Fetal Center – Page 5 – Texas Children's News

May 11, 2015

Bench and Bedside is a digest of the previous month’s stories about the clinical and academic activities of our physicians and scientists. We welcome your subsmissions and feedback.

April 28

Countdown to ICD-10: Deadline to meet educational requirements is September 1

On October 1, Texas Children’s and hospitals across the nation will switch from ICD-9 to the ICD-10 coding system to report patients’ diagnoses and procedures. The ICD-10 codes will allow greater specificity and accuracy in describing a patient’s diagnosis and classifying inpatient procedures. Texas Children’s education teams have developed helpful tools to ensure all employees are prepared for this mandatory conversion.

“We believe that communicating the change clearly and consistently will help ensure a smooth transition,” said Texas Children’s Chief Safety Officer Dr. Joan Shook. Read more

April 28

Super Star Physician: Dr. Stephanie Marton

Dr. Stephanie Marton from the Center for Children and Women – Greenspoint is the latest Texas Children’s Super Star physician. “Every day I see patients coming in to the Center, and I directly see the impact that Texas Children’s Hospital is making in this community.” Read more

April 28

Giardino to serve on ABMQ Board of Directors

Texas Children’s Chief Quality Officer and Senior Vice President Dr. Angelo Giardino was recently unanimously confirmed to serve on the American Board of Medical Quality (ABMQ) Board of Directors. The organization is closely associated with the American College of Medical Quality of which Giardino is a distinguished fellow. Read more

April 28

Patel receives distinguished fellowship award

Dr. Akash Patel will be presented with the 2015-2016 Christopher R. Getch Fellowship Award from the Congress of Neuroligical Surgeons Fellowships Committee during its annual meeting in September. This prestigious award provides $100,000 for advanced training and is given to a neurosurgeon or fellow engaged in clinical research that promises to significantly impact the field of neurosurgery. Read more

April 28

Dr. George Bisset receives prestigious award

Radiologist-in-Chief Dr. George Bisset will be honored for his contribution to pediatric radiology at the 45th annual Sociedade Paulista de Radiologia (SPR) meeting held in Brazil. The conference is the biggest diagnostic imaging meeting in Latin America and the fourth largest in the world. Bisset will be the first non-Brazilian to receive honorary membership in this organization. Read more

April 21

New Cain Labs website promotes groundbreaking epilepsy research

Texas Children’s has launched a new website dedicated to innovative epilepsy research conducted at the Cain Foundation Laboratories in the Jan and Dan Duncan Neurological Research Institute and other test centers around the world. The website also includes a repository of helpful information about epilepsy treatment programs for patients and their families, including a link to Texas Children’s Level IV Epilepsy Center. Read more

April 21

Surgeon-in-chief speaks at Texas Surgical Society meeting

Surgeon-in-Chief Dr. Charles D. Fraser, Jr. spoke at a Texas Surgical Society meeting on April 11 in Galveston. Fraser, who is the son-in-law of Dr. Denton A. Cooley, talked about the hospital’s 60-year history of pediatric heart surgery and the roles played by Cooley and himself. More

April 20

Texas Children’s Hospital helps determine standard of care for children with cleft lip and palate

Representatives from Texas Children’s Hospital: Dr. Laura Monson, pediatric plastic surgeon; Christy Hernandez, director of the Texas Children’s Hospital Outcomes and Impact Service; and Dr. John Wirthlin, craniofacial orthodontist, joined an international group of medical professionals, patients and parents to determine a standard set of outcome measures for children born with cleft lip and palate. These guidelines will help all institutions develp a standard treatment of care of this population of patients and will be available for implementation starting in February. Read more

April 14

Lee recognized for his contribution to fetal imaging advancements

Dr. Wesley Lee, co-director of Texas Children’s Fetal Center and section chief for women’s and fetal imaging at Baylor College of Medicine, recently received the William J. Fry Memorial Lecture Award from the American Institute of Ultrasound in Medicine (AIUM). Read more

