They say love knows no age. Whoever said that wasn’t taking into consideration that love is a confusing mystery before a certain age. Connect asked some young Texas Children’s patients what they thought of Valentine’s Day and the word “love” and they shared their hilarious thoughts on this day dedicated to the ones we love.
Watch this adorable video.
In less than a month, a multidisciplinary team of surgeons here at Texas Children’s Hospital will embark on what could be a 36-hour procedure to separate 9-month-old conjoined twins, Knatalye Hope and Adeline Faith Mata.
During that time frame, surgeons from 13 subspecialties will conduct a series of well-orchestrated operations on the girls, who share a chest wall, lungs, pericardial sac (the lining of the heart), diaphragm, liver and pelvis. The separation team will start the surgery and the reconstruction team will complete the procedure.
“This is a huge undertaking,” said Dr. Darrell Cass, pediatric surgeon and co-director of Texas Children’s Fetal Center. “There’s been an extensive amount of involvement from many of the departments in the hospital, including radiology.”
With help from a Dallas printing company, Chief of Radiology Research and Cardiac Imaging Dr. Rajesh Krishnamurthy built a 3D model of the twins’ anatomy to help surgeons plan for the girls’ separation. The model was built using a computerized image data set of the twins and a 3D printer.
“It’s very useful for preoperative surgical planning,” Krishnamurthy said of the model. “Especially when it comes to conjoined twins.”
Twins, specifically conjoined twins, tend to have pretty complicated anatomy. In the case of the Mata twins, there is a large part of the body – the chest, the abdomen and the pelvis – that is fused. Having a 3D model of the girls has given surgeons insight into what they are going to encounter.
The model – which goes into a fair degree of detail, including a detachable, transparent liver – has been especially helpful in the planning of the pelvic portion of the surgery, which presents an interesting and challenging anatomical situation in that each girl has her own pelvic organs but each of those organs gets blood supply from each girl.
“We’re going to have to make some real decisions about which bladder goes to which girl, which uterus goes to which girl and which ovaries go to which girl,” Cass said. “That might be the more complex aspect of the operation.”
The 3D model of the twins was created in about a week. The process started with a high-quality computer tomography or CT scan. The image data set was transformed into a 3D segmentation that was color coded and converted into a printable form. That form was sent to Medcad in Dallas where the physical, 3D model was made under the leadership of Dr. Jayanthi Parthasarathy.
In addition to the conjoined twins, 3D modeling at Texas Children’s is regularly done in orthopedic cases, such as in the setting of hip dysplasia or unusual rotational abnormalities of the bone. It’s also used in some congenital heart disease cases and could be used in other areas as well.
“3D modeling is a visual representation of the complexity that surgeons might encounter during a procedure,” Krishnamurthy said. “This is very powerful when you are trying to come up with unique solutions to a particular case.”
Cass said the 3D model is one of many reasons why the Mata twins are at Texas Children’s Hospital.
“The Mata family did their homework,” he said. “They got to know different hospitals and different surgeons and they chose us. We’re incredibly grateful to them for putting their faith and trust in us and we’re very optimistic that we’ve done all the preparation needed to have a very good result.”
Elysse Mata, the twins’ mother, said she is excited about her girls’ upcoming separation.
“I can’t wait to hold two babies and be able to take them home,” she said.
Knatalye and Adeline were born April 11 at Texas Children’s Pavilion for Women. Delivered via Caesarean-section at 31 weeks gestation, the twins each weighed 3 pounds, 7 ounces.
The girls’ parents, Elysse and John Mata, and their 5-year-old brother, Azariah, learned during a routine ultrasound on January 13 that Elysse was carrying twins and they were conjoined. Subsequently, the family was referred from a physician in Lubbock, their hometown, to the Texas Children’s Fetal Center where they underwent extensive prenatal imaging, multidisciplinary consultation and development of plans to achieve a safe delivery and postnatal care.
Now 9 months old, the babies are doing well as they continue to be cared for by a team of specialists in the Level IV Neonatal Intensive Care Unit at Texas Children’s Hospital.
Watch the newest “I Am Texas Children’s” video featuring employee Eduardo Hernandez in Texas Children’s Hospital West Campus – Pediatric Radiology.
