September 9, 2014

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Premature infants have special nutritional needs. Since their fragile bodies cannot consume as much breast milk as full-term babies, they need extra nutrients, minerals and protein to help them grow.

A recent Baylor College of Medicine study led by Texas Children’s Neonatologist Dr. Amy Hair, and published in The Journal of Pediatrics, found that adding a cream supplement in the diets of premature infants improved their growth outcomes in the Neonatal Intensive Care Unit (NICU).

“When premature babies are born, their lungs and other organs are still developing,” said Hair. “They need extra calories to help them grow adequately while in the NICU, thus improving their long-term health and developmental outcomes.”

Hair’s study examined 78 NICU infants weighing less than three pounds at Texas Children’s Newborn Center and the University Health System at San Antonio. Half of the infants received an exclusive human milk diet consisting of mother’s own milk or pasteurized donor breast milk, and a protein fortifier. The other half received the exclusive human milk diet plus a cream supplement derived from pasteurized human milk fat. Researchers found that premature infants who received the cream supplement had better growth outcomes in terms of weight and length than infants who received just the exclusive human milk diet.

“Premature babies can tolerate only a certain amount of feedings since their stomach and intestines are extremely sensitive,” said Hair. “The cream supplement is a natural way to give them fat and boost their caloric intake without changing the volume of milk.”

Texas Children’s is the first hospital in the world to add human milk-based cream to the diets of infants who weigh less than 3.3 pounds. Since our tiniest NICU patients are fed an exclusive human milk diet, this has significantly reduced the rate of necrotizing enterocolitis, a severe and potentially deadly intestinal infection common in premature infants.

“A mother’s milk is the best nutrition a baby can have, which is why we feed only breast milk to the babies in our NICU,” said Nancy Hurst, director of Women’s Support Services at Texas Children’s. “We depend on the generous mothers who donate their excess breast milk to our Milk Bank to ensure our NICU infants have a better chance of survival during this critical stage in their young lives.”

Additionally, Texas Children’s Pavilion for Women has implemented numerous breastfeeding programs for new mothers to ensure their babies get off to a healthy start. The hospital’s focus on neonatal nutrition underscored by its initiatives to promote successful breastfeeding, has helped Texas Children’s inch closer towards achieving the Baby-Friendly Hospital designation.

Click here to learn more about Texas Children’s Milk Bank Donation Program, and click here to read Dr. Hair’s Journal of Pediatrics study.

September 3, 2014

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On April 11, identical conjoined twin girls were born at Texas Children’s Pavilion for Women, each weighing about 3 pounds, 7 ounces. Born via Caesarean-section at 31 weeks gestation, Knatalye Hope and Adeline Faith share a liver, diaphragm, pericardial sac (the lining of the heart) and intestines. They were welcomed by their parents, Elysse and John Mata and their older brother Azariah.

Now estimated to weigh 10 pounds, 4 ounces each, the girls are being cared for by a team of specialists at Texas Children’s Newborn Center.

“The twins still require some respiratory support but they are doing well, and we don’t expect them to have any significant setbacks,” said Chief of Neonatology Dr. Stephen Welty.

Plans for surgical separation are being discussed among a team of multidisciplinary specialists. The Mata family and the care team’s goal right now is for the babies to continue to grow and gain weight.

“I expect it to go well,” Welty said in an interview with KHOU on Tuesday. “Will it be easy? No. The best thing to do is to do the safest thing, which is grow them up, get them bigger and healthier with great nutrition and great developmental care and then separate them at a time which is as safe as possible.”

Waiting a few months after the babies’ birth before proceeding with separation helps optimize the lung and organ function, which can minimize the risk of complications.

“Although other facilities have reported early separations, each case is different with regard to the number of organs that needs to be separated,” said Dr. Darrell Cass, co-director of Texas Children’s Fetal Center. “Also, in some instances those cases have experienced complications due to the early separation, which I believe can be avoided.”