April 14

New PAPRs help provide full complement of PPE

Texas Children’s recently acquired 30 powered air purifying respirators (or PAPRs) to protect emergency responders from chemical, biological, radiological and nuclear agents. This addition to our PPE inventory helps ensure the safety of our health care professionals when they are treating patients with highly contagious infectious diseases. Read more

April 14

Texas Children’s, AAP partnership helps physicians advocate for their patients

Texas Children’s and the American Academy of Pediatrics (AAP) signed a first-of-its-kind partnership agreement whereby every eligible faculty member of the Baylor College of Medicine Department of Pediatrics is a member in the AAP and the Texas Pediatric Society (TPS). Since this partnership began a year and a half ago, the following Texas Children’s faculty have been actively involved with the AAP and TPS to champion the health, safety and well-being of children: Dr. Robert Voigt, Dr. Robert Ricketts, Dr. Mark Gilger, Dr. Fernando Stein, Dr. Carol Tapia, Dr. Mark Ward, Dr. Krithka Lingappan and Dr. Bruno Chumpitazi. Read more

April 14

Texas Children’s Hospital receives Healthcare Informatics Magazine’s 2015 Innovator Award

Texas Children’s Hospital has earned second place in Healthcare Informatics Magazine’s fourteenth annual Innovator Awards. The award was given to Texas Children’s for its quality improvement work to identify, deploy and measure new best practices and improve outcomes for children with appendicitis.

“We felt there was an urgent need in the health care industry to accelerate the identification and deployment of shared guidelines of care,” said Dr. Charles Macias, Texas Children’s Chief Clinical Systems Integration Officer and Evidence Based Outcomes Center director. Read more

April 14

New pediatric urologist joins Department of Surgery

Dr. Duong Dai Tu has joined Texas Children’s as a new pediatric urologist. Tu, who started April 1, has been appointed assistant professor of urology and attending surgeon in urology at Baylor College of Medicine.

“Dr. Tu is bringing an exciting vision to the surgery team that will help us continue to develop a preeminent program, enabling us to better serve our patients and their families,” chief of Urology, Dr. David Roth said. Read more

April 7

Texas Children’s welcomes new surgeon and researcher, Dr. Sundeep Keswani

Dr. Sundeep Keswani joined Texas Children’s as a pediatric and fetal surgeon and an associate professor at Baylor College of Medicine. He also is the principal investigator of a National Institutes of Health (NIH) funded laboratory. Read more

April 7

Transplant team perform 95 organ transplants in 2014

Transplant teams with Texas Children’s Hospital performed 95 solid organ transplants in 2014, continuing to serve as one of the largest, most active and successful pediatric transplant programs in the nation. The heart and the lung transplant programs were the largest in the country last year with 32 heart transplants and 16 lung transplants.

“Texas Children’s Transplant Services continues to earn its reputation as one of the best pediatric transplant programs in the country,” said Dr. John Goss, medical director of Transplant Services. Read more

April 7

CRC presents resarch award to Dr. Srivaths

The Clinical Research Center presented the Clinical Research Award for First Quarter 2015 to Dr. Poyyapakkam Srivaths, Department of Pediatrics – Renal, Baylor College of Medicine. Dr. Srivaths’s research activities in the CRC focus on investigating cardiovascular morbidity associated with end stage renal disease (ESRD) in children. Read more

April 14, 2015

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Dr. Wesley Lee, co-director of Texas Children’s Fetal Center and section chief for women’s and fetal imaging at Baylor College of Medicine, recently received the William J. Fry Memorial Lecture Award from the American Institute of Ultrasound in Medicine (AIUM).

The award recognizes a current or retired AIUM member who has significantly contributed in his or her particular field to the scientific progress of medical ultrasound.

Lee’s lecture titled, “Great Expectations: The Way Forward in Fetal Imaging,” was presented during the opening session of the 2015 AIUM/WFUMB Annual Convention in Lake Buena Vista, Florida.

