April 8, 2014

Dear Texas Children’s Family:

Each year, we have the special opportunity to thank our truly remarkable volunteers for their dedication to Texas Children’s during National Volunteer Week – Sunday, April 6 through Saturday, April 12.

Our people define Texas Children’s. Our patients and families measure their experience by the clinical care we provide, the extra moments we take to care for their needs beyond the bedside, and the special attention we provide that assures them that their child is our child.

Each and every day, our volunteers honor Texas Children’s Hospital and our patients and families with the gift of their time. It has been often said that someone who gives you their time, gives you part of their life. In this way, our volunteers share their time, talent, and love to improve the lives and experiences of patients, families, and staff of Texas Children’s in ways only they can.

The Auxiliary to Texas Children’s Hospital, an organization founded even before the hospital opened its doors on February 1, 1954, has chronicled the history of our institution. Over the past year, 1,668 Auxiliary volunteers, equivalent to more than 45 full-time employees, focused solely and directly on the needs of our patients, families and staff.

Texas Children’s is also extremely proud to be the home of community-wide service organizations such as Ronald McDonald House, The Junior League of Houston, and The Blue Bird Circle, among many others. Collectively, these groups accounted for an additional 703 volunteers at Texas Children’s in 2013. We are indebted to these and all organizations that enhance our mission through their generosity and kindness.

A smile found, a hand held, a craft created, a need attended, a song sung, a heart guided – these are the differences of the 2,400 active volunteers across Texas Children’s system. These are the differences that can only be made by our amazing and beloved volunteers.

This remarkable asset and these partnerships are to be cherished, supported, and cultivated. Please join us in thanking our volunteers this week and every week, as they selflessly act in support of Texas Children’s mission every day.

Sincerely,

Michael T. Walsh, Jr.
Director, Texas Children’s Volunteer Services

April 1, 2014

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Dr. Mark Kline sits in his office checking his watch. At one minute before 1 p.m. on March 20th he’s feeling anxious. At exactly 1 p.m. is the moment he will find out the group of residents matched to Texas Children’s and Baylor College of Medicine’s residency programs. It’s that moment when the leader of each program across the country is able to log in to a website where their matches are revealed. The residency programs affiliated with Texas Children’s include a categorical pediatric residency program, a pediatric global health program, the surgery residency as well as the residency in obstetrics and gynecology. For Dr. Kline and the other leaders involved, this is the culmination of months of interviewing.

“I meet with every hopeful resident who visits us to tell them about our organization and what it means to be here,” said Kline. “What I’m looking for is people who are not just smart but nice. I don’t need them to be nice to me, everyone is nice to me, I want them to be nice to people who have no power over their position here.”

Kline calls it “accessible brilliance.” A phrase he uses often when referring to recruitment at all levels. Whether it’s residents or chiefs of service, it’s a quality that exemplifies the Texas Children’s brand. Today, it’s the residents who have matched to the institution and will be bringing that accessible brilliance to an organization which touches about 8,500 patients daily.

When he’s finally given the list, Kline and his chief residents compare the matches to the list of top candidates who were interviewed. Each year, Texas Children’s interviews hundreds of hopeful residents, when the interviews are over, the organization is given a chance to pick candidates and rank them on a list. The residents are given the same opportunity to pick their top programs ranked similarly. Each student is then matched to the institution that is highest on the list and has ranked them on the top of theirs. It’s highly competitive between the top children’s hospitals across the nation.

What attracts residents here is not just the breath and depth of cases they will be able to see, it’s the leaders who become their mentors throughout their years here.

On March 21st, less than 24 hours after residency program directors have been informed of their residents, it’s the medical students’ turn to count down to their own matches. Baylor College of Medicine hosted a Match Day 2014 brunch for the students and their families as they celebrated this momentous day in their journeys to becoming doctors. Residents gathered in the Baylor courtyard anxiously pacing about as they waited for 11 a.m. A 10 second countdown led to the class president ripping open a paper-covered board where each student found an envelope with their names; inside, a letter congratulating them on their match with the name of the program where they will be spending the next few years as residents.

Loud cheers, some tears of joy and lots of hugging and the residents were finally able to celebrate their accomplishments. A day they’ve awaited for years. A day where they could find out they have been matched to programs like those at Texas Children’s and Baylor College of Medicine.

