September 19, 2017

Since the topping out celebration of Texas Children’s Legacy Tower nearly seven month ago, significant construction milestones have been reached inside the tower’s 400-foot-tall structure at Texas Children’s Medical Center campus.

Carefully designed to promote the safest possible environment to care for our most critically ill patients and their families, construction is underway on the patient care rooms in the cardiovascular intensive care unit (CVICU), pediatric intensive care unit (PICU) and the progressive care unit (PCU). Last year, a series of patient care simulations were conducted to identify and eliminate any latent safety defects in the final design of the critical care tower before actual construction began.

Based on helpful feedback from our providers and patient families, the size of the critical care rooms inside the Legacy Tower will be between 350 to 450 square feet – three times the size of the hospital’s current ICU rooms. The rooms will feature a dedicated family space, a bathroom and shower, and care teams will have enhanced visibility and monitoring between patient rooms and into the patient rooms from the nurses’ work stations. The ICU rooms also will be equipped with state-of-the-art technology including a boom that will provide gas, power and data from the ceiling.

“Booms allow us to position the patient almost anywhere in the 360-degree circle,” said Chief of Critical Care Medicine Dr. Lara Shekerdemian. “This means that we can use some very state-of-the-art equipment for mounting all of the pumps, monitors and ventilators at the patient’s bedside while keeping the equipment off the floor.”

The Legacy Tower’s high intensity operating rooms and intraoperative state-of-the-art MRI suite also will provide dedicated subspecialty care for surgical patients.

“Our pediatric surgical patients are different than other ICU patients,” said Texas Children’s Chief of Plastic Surgery Dr. Larry Hollier. “For the first time, we’re going to have them in a setting where the care is designed specifically for that surgical patient, and that’s going to be located one floor above the operating rooms. The new tower will help us increase our OR capacity so we are not turning patients away from receiving critical care.”

The Legacy Tower will open in two phases. The first phase will occur in May 2018 when the PICU, PCU, operating rooms and Radiology open. A few months later, the Heart Center will move into the new tower in August 2018.

The 25-floor Legacy Tower will house 126 beds for pediatric and cardiovascular intensive care, six new operating rooms (ORs) with the latest technology to complement the hospital’s existing 19 ORs, and will be the new home of Texas Children’s Heart Center, including the outpatient clinic, four cardiovascular ORs and four catheterization labs. This vertical expansion will help reinvest in the programs needed to provide the highest level of care to our most critically ill patients.

“I don’t know of any other children’s hospital in the country that has the type of experience that Texas Children’s has in bringing all of these elements together,” Hollier said. “With larger, more functional spaces, we will be able to provide patients and families with the best possible environment to receive care.”

August 22, 2017

When Bristol Dunlap was born, she was perfectly healthy. But by the time she was three months old, she was failing to reach her milestones and began showing worrisome symptoms.

“She could not lift her head up or sit upright, her body was unusually floppy, and her left eye began turning inward even though her vision was fine,” said her mother Evonia Dunlap. “As my daughter grew older, she was slow to crawl, stand and walk, and had difficulties in chewing, swallowing and talking.”

Bristol was diagnosed with congenital hypotonia which explained her poor muscle tone throughout her body. While therapy helped her daughter sit, walk and talk, there was one thing Dunlap wanted to know: What caused Bristol to develop hypotonia?

After seeing many specialists and undergoing a battery of diagnostic tests with still no answer, the family’s five-year medical odyssey ended at the Jan and Dan Duncan Neurological Research Institute (NRI) at Texas Children’s, where they were referred to neurologist Dr. Hsiao-Tuan Chao and Dr. Michael Wangler, geneticist and assistant professor of Human and Molecular Genetics at Baylor College of Medicine.

Through the NIH-funded Undiagnosed Disease Network (UDN), which brings together experts from across the country to help solve mysterious medical conditions by searching for their genetic basis, Chao and Wangler learned of a 7-year-old boy who exhibited symptoms similar to Bristol’s and also carried a point mutation in the Early B-Cell Factor 3 (EBF3) gene.

After re-examining Bristol’s exome sequencing results, they found she, too, carried the same mutation that produces a defective EBF3 protein. Since this protein is a master regulator of hundreds of other genes, even the tiniest alteration in its function could potentially cause widespread damage to the nervous system and muscles.

A referral center for undiagnosed diseases

Like the Dunlaps, many patient families are referred to Texas Children’s because of our renowned expertise and specialization in the diagnosis of diseases that are rarely seen and often unrecognized. Besides bringing together experts in genetics, pediatrics and neurology at Texas Children’s and its academic partner, Baylor College of Medicine, the UDN unites clinicians and scientists from across the country to help solve the most difficult medical cases. It is one of seven UDN sites nationwide.

More than 50 percent of UDN patients exhibit neurological symptoms. Texas Children’s chief of Neurology Dr. Gary Clark is one of the co-leaders of the UDN program at Texas Children’s and Baylor, and works closely with Texas Children’s neurologist Dr. Lisa Emrick in solving these mysterious neurological disorders.

