Paeds · fetal-neonatal-and-perinatal
Antenatally diagnosed fetal conditions: paediatric planning
Also known as Antenatally diagnosed fetal anomaly · Prenatally diagnosed congenital condition · Fetal diagnosis and neonatal planning · Multidisciplinary antenatal planning · Delivery-room planning for fetal anomaly · Place, time and capability of delivery · EXIT procedure planning · Neonatal alert for prenatal diagnosis
Fellowship guide to paediatric planning for the antenatally diagnosed fetus: translating a prenatal diagnosis into a postnatal plan, running the multidisciplinary team, deciding place, time and capability of delivery, anticipating delivery-room resuscitation for ductal-dependent cardiac lesions, congenital diaphragmatic hernia, gastroschisis, omphalocele, congenital pulmonary airway malformation and neural tube defects, planning the EXIT airway strategy, counselling families, and long-term developmental follow-up with regional perinatal-network differences.
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Target exams
Red flags
- A ductal-dependent cardiac lesion delivered at a centre without prostaglandin E1 or cardiac capability
- Mask ventilation of a congenital diaphragmatic hernia that inflates the intrathoracic stomach and worsens respiratory failure
- Gastroschisis bowel left exposed without covering, warmth or surgical alert at birth
- A predicted airway obstruction delivered without an EXIT-capable team briefed and ready
- An antenatal diagnosis with no written neonatal alert that is lost between shifts, sites or clinicians
- Omphalocele managed like gastroschisis, missing its chromosomal and cardiac associations
- A normal karyotype treated as exclusion of all structural or single-gene disease
- A confirmed diagnosis with no named owner, no follow-up booked, and no safety-net before discharge
Life stages
Care settings
Clinical exam formats
Board mappings
- Neonatal medicine
- General and Community Paediatrics
- Paediatric surgery
- Current 2026 PREP curriculum — fetal and neonatal medicine
- Current 2026 PREP curriculum — neonatal cardiology
- Renewed curriculum for first-year trainees from 2027 — essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — communication with patients, families, and health professionals
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- Patient management
- Communication
- Health promotion and illness prevention
- Neonatology: antenatal counselling and the newborn with a prenatally diagnosed condition
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- General Pediatrics Content Outline — Domain related to Neonatology
- General Pediatrics Content Outline — Universal Task 2: Epidemiology and Risk Assessment
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care: antenatal and neonatal transition planning for prenatally diagnosed conditions
- Systems-Based Practice: coordination of care across maternal-fetal medicine, neonatology, paediatric surgery and cardiology
- Interpersonal and Communication Skills: non-directive family-centred counselling
- Medical Expert
- Communicator
- Collaborator
- Pediatrics EPAs related to neonatal transition and antenatal consultation
Overview & Definition
Most antenatal diagnoses arrive on the paediatrician's desk as a referral, a multidisciplinary note, or a phone call from fetal medicine. The family was expecting reassurance and has instead received news that changes the shape of the pregnancy. The obstetric team has made the diagnosis; the paediatrician's distinct role is to convert that diagnosis into a safe, executable postnatal plan. [2]
The single most useful organising idea is place, time and capability of delivery. Place means the centre with the right team present — neonatology, surgery, cardiology, retrieval — not merely the nearest hospital. Time means the gestational age at which delivery gives the best balance between the condition's natural history and the risks of prematurity. Capability means the specific skills and equipment the diagnosis demands, from prostaglandin for a ductal-dependent heart to an EXIT-capable airway team. These three decisions, made together with the family and the obstetric team, are the deliverable of antenatal paediatric planning. [1] [2]
Antenatal planning rests on a simple biological truth: knowing what is coming lets you assemble the right people in the right place at the right time, and for several serious conditions that single advantage changes survival. The catch is that a plan only earns that benefit when it is written, shared, and executed by whoever is on shift when the baby arrives — a plan that lives in one person's head is a plan at risk of being lost. [7] [9]
What you actually do after a diagnosis
- 1
Confirm the diagnosis
Review the fetal medicine report, the imaging and the karyotype. Separate a confirmed structural finding from an uncertain or isolated variant.