Doctors anticipate beginning the twins’ separation process between the ages of 6 months and 8 months. First, our plastic surgery team will place tissue expanders to help induce the growth of additional skin that will be needed once the two babies are separated. The process of tissue expansion is six to eight weeks. Afterward, a multidisciplinary team of specialists will proceed with separation of the twins. The separation will involve many surgeons, including those from Pediatric General Surgery, Urology, Plastic Surgery, Orthopedic Surgery, Cardiac Surgery and Gynecology.

“There will be two surgical teams,” Cass said. “One team will start, and then once the babies are separated, the teams will separate to work on each infant and finish the reconstruction.”

The surgical teams include:

  • Anesthesiology: Dr. Helena Karlberg and Dr. Steve Stayer
  • Pediatric General Surgery: Dr. Darrell Cass (team lead) and Dr. Oluyinka Olutoye
  • Pediatric Urology: Dr. Patricio Gargollo and Dr. Chester Koh
  • Pediatric Plastic Surgery: Dr. Ed Buchanan and Dr. Larry Hollier
  • Pediatric Orthopedic Surgery: Dr. David Antekeir and Dr. Frank Gerow
  • Pediatric Gynecology surgery: Dr. Jennifer Dietrich

Cass said the surgery is risky, as there always is the risk of death for one or both children. However, he believes the risk is small and the team is anticipating an excellent outcome.

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By Dr. Charles Hankins

As a Texas Children’s neonatologist, I have treated many premature and critically-ill infants in the Neonatal Intensive Care Unit (NICU). When babies are born prematurely, their lungs and other organs are still developing. They are entering the most critical stage of their young lives. Their parents entrust their newborns to us to provide the highest level of care possible.

Our mission at Texas Children’s Hospital has always been to build a healthy community of children. In some cases, this begins in premature and critically-ill infants. To achieve the best neonatal outcomes, Texas Children’s has partnered with community NICUs in the Greater Houston area to ensure these patients receive the right care at the right time and in the right place.

As chief medical officer for Texas Children’s Hospital West Campus, I serve as the primary medical liaison to community physicians and work closely with them to expand access to patient care in the community setting, which is particularly important for the families of our NICU patients.

With a commitment to family-centered care, every effort is made to keep these infants close to their families in the community. Texas Children’s provides these local NICUs with administrative and clinical support, giving patients access to the latest treatments available in neonatal and pediatric care, state-of-the-art equipment and pediatric subspecialists.

If a child is born in one of the community hospitals and needs care offered only in a Level IV NICU, that baby is transferred immediately to our main campus at Texas Children’s Newborn Center, ranked No. 2 in the nation. When these babies graduate to a lower level NICU, the family can request transfer back to their community hospital and maintain the continuity of care which is so vital to helping these newborns thrive.

Texas Children’s is proud to work with these hospitals to provide high-quality care to newborns:

  • Houston Methodist West Hospital
  • Houston Methodist Willowbrook Hospital
  • Houston Methodist San Jacinto Hospital
  • Houston Methodist
  • St. Joseph Medical Center
  • CHI St. Luke’s Health – The Woodlands Hospital
  • CHI St. Luke’s Health – The Vintage Hospital

More than 2,000 NICU infants are cared for each year at Texas Children’s Newborn Center, making us one of the largest, most experienced NICUs in the country. Partnering with community NICUs in the Greater Houston area will ensure our critically-ill babies receive high-quality care, while helping us carry out our mission of creating a community of healthy children.

August 19, 2014

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Imagine preparing more than 600 syringes or bottles of milk every day for an average of 80 hungry infants in the Neonatal Intensive Care Unit (NICU) at Texas Children’s Newborn Center. That’s roughly eight feedings per day for each baby in the NICU who receives human milk prepared by the Milk Bank.

Preparing milk for these fragile newborns is more than just pouring it into a bottle. Our Milk Bank technicians follow strict procedures and high quality standards to ensure the right milk is delivered to the right baby.

“It’s one of the hardest jobs to fill because it requires meticulous attention to detail, exceptional math skills, the ability to multi-task and follow procedural guidelines at the same time,” said Kristina Tucker, manager of Texas Children’s Lactation and Milk Bank Services. “Our technicians spend most of their time on their feet preparing the milk that will nourish our tiniest and most vulnerable NICU patients.”