Among his many accomplishments, Lee has authored 148 peer-reviewed articles and 20 book chapters pertaining to maternal-fetal medicine, prenatal detection of congenital anomalies, 3-/4-dimensional fetal sonography and fetal magnetic resonance imaging.

April 7, 2015

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Texas Children’s Hospital is excited to announce the addition of Dr. Sundeep Keswani. Keswani, whose appointment was effective March 2, is a pediatric and fetal surgeon at Texas Children’s and an associate professor at Baylor College of Medicine. He is also the principal investigator of a National Institutes of Health (NIH) funded laboratory.

“I am thrilled to welcome Dr. Keswani to our team,” said Dr. Jed Nuchtern, chief of the division of pediatric surgery at Texas Children’s Hospital and professor of surgery and pediatrics at Baylor. “Dr. Keswani provides expertise in several important areas that our division is expanding or creating. These include fetal diagnosis and therapy, pediatric wound care and general pediatric surgery. He also brings a significant NIH-funded research effort that will be a substantial addition to our current research portfolio.”

Keswani completed his surgical residency at Louisiana State University in his hometown of New Orleans and a fellowship in fetal surgery and surgical research at The Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania. He subsequently trained in pediatric surgery at the Saint Louis Children’s Hospital and the Washington University School of Medicine.

Keswani’s research interests closely pair with his clinical interests and include fetal regenerative wound healing, gene therapy applications, bone marrow contribution to tissue repair and fetal diagnosis and treatment. Currently, he is the principle investigator of a R01 and K08 grant from the National Institute for General Medical Sciences at the NIH. The goal of his research is to understand the underlying mechanisms of how the fetus heals without scarring to achieve postnatal regenerative tissue repair in various organ systems.

Texas Children’s division of pediatric surgery is one of the most robust pediatric surgery programs in the country with 16 full-time pediatric surgeons on staff. The range of surgical procedures performed by the division include fetal surgery, abdominal and thoracic surgery, pediatric surgical oncology, minimally invasive surgery including laparoscopic and thorascoscopic diagnosis and treatment, endocrine and biliary surgery, and adolescent bariatric surgery. In 2014, the division of pediatric surgery completed 5,792 surgeries and 11,809 clinic visits.

Texas Children’s Fetal Center works hand-in-hand with the division of pediatric surgery and is committed to providing the best possible care and outcome for each mother, baby and family. The core staff of Texas Children’s Fetal Center includes fetal and pediatric surgeons, maternal fetal medicine specialists and specialized coordinators. The Fetal Center’s physicians are recognized leaders in fetal medicine and fetal and neonatal surgery. As one of only a few centers in the United States to provide the full spectrum of fetal therapies, Texas Children’s attracts parents from around the world seeking the ultimate in care for their unborn child.

March 31, 2015

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One month after their successful separation surgery, Knatalye and Adeline Mata are progressing well as two separate little girls.

Knatalye can breathe on her own and was recently transferred to the Progressive Care Unit where she will resume her recovery. Her sister, Adeline, is still on a ventilator in the Pediatric Intensive Care Unit (PICU), but her doctors remain optimistic that she will breathe on her own just like her twin.

“Knatalye’s progress has been a tiny bit faster than Adeline, but it was just because of where they started out,” said Dr. Darrell Cass, co-director of Texas Children’s Fetal Center. “We’re still in the acute recovery phase of care where we’re working on breathing, sedation and pain management and working on their intestinal function.

Prior to the girls’ separation surgery, Knatalye and Adeline spent the first 10 months of their life in the Neonatal Intensive Care Unit (NICU) where they received daily care from their team of NICU nurses. To adequately prepare them for their separation surgery, the NICU nurses helped engineer a custom bed space for the girls in the NICU and collaborated with Hanger Clinic, to devise a swing that would safely keep the twins upright for a large portion of each day after their tissue expanders were in place.