“When a patient is referred to our UDN site, their DNA sample is submitted for sequencing,” said Emrick. “We conduct phenotyping and provide our UDN and NRI partners with the clinical patient data they need to help identify variant genes that may be responsible for a patient’s disease. Before advanced technologies like sequencing, only a small percent of these cases could be diagnosed.”

In addition to state-of-the-art medical imaging, metabolomics, and genetic testing including genome sequencing and exome sequencing, clinicians and researchers in the UDN rely on the Model Organism Screening Center (MOSC), where genes are studied in fruit flies to help diagnose patients. The center is led by Dr. Hugo Bellen, professor of Molecular and Human Genetics and Neuroscience at Baylor; Dr. Shinya Yamamoto, NRI investigator and assistant professor at Baylor; and Wangler. This dynamic team uses fruit flies, Drosophila melanogaster, to study new disease candidate genes and variants. They also closely collaborate with researchers at the University of Oregon in generating zebrafish models to study origins of disease.

In the MOSC, researchers combine bioinformatics analysis and experimentation in these ideal organism models to determine whether a specific variant identified in the genome of the patients may be responsible for the disease. “Integration of human genomics and experiments in simple model organisms such as fruit flies and zebrafish greatly facilitates disease diagnosis and mechanistic studies,” said Bellen.

“An exciting technique we developed is a way to humanize a fly gene,” said Yamamoto. “By knocking out the homologous gene in the fly and replacing it with the human gene, we can test the specific variant found in the patient to see how well it performs.”

Since fruit flies share many similar genes with humans, they have become a powerful model organism for the study of genetics. To study human disease in fruits flies, scientists mutate, or disrupt, the same gene that is known or suspected to cause the disease, and then figure out why mutations with this gene leads to disease.

Through collaboration with the UDN, Texas Children’s and Baylor continue to make significant strides in helping to accelerate the diagnoses of previously undiagnosed and rare neurological conditions.

For the Dunlap family, this provides a source of encouragement.

“While the journey to find a cure for our daughter’s illness has just begun, we are happy to finally have some answers,” Evonia said. “We are thankful for the pioneering work being done by physicians and researchers at Texas Children’s.”

Texas Children’s work to develop a novel non-invasive device for pediatric ureteral stent removal after a urinary tract procedure, with Baylor College of Medicine, Rice University’s Oshman Engineering Design Kitchen (OEDK) and Department of Bioengineering, as well as local life sciences commercialization firm Fannin Innovation Studio, was recently funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH). The $225,000 Small Business Innovation Research (SBIR) grant will be used to conduct further development of an electromagnetic device for removal of ureteral stents in pediatric patients.

Through the Rice undergraduate design program, a group of Rice University engineering students collaborated with Dr. Chester Koh, a pediatric urologist and surgeon at Texas Children’s and Baylor College of Medicine, to create the device in 2015, after Koh challenged the students to develop an innovative tool that would simplify ureteral stent removals, a fairly common procedure that is performed on more than 2,000 pediatric patients nationwide each year.

After extensively collaborating with Texas Children’s surgeons to better understand the challenges of the current procedure and the need for refinement, the collaborative team developed a non-invasive device to remove ureteral stents from children using a small magnetic bead and a powerful custom-built electromagnet that was designed with the assistance of 3-D printing at Rice’s OEDK labs. The electromagnet safely pulls on the tiny metallic bead that is attached to the ureteral stent to allow passage through the urethra without the need for an invasive procedure or general anesthesia.

This new innovation in pediatric ureteral stent removal is less painful and costs two-thirds less than the standard procedure because it avoids general anesthesia and the time and equipment necessary for a surgical procedure. The team’s invention has won two significant awards: the top prize at Rice University’s 2016 annual Engineering Design Showcase and the Grand Prize for Student Design at the 2016 annual Design of Medical Devices conference in Minneapolis.

“The development of pediatric medical devices lags adult device development by more than 10 years,” said Koh, who has a mechanical engineering degree from the University of California, Berkeley. “This is an important example of why academic partnerships are needed to advance pediatric medical device projects, since the pediatric medical device pipeline is currently limited. I applaud the Rice and Fannin Innovation Studio team members for showing their dedication and passion to the kids under our care at Texas Children’s.”

Prior to coming to Texas Children’s to establish the robotic surgery program in 2013, Koh co-founded a U.S. Food and Drug Administration-supported pediatric device consortium based in Southern California. He is creating a similar initiative at Texas Children’s, drawing on the top engineering and device development talent in the region.

The early work for this project was supported by the Denton A. Cooley Fellowship for Surgical Innovation of the Texas Children’s Auxiliary and by the Texas Children’s Department of Surgery, which continues to support the pursuit of innovation solutions to the unmet surgical needs of children.

The SBIR Phase I grant from the NIDDK will allow the team to implement design modifications to further refine the device as well as perform benchtop and pre-clinical studies with a target goal of larger SBIR Phase II grants.