82014MilkBankinside640After the mothers’ expressed milk is delivered to the Milk Bank on either the fourth floor of the West Tower or the eighth floor of Texas Children’s Pavilion for Women, our technicians verify the information on the labeled bottles, scan it into the system, and store the mother’s breast milk and pasteurized donor milk in large freezers and refrigerators until they are ready for use.

Every day is a busy day at the Milk Bank. From the time our technicians begin their 10-hour shift at 7:30 a.m., they’re working around the clock to ensure all feed orders from physicians are filled and ready for delivery to the NICU at 5 p.m. Despite working in a fast-paced environment, there is no room for error. Every order, which contains the physician’s instructions, is examined numerous times before the milk bottles and syringes are sent to the NICU nurses who feed the babies.

“Sometimes physicians will request that certain fortification products be added to the milk,” said Michelle Jones, a Milk Bank technician at Texas Children’s. “Since each baby’s nutritional needs are different, our primary goal is to make sure the babies receive the right fortified milk which is critical to their care.”

When fortifying the milk, technicians may add complex proteins, carbohydrates and minerals including Prolacta® products which include a cream supplement made from human milk fat that is added to the diet of premature infants who weigh less than 3.3 pounds. These products are derived from pasteurized donor breast milk and when added to mother’s own milk, provide an exclusive human milk diet for these small, vulnerable infants thereby protecting them from infection and disease.

“Most premature babies require these additional additives to help them grow,” said Nancy Hurst, director of Women’s Support Services at Texas Children’s. “The fortifiers add calories and nutrients to the milk without changing the volume since premature babies can tolerate only a certain amount of feedings.”

Once the milk is mixed, prepared and delivered to the NICU, the mission is accomplished.

At the end of the day, it doesn’t matter how many hours these Milk Bank technicians work or how much their feet hurt from standing all day. What matters the most to them is that all the babies receiving breast milk have been fed.

“It’s all about feeding the babies,” said Jones, who has worked at Texas Children’s Milk Bank for eight years. “It brings me great joy to see the positive impact that my colleagues and I have on these infants, and the trust that the parents have in us to ensure their babies’ nutritional needs are met.”

KTRK recently spotlighted a Houston-area family whose NICU baby benefited from Texas Children’s Milk Bank services. Click here to watch the video.

For more information on how to donate breast milk to the Milk Bank, click here.

June 10, 2014

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Many hospitals have Neonatal Intensive Care Units (NICUs), but not all NICUs are the same.

Texas Children’s Newborn Center is one of the only level IV NICUs in the Houston region that is able to provide babies with the highest level of care. In fact, many area hospitals with less advanced NICUs transfer infants to us when more experience and specialized care is required.

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The American Academy of Pediatrics differentiates between units by defining levels of care based on the complexity of medical conditions the facility is equipped to treat. We hope this will help you better understand the different levels of care in the NICU:

Level I: Regular nursery care available at most hospitals that deliver babies

Level II: Intensive care for sick and premature infants

Level III: Comprehensive care for more seriously ill newborns

Level IV: Major surgery, surgical repair of serious congenital heart and anomalies that require cardiopulmonary bypass and/or extracorporeal membrane oxygenation (ECMO) for medical conditions. Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day.

Many area hospitals have level II or III NICUs, but are not equipped to provide the most advanced level of care some newborns need. Our combined level II and III NICUs offer specialty care for newborns. An additional level IV NICU located across the connecting bridge gives babies more extensive support and access to dozens of pediatric subspecialists.

Texas Children’s Newborn Center was recently ranked no. 2 in this year’s U.S. News & World Report survey, a gain from last year’s no. 17 ranking. As you know, U.S. News ranks the top 50 pediatric centers in 10 specialty areas, so being recognized within the top two is no small feat.

Our commitment to improving neonatal outcomes is really something to be proud of, and I am grateful that our diligent efforts are making a positive impact in the lives of so many babies.

For more information about Texas Children’s Pavilion for Women and our Neonatal Intensive Care Unit, visit here and to take a video tour of our NICU, visit here.

