborns and young children. The procedure is still being developed and trialed in a number of centers in terms of what technique to use, and we expect one of these techniques will emerge as the safest and most effective. The leader of our CDH program, Dr. Rebecca Stark, is working closely with Drs. Paek and Walker to offer this prenatal treatment.

Where is fetal therapy research headed?

Dr. Lewin: There is research happening on many fronts, and we expect this field will grow quickly, with our new Center at the heart of it.

The question we are asking is: How can we look at foundational research in a lab that can be used as a stepping stone to patient-oriented interventional procedures? We’re just beginning to develop the collaboration and improve the communication between the patient caregivers and clinicians with the people who can actually study those disease processes at the bench.

We will not only leverage who we have here now and work with scientists at UW and other institutions, but we’ll also recruit and hire additional research scientists at Seattle Children’s for that purpose.

Beyond that, we are also hopeful that certain strengths we have as an institution can be leveraged, i.e., our incredible skillset around genetic medicine and stem cell therapy that will help modify diseases that are caused by mutations of the genome.

What excites you most about the Center?

Dr. Lewin: As a cardiologist, I’m especially enthusiastic about the prospect of offering fetal intervention to help children live better lives who have Duchenne muscular dystrophy (DMD). These are boys who reach the age of 12 to 14 and become wheelchair bound because of muscle weakness that also affects their heart. Our researchers are working on stem cell changes that will modify that process. There are a variety of other disease processes we can attack in similar ways. Once you go down that road, obviously you need a strong research infrastructure, which is what we are building toward.

I should mention we just recruited a cardiologist, Dr. Connie Choi, from Boston Children’s who is trained in fetal cardiac intervention. We’ll start doing prenatal cardiac procedures in the next few years.

Dr. Walker: I’m excited about how the Center will benefit families for generations to come. When Dr. Paek and I were in private practice at Evergreen, a lot of things went right to help us grow that practice: having an amazing team to work with, great support from Eastside Maternal Fetal Medicine and Evergreen Hospital and essentially no competition. But we could only grow so far. We feel a real responsibility to make sure there are great people coming up behind us, by attracting and training the next generation of fetal therapists at Seattle Children’s.

Dr. Paek: My hope is that families will come to us and feel they’ve been embraced by a world-class institution and a caring, compassionate mom-and-pop shop combined. That’s my vision for our families.

How will the experience of families be even better with the expanded Center?

Dr. Lewin: Families will find they are receiving care from a system that integrates fetal care with other key specialty services, and a care team that’s much broader than they would have had with just us or just Drs. Walker and Paek previously. They will have easy access to specialties like cardiology and genetic medicine, with wraparound care from social work and family support teams. And that continues after birth. It’s a holistic model of care that provides their child with comprehensive care over their whole life, from prenatal to newborn to toddler and up.

Dr. Paek: Our previous practice was known for its warmth and compassion. Our amazing team — who came with us to Seattle Children’s — was key to creating that environment. Seattle Children’s family-centered model of care is a good fit for us. Families will get the very best in care.

Are there other options for fetal surgery elsewhere in our region?

Dr. Lewin: There is no other hospital in the Pacific Northwest that offers fetal care and treatment with the depth of expertise we have. Drs. Paek and Walker are highly skilled, experienced, internationally known doctors who can handle any sort of complex case, today.

Is telehealth offered?

Dr. Lewin: Yes. We recognize that we cover a gigantic region of the country. Not all families can easily travel here. We will have a robust telehealth service for family consultation, patient care and second opinions.

What is your main message to OBs, MFM doctors and radiologists?

Dr. Paek: “Pick up the phone!” Don’t hesitate. There’s no such thing as an irritating phone call. Referring providers can call us directly day or night to talk about their patient and get them seen right away — the same day or next day.

Dr. Walker: Ditto on calling us any time. Families don’t need a referral to get scheduled; we will get them right in.

Most of our readers are PCPs. What’s your main takeaway for them?

Dr. Lewin: Over the next era, as our program grows, PCPs will see a patient population with less morbidity associated with their diseases than before, whether it’s cardiac disease, lung disease, neurological disease or potentially a genetic disorder. Kids will still have these conditions, but they’ll be healthier because of procedures they had prenatally. That’s our goal, our dream and what we believe we can deliver over the next three years.

Will you keep us updated on innovations in fetal therapy?

Dr. Paek: Our hope is to host regular webinars in 2022 to share the latest in fetal care and treatment and address urgent issues. For the latter, for example, there is a general lack of understanding about treatment options for monochorionic (shared placenta) twins that we’d like to do education around. We know based on statistics and our region’s population size that we are only seeing half the pregnancies where there is twin to twin transfusion syndrome (TTTS). That means the other half are not getting help, likely resulting in at least one of the twins dying or miscarrying. Educating around this with referring providers can make a huge difference.

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