“We emotionally, physically and intellectually invested a lot of care in the girls,” said Alex Luton, a clinical nurse specialist at Texas Children’s Newborn Center. “I know it was a difficult but necessary transition for them to go to the PICU.”

To ensure a smooth transition of care for the girls and their family, the NICU nurses partnered with the PICU team before and after the separation surgery.

“We sent a couple of nurses per shift for the first few days post operatively to kind of be there as a familiar face for the family as they began to build their relationships with nurses in the PICU,” Luton said.

Each of the babies had a PICU nurse and a NICU nurse for the first few days after separation surgery.

“As they stabilized and their condition improved, one nurse was assigned for each baby,” said Shannon Holland, assistant director of nursing in the PICU. “Now, they have one nurse for the two babies together.”

In addition to receiving around-the-clock care from the PICU nurses, Knatalye and Adeline receive therapy every day – physical therapy in the morning and occupational therapy in the afternoon to optimize their muscle development and motor coordination.

“We are practicing a lot of reaching and grabbing using both hands, bringing their hands together, banging toys together, visual tracking, “said Texas Children’s occupational therapist Chelsea Pierce.

Texas Children’s physical therapist Frank McCormick assists the girls with head control, trunk control, stretching, range of motion and working with their feet.

“The sessions are dictated by kind of what they can tolerate,” McCormick said. “Usually 30 minutes is a window, but if they can go further and are still awake and participative, then it can go upwards of 45 minutes to an hour.”

While Knatalye and Adeline’s recovery will take some time, their doctors are optimistic about their future.

“We would expect their gait, their walking stride, to be somewhat altered initially,” Cass said. “We’ll have to monitor them. With some therapy, we’re optimistic that they will be able to walk and live a normal life.”

Texas Children’s Surgeon-in-Chief Charles D. Fraser also shares that same spirit of optimism.

“This is another example of why a case like this should be done at Texas Children’s because we have the team and expertise to handle complex medical conditions,” Fraser said. “I am very, very confident that we will continue to move them on a positive recovery trajectory.”

Connect videos of the Mata twins:

Voices of Nursing: NICU nurses’ reflection on caring for the Mata twins

Hope, faith and expertise: Surgical team leads historical Mata conjoined twins surgery

3D Model of Mata twins helps surgeons prepare for girls’ separation

Positioning team designs, builds swing to help conjoined twins sit up

Mata conjoined twins take first step toward separation with tissue expansion

September 9, 2014

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Physicians at the Fetal Center completed their first fetoscopic procedure to repair spina bifida in-utero – an innovative approach that was developed by Dr. Michael Belfort, obstetrician and gynecologist-in-chief at Texas Children’s Pavilion for Women and Dr. William Whitehead, pediatric neurosurgeon at Texas Children’s.

“Our hope is that these types of innovations will lead us to a new era of fetal medicine and surgery,” Belfort said.

Myelomeningocele, or open neural tube defect (NTD), is a form of spina bifida and 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. Myelomeningocele 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, or the buildup of cerebrospinal fluid in the brain, which requires surgical treatment to drain the fluid via an implanted device called a shunt. Originally, closure of the defect occurred after the birth of the baby, which was associated with an 80-90 percent chance that a shunt would be required for life.

But after a breakthrough NICHD-funded study entitled the Management of Myelomeningocele Study (MOMS) 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 Fetal Center adopted this as a treatment option and began performing open fetal surgery to treat spina bifida. To date, we still have one of only a handful of centers in the country that is able to perform this complex in-utero repair. Texas Children’s Fetal Center has completed 23 of these surgeries since 2011, with excellent results.

This technique, the standard of care in the US, involves a uterine incision and can cause maternal complications. With this in mind, the team at the Fetal Center wanted to focus on reducing the risks to the mother and countering the risks of preterm delivery. Working in conjunction with Dr. Jose Luis Peiro and Dr. Elena Carreras of Vall D’Hebron Hospital in Barcelona, Spain, they developed a fetoscopic approach to the repair.