May 20, 2014

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St. Joseph’s Women’s Medical Center in downtown Houston recently cut the ribbon on its newly renovated neonatal intensive care unit. The renovations were a result of a partnership agreement with Texas Children’s Hospital which extends our neonatal care to the downtown hospital. The project cleared the way for state of the art support devices critical for the care of medically fragile infants. Just as important, it improved the environment for the patient and families in ways that have been shown to improve outcomes for critically ill infants.

“This partnership is critical to our overall regional strategy of ensuring the best care is available within reach for babies not just at Texas Children’s Hospital, but across the area,” said Dr. Stephen Welty, chief of neonatology. “We work closely with excellent nurseries in the community to promote the same quality and care standards followed in our level IV NICU.”

Texas Children’s provides St. Joseph’s with administrative and clinical support, giving patients access to the latest treatments available in neonatal and pediatric care, state-of-the-art equipment and pediatric sub specialists. That includes cardiology, neurology, infectious disease, ophthalmology and more.

St. Joseph’s is the seventh hospital in the Greater Houston community affiliated with our NICU. The others include Methodist West Houston Hospital, Methodist Willowbrook Hospital, Methodist San Jacinto Hospital, The Methodist Hospital, St. Luke’s The Woodlands Hospital and St. Luke’s Hospital at the Vintage. The partnerships also mean in the relatively rare circumstances when level IV care is necessary, the patients will be transferred to Texas Children’s Hospital.

“At Texas Children’s Hospital, our mission to build a healthy community of children begins at the very start of life,” said Cris Daskevich, senior vice president of Texas Children’s Pavilion for Women. “Our relationship with St. Joseph’s allows us to partner in providing exceptional neonatal care to the premature and critically-ill infants that need it most, so that babies can have the best possible outcomes.”

February 25, 2014

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Finding herself awake in the middle of the night, Jenni Stearman, a NICU nurse at Texas Children’s Newborn Center, began scrolling through posts on Facebook before stopping at one that struck a chord in her heart.

It was a touching update from a NICU parent expressing appreciation for everything the NICU nurses do, and it inspired Stearman to return the compliment by conveying her appreciation and empathy for NICU parents.

“I guess I was just a little bit emotional and I read the post and it was just really inspiring. It was too late to call anyone and talk about my feelings, so I typed,” said Stearman.

Although she was home, off-duty, and had a lot going on in her personal life with an upcoming move, wedding and honeymoon, Stearman took some time to reflect on the rewarding experience of getting to know so many loving families in the NICU at Texas Children’s. In her late-night Facebook post, Stearman recounted the journey and struggle of a NICU parent.

“You are in a situation that you didn’t plan on being in and everything that you did plan is now unobtainable. You feel completely out of control of the situation around you. You are dependent on others to do what you so dearly long to be able to do for your own child. Everything that you would normally do to comfort and care for your baby has been taken away from you. I’m here to tell you, I understand your pain and I appreciate you,” she wrote.

She continued by sympathizing with them and expressing gratitude for all that they do to make her job and life even better.

“You trust me with your most valued possession. You learn to trust my instincts and I yours. We become a team with one common goal in mind and that is to get your child home with you as quickly as possible and as healthy as possible. Thank you for that trust. You become my “friends” while we spend 36hrs/week together. After months of this, we have shared more conversation than I have with some of closest friends. We have shared times of pain and times of joy. We have cried together and we have shared laughter. In some cases we share bonds that will extend far beyond the NICU. Thank you for being my friend.”

And finally, she thanked them for staying in touch and giving her hope during tough times.

“The NICU can be a depressing place (as you know). Your updates help us keep faith that all we do is for a very good reason,” she wrote.

Stearman tagged some of the NICU parents she knew in the post, and by morning, many people had forwarded it on and reached out to tell her how much it meant. The post gained so much momentum that the Huffington Post decided to publish it as an op-ed health piece on their national site, highlighting how much our NICU nurses care about the patients and families at Texas Children’s. The post has generated thousands of social media “likes” and shares.

“I wrote it for the NICU moms so I was happy to hear they were sharing it,” said Stearman. I’m really, really happy that people loved it and felt inspired by it.”