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You are a neonatologist in a small rural hospital with a newborn nursery. The nearest hospital with a NICU is 50 miles away. The nearest tertiary care hospital, with all pediatric surgeries and subspecialties is 100 miles away. An obstetrician wants your advice about the delivery plan for a patient whose fetal echocardiogram is shown in the Video. The family is planning a home birth and would like “everything to be done” for their baby. What is the best advice to give this family?
A. Deliver at home as planned because the fetus has a structurally normal heart
B. Deliver in the local hospital and transition with the mother in the nursery
C. Deliver in the nearest hospital with a NICU so that the neonate could be placed on telemetry
D. Deliver in the nearest hospital with a NICU and perform echocardiography before discharge
E. Refer to the nearest tertiary center with plans to deliver the neonate at that institution
Click here to view the video. The video clip shows a four-chamber view of a fetal heart illustrating a severely underdeveloped left ventricle, which is most consistent with hypoplastic left heart syndrome (HLHS).
The patient goes into labor and delivers the infant at your hospital. Immediately after delivery, the neonate is given …
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