“The better talent that we can attract at this level right out of medical school, the better we will be 5 years, 10 years, 15 years down the line,” said Kline.

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On February 23, 2012, the Fetal Center announced the birth of baby Charlotte, the first baby at Texas Children’s to receive in-utero surgery to treat spina bifida. Now, a little more than two years later, the center is celebrating another milestone with 20 cases completed.

After years of treating spina bifida by a neurosurgical closure of the spine defect during the first days of life, research breakthroughs prompted the Texas Children’s Fetal Center team to begin performing in-utero surgery on patients with a prenatal diagnosis of spina bifida.

Myelomeningocele, also known as spina bifida or open neural tube defect (NTD), is a developmental defect in which the spine is improperly formed and the spinal cord is open to and fused with the skin; it is usually associated with hydrocephalus, which requires surgical treatment to drain the fluid via a shunt. Myelomeningocele occurs in 3.4 out of every 10,000 live births in the U.S. and is the most common permanently disabling birth defect for which there is no known cure.

Advancements in fetal imaging and early prenatal diagnosis allow the team to gain access to a fetus while still inside a mother’s womb. Texas Children’s Fetal Center has developed extensive screening and diagnostic algorithms for pregnancies with fetal spina bifida. These algorithms determine which patients are appropriate candidates for the in-utero surgery.

The surgery is a huge, multi-disciplinary effort, bringing together a team of specialized experts, who all play a vital role in the medical treatment of both mom and baby. The team includes maternal-fetal specialists, led by Dr. Michael Belfort, fetal surgeons, led by Dr. Darrell Cass and Dr. Oluyinka Olutoye, and a neurosurgery team, led by Dr. William Whitehead. Once the fetus is exposed, Dr. Whitehead and his team surgically close the spinal defect before fetal surgeons return the baby to the womb. This procedure reduces the risk of hydrocephalus and may improve motor function in select patients.

A NICHD-funded study entitled the Management of Myelomeningocele Study (MOMS) published in the New England Journal of Medicine demonstrated a significant decrease in the risk of hydrocephalus for select patients undergoing fetal closure of the spine, as well as possible improvement in lower extremity function, compared to patients who underwent standard closure after birth. The MOMS trial is the second fetal intervention that has proved beneficial through a multi-center randomized clinical trial. The first was the Euro FETUS trial for laser ablation in the treatment of twin-to-twin transfusion syndrome (TTTS).

“Breakthrough studies like the MOMS trial are exciting and reaffirm our commitment to advancing fetal medicine and giving babies with complications and anomalies the healthiest possible start to life,” said Dr. Darrell Cass, co-director of Texas Children’s Fetal Center. “Our program has grown exponentially since we completed our first NTD repair in 2012, and we remain cautious, but it seems as though our center’s results are exceeding even those of the trial.”

The final piece to this puzzle is Dr. Kathryn Ostermaier, clinic chief of the Spina Bifida Clinic. It is under her guidance that the hospital provides long term care to surgical patients. The hospital’s Spina Bifida Clinic is a specialized program that serves only those patients with spina bifida, and includes several specialty services: orthopedics, neurosurgery, pediatrics, physical medicine and rehabilitation and urology.

The team that cares for NTD patients before birth, after birth and into childhood includes physicians from maternal fetal medicine, pediatric surgery, neurosurgery, anesthesiology, neonatology, pediatric radiology, cardiology, orthopedics, urology, physical therapy, and a highly dedicated group of specialized nurses, ultrasound technologists and genetic counselors.

“The confirmation that fetal surgery may decrease the physical challenges some of these babies face is not only a ray of hope for families, it is also a significant achievement for fetal medicine,” said Cass.

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Intestinal worm infections rank among the most common afflictions of people living in extreme poverty, with reports of more than 800 million people who are harboring Ascaris roundworms in their gastrointestinal tract, and approximately 450 million people who are infected with either hookworms or Trichuris whipworms. These numbers suggest that almost every person living in a developing country is infected with worms, a consequence of the fact that the infective egg or larval stages of these parasites are practically ubiquitous in the soil.

“Each type of worm brings its own little shop of horrors,” said Peter Hotez, President of the Sabin Vaccine Institute and Texas Children’s Hospital Endowed Chair in Tropical Pediatrics.

While the World Health Organization (WHO) is leading a global campaign to “deworm” via mass drug administration at schools, Texas Children’s Hospital is pioneering the development of new worm vaccines.