- 2
Judge time-criticality
Is this condition dangerous at birth — ductal-dependent, airway-compromising, bowel-exposing — or surveillance-only? The answer sets place and capability.
- 3
Convene the team
Maternal-fetal medicine, neonatology, paediatric surgery, cardiology, genetics and allied health. Decide place, time and capability together.
- 4
Write it down
A written neonatal alert and resuscitation plan that survives shift and site changes. Name an owner.
- 5
Counsel and close the loop
Non-directive family-centred counselling, teach-back, booked follow-up, safety-net. The loop continues after birth with developmental surveillance.
References20ShowHide
- [1]Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation, 2014.PMID 24763516
- [2]Benachi A, Sarnacki S. Prenatal counselling and the role of the paediatric surgeon. Seminars in pediatric surgery, 2014.PMID 25459006
- [3]Lees CC, Romero R, Stampalija T, et al. Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. American journal of obstetrics and gynecology, 2022.PMID 35026129
- [4]American College of Obstetricians and Gynecologists. Fetal Growth Restriction: ACOG Practice Bulletin, Number 227. Obstetrics and gynecology, 2021.PMID 33481528
- [5]McGoldrick E, Stewart F, Parker R, et al. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. The Cochrane database of systematic reviews, 2020.PMID 33368142
- [6]Adzick NS, Thom EA, Spong CY, et al. A randomized trial of prenatal versus postnatal repair of myelomeningocele. The New England journal of medicine, 2011.PMID 21306277
- [7]Snoek KG, Reiss IK, Greenough A, et al. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia. Neonatology, 2016.PMID 27077664
- [8]Holden KI, Rintoul NE, McNamara PJ, et al. Congenital diaphragmatic hernia-associated pulmonary hypertension. Seminars in pediatric surgery, 2024.PMID 39018718
- [9]Bhat V, Moront M, Bhandari V. Gastroschisis: A State-of-the-Art Review. Children (Basel), 2020.PMID 33348575
- [10]Copp AJ, Adzick NS, Chitty LS, et al. Spina bifida. Nature reviews. Disease primers, 2015.PMID 27189655
- [11]Leblanc C, Baron M, Desselas E, et al. Congenital pulmonary airway malformations: state-of-the-art review for paediatricians. European journal of pediatrics, 2017.PMID 29046943
- [12]David M, Lamas-Pinheiro R, Henriques-Coelho T, et al. Prenatal and Postnatal Management of Congenital Pulmonary Airway Malformation. Neonatology, 2016.PMID 27070354
- [13]Farmer DL, Thom EA, Brock JW 3rd, et al. The Management of Myelomeningocele Study: full cohort 30-month pediatric outcomes. American journal of obstetrics and gynecology, 2018.PMID 29246577
- [14]Shepherd ES, Goldsmith S, Doyle LW, et al. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. The Cochrane database of systematic reviews, 2024.PMID 38726883
- [15]Seidler AL, Aberoumand M, Hunter KE, et al. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data network meta-analysis. Lancet, 2023.PMID 37977169
- [16]Dingemann C, Eaton S, Aksnes G, et al. ERNICA Consensus Conference on the Management of Patients with Esophageal Atresia and Tracheoesophageal Fistula: Diagnosis, Preoperative, Operative and Postoperative Management. European journal of pediatric surgery, 2020.PMID 31266084
- [17]Prefumo F, Fichera A, Fratelli N, et al. Fetal anemia: Diagnosis and management. Best practice & research. Clinical obstetrics & gynaecology, 2019.PMID 30718211
- [18]Conner P, Vejde JH, Burgos CM, et al. Accuracy and impact of prenatal diagnosis in infants with omphalocele. Pediatric surgery international, 2018.PMID 29637257
- [19]Tulzer A, Huhta JC, Hochpoechler J, et al. Hypoplastic Left Heart Syndrome: Is There a Role for Fetal Therapy? Frontiers in pediatrics, 2022.PMID 35874565
- [20]Martinez-Biarge M, Jowett VC, Cowan FM, et al. Neurodevelopmental outcome in children with congenital heart disease. Seminars in fetal & neonatal medicine, 2013.PMID 23706956