“I work in the Radiology Department at Texas Children’s Hospital West Campus,” said Hernandez. “I love the work environment and my coworkers, and I get to take care of patients and their families every day.”
Check out Hernandez’s video, and find out how you and your coworkers can be featured in the “I Am Texas Children’s” section on Connect.
Texas Children’s Hospital West Campus is proud to announce Dr. Allen Milewicz as chief surgical officer of the hospital. In his new role, Milewicz will be responsible for organizing Texas Children’s surgery within the community, focusing on Texas Children’s Hospital West Campus. Additionally, he will be working in conjunction with the entire Texas Children’s Department of Surgery to optimize surgical service for patients, families and referring physicians.
“I look forward to expanding surgical services in the community while ensuring that each patient receives the experience, expertise and clinical outcomes for which Texas Children’s is known,” Milewicz said.
Board-certified by the American Board of Pediatric Surgery, Milewicz received his undergraduate degree from City College of New York and earned his medical degree from New York University School of Medicine. After completing his general surgery residency program at The University of Texas Southwestern Medical Center, he went on to pursue specialized training in pediatric surgery. Milewicz is a member of the American Pediatric Surgery Association and a fellow of the American College of Surgeons. He also is an associate professor of pediatrics-surgery at Baylor.
The first Cutting Edge of Pediatrics conference sponsored by the Department of Surgery was held January 24, providing 138 Houston-area pediatricians, family practice physicians and advanced practice providers an opportunity to learn about common pediatric surgical conditions from Texas Children’s surgeons.
From the first speaker to the last, the surgeons and pediatric providers engaged in lively discussions of the topics, which included anesthesia, ethics, adolescent gynecology, ophthalmology, orthopedics, otolaryngology, pediatric general surgery, plastic surgery and urology.
Following a welcome from Surgeon-in-Chief Dr. Charles D. Fraser, Jr., presenters included Dr. Dean Andropoulos, Dr. Jennifer Bercaw-Pratt, Dr. David Coats, Dr. Nicolette Janzen, Dr. Edward Lee, Dr. Mark Mazziotti, Dr. Julina Ongkasuwan, Dr. Scott Rosenfeld and Dr. Veeral Shah.
The conference’s planning committee included representatives from the Department of Surgery, Texas Children’s Pediatrics and Kelsey-Seybold. Committee members included Dr. Allen Milewicz (Chair), Dr. Ellis Arjmand, Dr. Carol Green, Dr. Anita Jimenez-Belinoski, Ryan Krasnosky, Dr. Megan May, Dr. David Roth and Dr. Stanley Spinner.
Texas Children’s pediatric gastroenterologist Dr. Sanjiv Harpavat is working to ensure every newborn is screened for biliary atresia, a rare but deadly liver disease affecting 1 in 10,000 births in the U.S. It’s the number one reason for liver transplants in infants.
Biliary atresia occurs when the bile duct connecting the liver to the small intestine is blocked. The buildup of bile in the liver scars the tissue so rapidly that most infants need a liver transplant to survive.
“Infants with biliary atresia have more scarring after the first few months of life than a chronic alcoholic’s liver,” said Harpavat. “An important way to improve their outcomes is by detecting and treating the disease early before symptoms appear.”
Just like a hearing screen is a standard test for all newborns in the U.S., Harpavat hopes to implement a newborn screening program nationwide for biliary atresia. While this may seem like an uphill battle, it’s not if you’re armed with compelling data and research.
In a retrospective study published in the journal Pediatrics, Harpavat, along with a team including Department of Pathology Chairman Emeritus Milton Finegold, examined lab records of 61 children with biliary atresia referred from their birth hospitals to Texas Children’s for care. Unlike healthy infants, all newborns with biliary atresia had persistently high levels of conjugated bilirubin (CB) in their blood, which indicates a problem with liver function.
“While the total bilirubin levels of newborns are routinely checked after birth, most pediatricians are trained to look for the unconjugated bilirubin that determines the severity of jaundice in newborns,” Harpavat said. “The other type of bilirubin – direct or conjugated bilirubin – is recorded but often ignored.”