The surgery was over three years in the making and features an in-utero, single layer, sutured repair through only two, four millimeter incisions in the uterus (rather than the 5-6cm opening that is required for an open procedure). In order to practice and perfect performing the closure using a minimally invasive fetoscopic approach, the team built a simulator using a child’s kickball that replicated the mother’s uterus. Inside the kickball, a doll acted as the fetus including a spina bifida defect on the doll’s back. Drs. Belfort and Whitehead practiced closing the defect using a team approach in which they both carry out specific parts of the surgery in a coordinated fashion. The two surgeons performed more than 30 simulated procedures including two full simulations, gowned and gloved, under actual OR conditions with a full support team.

“We have a magnificent team of specialists from a number of departments working together in the best interests of our fetal and neonatal patients. I am incredibly proud to be a member of this outstanding team and to be able to play a role in this mission,” Belfort said.

With a multi-disciplinary structured program in place, clinical planning and training and full Institutional Review Board approval for this experimental procedure, the team performed the first in-utero spin bifida closure on their first patient on July 30, 2014. The procedure went as planned and so far mom and baby are doing well. Doctors are optimistic and are waiting to access the outcome of the repair once the baby has been delivered.

“It is important to note that this mother has not been exposed to a significant uterine incision and we are much less concerned about her risk of a ruptured uterus during this pregnancy than we are after an open repair,” Belfort said. “We look forward to an uneventful delivery and a healthy baby.”

In addition to an expert operating room team and nursing staff, a multidisciplinary team of specialists led this first surgery at Texas Children’s Fetal Center, including Dr. Michael Belfort, Dr. William Whitehead, Dr. Alireza Shamshirsaz, Dr. Oluyinka O. Olutoye, Dr. Olutoyin Olutoye, Dr. David Mann, and Dr. Rodrigo Ruano.

“With the ever-advancing technology and imaging capabilities and dedicated surgeons, I am excited to see what the future holds when it comes to repairing anomalies fetoscopically,” Belfort said. “I am so impressed by what can be achieved with our exceptional team.”

August 12, 2014

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Dr. Tamara Todd was 5 months pregnant when she found out her unborn daughter had a heart defect and would most certainly need surgery within her first moments of life. Her maternal fetal medicine specialist in Hilo, Hawaii told Todd and her husband that their baby girl, whom they planned to name Kirana, had Tetralogy of Fallot. Hilo does not have a children’s hospital, and the one in Honolulu does not have regular cardiothoracic surgery services, so they decided the best option was to head to the mainland U.S for delivery and post natal care.

They chose Texas Children’s Hospital for a variety of reasons. At the beginning of her career as a doctor, Todd was a part of Baylor International Pediatric AIDS Initiative (BIPAI) from 2006 to 2008 in Botswana and Lesotho so she was familiar with the reputation of both Baylor and Texas Children’s.

“I knew Texas Children’s would be a great place to get the best care,” says Todd of her choice to move to Houston. “Not only is it ranked as one of the top pediatric hospitals for cardiology and heart surgery, but also my parents live in the Houston area, so it really just felt like home.”

Once the decision was made, Todd connected with Christie Moran, nurse coordinator from the Texas Children’s Fetal Center, and transferred her OB care at 36 weeks of pregnancy, and arranged prenatal consult with pediatric cardiology and pediatric surgery.

“Every single person that we interacted with during outpatient visits, my admission for induction and ultimate c-section, our time in the NICU with Kirana and, of course, the surgical team were all outstanding,” says Todd of her time in Houston. “Texas Children’s quickly felt like a home away from home for my family.”

Kirana was born on December 31, 2013 at the Texas Children’s Pavilion for Women and taken immediately to surgery to repair the defect in her heart. Dr. Charles D. Fraser led a team of specialists in surgery, including Dr. Shaine Morris from Cardiology and Dr. Erin Gottlieb from Anesthesiology. The team at the Cardiovascular Intensive Care Unit managed Kirana’s post-surgical care.