According to Hotez, one of the problems with deworming is rapid post-treatment reinfection. There also is information to suggest that while the drugs work well on some worms, others such as hookworm and Trichuris whipwork are more resistant. And while deworming is one of the world’s largest global public health programs, so far less than 40 percent of the world’s children who could benefit from deworming actually receive the medicines.

“There is a lot of work to do,” said Hotez. “Global deworming needs to continue to scale-up and expand. We also need research into better drugs and vaccines, especially for hookworm.”

The Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development have been working to do just that. The hookworm vaccine they developed is now in clinical trials in Brazil, and will soon enter clinical testing in Gabon. And a schistosomiasis vaccine is about to undergo phase 1 trials for safety and immunogenicity here in Texas. They are also pursuing the possibility of a vaccine that could target all of the intestinal worms.

Worms can result in severe health consequences for growing children and, in the case of hookworms, also for pregnant women. Recently, the Global Burden of Disease Study that evaluated almost all disease conditions for the year 2010 determined that intestinal worms cause as much or more global disability than better known childhood conditions such as autism, ADHD, or cleft-lip and palate. Hookworms accounted for more than two-thirds of that disability. There have also been occurrences of some unique worm infections here in Texas, including toxocariasis and cysticercosis, which is associated with epilepsy and other brain disorders. It’s important to be aware of these diseases and spread word about their dangers, in order to raise awareness and funding to fight intestinal worm infections in developing countries and at home.

“Worm vaccines would represent important new global health technologies in order to improve the health and vigor of children in the world’s poorest countries,” said Hotez. “A world free of worms would be one in which children achieve their full physical, intellectual and economic potential.”

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We are looking back to the 1960’s this month and invite you to share your favorite Texas Children’s memories. Read more

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When my husband and I first heard the news that our unborn daughter had CDH (congenital diaphragmatic hernia), time stood still in what seemed like a dense fog. As many would do, I ran to internet sites like Google and Wikipedia to find out more about this sometimes fatal abnormality. I was inundated with medical terminology and survival statistics. I was able to create a huge binder with all of the research I had done and carry that stack of documents with me to every appointment we had. Needless to say, I thought I was prepared for the various outcomes we could experience after our little girl was born.

On November 28th, 2010, Brooklyn Elizabeth Hales was born one day shy of her Father’s birthday and one month short of her due date. She was immediately intubated and taken to the NICU III in West Tower. For the next few weeks she struggled with stability and even ended up on ECMO. There were many dark moments in those first weeks of her life, but like I said before, we knew what we were up against. We knew that the ugly road of CDH was not an easy one, and we had prepared our hearts for heartbreak.

What we hadn’t planned for, and what never even came to mind, was how we would cope with “NICU life.” In the four months of Brooklyn’s hospital stay, I spent majority of my time at her bedside, walking the halls of West Tower, or trying to catch some rest in the Ronald McDonald House on the fourth floor. I lived, breathed, and smelled like the NICU. I had a fully organized folder on what Brooklyn could be faced with, but I had an empty hand when it came to information on how to navigate my role as a parent in the NICU. As a parent, you are your child’s most valuable advocate. You have intuition and you will spend the most time with your child. But how do you know which beep means business? Or how do you know when to speak and when to be quiet?

Or… what if my child’s pod mate passes away?
These are all questions and scenarios I had to navigate thru as a first time NICU parent. The one thing I learned over anything else when living in the NICU is that there’s a lot you CAN prepare for, and a lot you CAN’T prepare for.

As an employee of Texas Children’s, I know that we are constantly seeking out opportunities to better our families and their experiences. And as a NICU parent, I am even more excited about the creation of a new resource class available to our parents. A few months ago I had the privilege to brainstorm with the creators of the class, Preparing for Your Newborn’s Hospitalization. The purpose of our meeting was to gain the perspective of a NICU parent and bring up what could have been helpful prior to that “NICU life.” This class, with the help of its leaders and speakers, will better prepare those parents who are awaiting their newborn’s stay. I feel that had this been at my disposal prior to Brooklyn’s birth, I would have been one of the first to sign up. I believe it will be a tremendous value to our parents and great addition to the many great classes provided by the Pavilion for Women.

To sign up for “Parenting your hospitalized baby” or any of the other classes available to Pavilion patients, visit: http://women.texaschildrens.org/Patient-Education/