In collaboration with neonatologists at Texas Children’s Newborn Center, Ben Taub Hospital, St. Luke’s Episcopal Hospital in The Woodlands and St. Luke’s Vintage Hospital, Harpavat is leading a large, multicenter prospective screening study to validate a blood screening tool that measures CB levels in newborns shortly after birth and retests newborns with high CB levels at their 2-week pediatrician checkup to confirm biliary atresia. “The rescreen eliminates false positives since many healthy newborns have slightly high CB levels at birth while their liver is going through a critical transition period,” Harpavat said.
Of the 11,500 newborns screened in this ongoing study, 121 had high CB levels. After repeat testing, 12 babies had high CB levels and two were diagnosed with biliary atresia. This disease can only be treated with a liver transplant or the Kasai procedure, which removes the abnormal bile duct and connects the liver to the small intestine to create a new duct.
“Preliminary data suggests infants who undergo Kasai before 30 days of life have a better outcome and may have less chance of needing a liver transplant,” said Texas Children’s pediatric surgeon Dr. Mary Brandt, who performs roughly 10 to 12 Kasai operations a year at Texas Children’s. “Waiting until there is significant scarring in the liver increases the chance of needing a liver transplant.”
Texas Children’s Neonatologist Dr. Joseph Garcia-Prats, who helped implement a screening program for biliary atresia at Texas Children’s and Ben Taub General Hospital based on Harpavat’s research, says biliary atresia screening should be a standard of care for all newborns. “Unlike a stool color card test, the newborn CB screening test diagnoses the disease before infants get sick and it is inexpensive.”
To mobilize statewide support, Harpavat has collaborated with longtime newborn screening advocate and Texas Children’s Neonatologist Dr. Charleta Guillory to encourage Texas and other states to add biliary atresia to their newborn screening panel.
Harpavat has presented his findings to the Texas Medical Association, the Texas Pediatric Society’s Fetus and Newborn Committee, the March of Dimes, and the State Newborn Screening Advisory Committee that Guillory co-chairs. Harpavat also is promoting his research at pediatric conferences around the country.
“The more compelling statistics we present in the state of Texas, the more credibility we’ll have in pushing forth this newborn biliary atresia screening test on a national level,” said Guillory.
Harpavat’s goal is to screen 70,000 newborns in his study before presenting his findings to national health screening panels, like the National Screening Advisory Committee.
Texas Children’s Hospital International Colloquium, now in its 25th year, is an annual educational forum targeting the learning needs of clinical providers and specialists in the areas of pediatrics, surgery, obstetrics and gynecology, and related fields.
During the past two and a half decades, the colloquium has developed into a convening body for stakeholders in global health from across Texas Children’s network of in-country programs and partners in more than 20 countries.
In honor of its 25th anniversary, this year’s Texas Children’s Hospital International Colloquium – to be held Monday, March 9 through Wednesday, March 11 – is slated to be the most impressive to date with simultaneous tracks, simulations and workshops from speakers across pediatrics, surgery, obstetrics and gynecology, and hospital-based services.
The dynamic, multi-disciplinary content of the forum was developed by the 2015 Curriculum Committee, which is comprised of Dr. Peter Hotez, Dr. Oluyinka Olutoye, Dr. Susan Raine, Dr. Gordon Schutze and Dr. Jesus Vallejo. The course curriculum for 2015 is also CME accredited for the first time.
A long-time partner of Texas Children’s Global Health Initiative and a former Texas Children’s fellow, Dr. Rodolfo Treviño, of Tecnologico de Monterrey, has participated in nearly every colloquium since its inception and recently said the event has been the primary platform for transferring medical knowledge and best practices across different disciplines for many countries.
“Each year you can see the genuine interest of Texas Children’s Hospital and the curriculum committee to develop strategies to improve the care of children,” Treviño said. “Through relationships created at the Texas Children’s Hospital’s International Colloquium, many opportunities have arisen for our team.”
Some of those opportunities have helped reduce the mortality rate from cardiovascular surgery, Treviño said, while others have prompted the implementation of quality improvement practices in neonatology to specifically reduce nosocomial catheter-associated infections in neonatal intensive care patients.
The 2015 Texas Children’s Hospital’s International Colloquium will be held at the BioScience Research Collaborative – Rice University at 6500 Main St. To learn more and to register, click here.