“We were very fortunate that Kirana’s tetralogy of fallot was prenatally diagnosed by her doctor in Hawaii. Her family was able to temporarily move to Houston and deliver at the Pavilion for Women,” according to Kirana’s cardiologist, Dr. Morris. “Kirana’s heart condition is one that we treat often at Texas Children’s, and thanks to a multidisciplinary team, led by Dr. Fraser, we were able to provide her with the best care, and Kirana’s prognosis is very good.”

Kirana’s surgery was a success, and now just a few months later, the family is back home in Hawaii with their beautiful, healthy daughter

August 5, 2014

Riki Graves was already fighting a battle when she found out, at 20-weeks pregnant, that her unborn daughter, whom her and her husband, Chris, planned to name Juliana, had a complex heart condition, with the full and final diagnosis listed as, unbalanced AV canal with severe bivetnricular dysfunction, small arotic arch, severe right AV valve regurgitation, parachute left sided AV valve with regurgitation in heart failure. Juliana would likely need several heart surgeries, and even with the surgeries might not survive.

Riki describes how she felt when she received the devastating diagnosis, “Hearing those words sent a panic through me that, even now, is hard to describe. After the initial diagnosis, my doctor referred us to the Texas Children’s Fetal Center.”

Riki’s journey actually began at 8-weeks pregnant, when she was diagnosed with breast cancer. Riki made the painful choice to pause treatment while still pregnant, fully understanding that it may make her own battle more difficult.

“It was an extremely difficult and highly personal decision. In the end I wanted to provide my daughter with the strongest pregnancy and healthiest beginning to life possible. During that time there was a lot of things out of my control, but with my treatment, I was able to take the reigns, make a decision to provide for my baby,” said Riki.

When Riki presented at the Fetal Center, it appeared that her unborn daughter would likely require three heart surgeries – the Norwood, Glen and Fontan. But, as the pregnancy neared the end it became unclear what surgeries could be expected when Juliana was born.

Christie Moran was the Fetal Center coordinator who cared for the Riki. She developed a special bond with the family, “Mrs. Graves pregnancy was further complicated by the fact she had been diagnosed with breast cancer during this pregnancy. Either diagnosis during pregnancy can be challenging to manage but the combination made Riki’s case very unique. I felt very privileged to help guide them through this pregnancy, to provide information, to give support and to offer hope.”

Riki’s team of doctors at the Fetal Center continued to monitor her pregnancy very closely. Dr. Wesley Lee, co-director Dr. Nancy Ayres, director or non-invasive imaging and fetal cardiology at the Fetal Center, were among the multi-disciplinary team that cared for Riki during her pregnancy.

Juliana was born on April 9, 2014 and, it was determined that her heart was too structurally abnormal and weak to undergo surgery. Juliana was placed on the transplant list on April 21. On April 26, at 17 days old, she received her new heart.

Dr. Jeffrey Heinle, associate chief of Congenital Heart Surgery led the transplant surgery. Juliana’s transplant surgery was a success, and she is recovering smoothly. Since the transplant, Dr. Aamir Jeewa, pediatric cardiologist, has been following Juliana and working with the Graves to provide them with continuous, ongoing care. The Graves family is relocating from Corpus Christie to Houston to be closer to Texas Children’s, and Riki is currently undergoing treatment for her cancer at M.D. Anderson, staying positive and hopeful for the future.

Riki reflects on her time at Texas Children’s, “We made it with the help of the staff of Texas Children’s Hospital. From my maternal-fetal doctor Dr. Ramirez, who was beyond supportive, to our fetal cardiology nurse coordinator Christie Moran, who helped us get settled in Houston, to all of the doctors, fellows and nurses that helped us get through, we can’t thank them enough. They were there for Juliana and my family during the entire process.”

To read more about the Graves, please visit the Today Show or ABC News websites.

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