August 8, 2017

Nurses at Texas Children’s are natural innovators. They ask questions, ponder processes and think outside the box to develop solutions that improve care and outcomes for patients. For nurses Michael Pickett, Nicholas Keith and Anthony Bentley, a shared passion for patient-centered innovation ultimately brought them together.

“After working on projects of our own, we talked and realized we all faced the same kinds of challenges and frustrations,” said Keith, a float pool nurse at Texas Children’s. “Knowing how grueling the process can be to implement a new idea, we set out to develop a council that would support frontline staff using a bottom-up approach to give life to ideas from end users.”

The idea to create a venue that would bring end user needs, ideas and solutions to clinical practice provided the visionary roadmap they needed to launch Texas Children’s first-ever Innovative Solutions Nursing Council that would be run entirely by staff nurses.

“While none of us had prior shared governance experience, we approached our nursing leaders, Emily Weber and Charley Elliott, who supported our idea,” said Pickett, a nurse practitioner in the Anesthesia section at Texas Children’s. “We presented our strategic plan at several leadership meetings. Our leaders supported us and assigned a senior project manager who helped us with the council start-up process.”

After months of planning, the council – comprising 12 staff nurses and an advisory team – held its first operational meeting in May 2016. The broad array of specialty areas represented on the council included physical therapy, supply chain, biomedical engineering, information services, business development, nursing quality and nursing research.

Developing solutions to support new ideas

Once a month for an hour and a half, the council and support staff meet to brainstorm new ideas, deliver strategic guidance, and create and implement action plans for nurse-led projects that address particular needs or concerns. This unique style of collaboration sets the stage for significant results.

The council receives ideas or identified needs from various sources. For example, a staff member may have a solution but not know how to get support; or a leadership initiative or staff member may identify a need, but have no clear solution for how to address the challenge. Once an idea is introduced, the process of developing a solution begins with council members conducting a thorough needs and solutions analysis.

“Combining research data, surveys and end-user feedback, we simulate and prototype the solution to develop and vet the proof of concept before presenting collaborative recommendations to leadership for their support,” Pickett said. “We are continuously evaluating and making adjustments throughout this process to ensure that the final design of the product will meet the specific needs of the end user.”

Collaboration leads to innovative solutions

Since the council was formed, the team has already reached innovative milestones that would not have been possible without support from collaborative partners and executive leaders including departmental colleagues, nursing leadership and the council leadership sponsors.

Working with Pryor Products, a leading manufacturer of IV poles and accessories, the council helped staff co-design a prototype IV pole to which an oxygen canister and chest tubes could be more easily attached. The council also worked with GCX, a worldwide leader in medical instrument mounting, to develop a more secure method for mounting a monitor on the IV pole.

Previously in the cardiovascular intensive care unit, the attachment of these medical items created a patient safety concern. Oxygen tanks were hung too loosely, allowing them to swing. Monitors and chest tubes were tied to the poles with rope and secured with tape and trach ties. Heart line transducers were hung at inappropriate levels and would not fit on the poles at patient level.

“Our innovations provide a safe and secure holder for oxygen tanks and chest tubes,” Keith said. “We now have a mount on the IV pole that keeps our monitors visible and holds them securely in place and a pole extension for our transducers that will remain at the appropriate level of the patient.”

Another example was the production of a 360-degree virtual reality video that simulated, inside a pre-construction mock-up space, proposed neurosurgical and MRI facilities for Texas Children’s Legacy Tower. The video proved to be a valuable tool that allowed the team and leaders involved in the design process to re-evaluate the space in real time.

“This video has benefited staff and leaders because it provides a 360-degree view of the room,” Keith said. “The viewer can select which point of view to experience by simply restarting the video and changing their focus.

The council has many more projects in the pipeline, including developing solutions to reduce neonatal vibration in isolettes and resolving skin care challenges in patient care units.

“Our council is a huge resource for Texas Children’s,” said Bentley, a nurse with Texas Children’s Kangaroo Crew. “Employees and staff now have a place where their ideas can take root, be nurtured, and one day produce measurable outcomes for patients and their families. We are grateful to our leaders for their instrumental and continued support that led to the success of this project.”

August 1, 2017

As a mother to three young boys, Sarah Yarbrough made sure her babies received the best life-saving gift she could give them – her own breast milk. While breastfeeding has many health benefits for infants, Yarbrough knows the challenges that new mothers often experience during their breastfeeding journey.

“After the birth of my first baby, I had a lot of difficulty with breastfeeding,” said Yarbrough, a lactation consultant at Texas Children’s Pavilion for Women. “Without the help of a very dedicated postpartum nurse and my mother, I would have had a much harder time.”

Besides being a mom, Yarbrough finds her job at the Pavilion for Women very rewarding – educating new mothers on the health benefits of breastfeeding and helping them achieve their breastfeeding goals.

“We assist mothers with positions and techniques for breastfeeding and develop individualized care plans for families when feedings aren’t going as planned,” Yarbrough said. “We also assist families in all areas of the hospital with their unique breastfeeding situation including NICU moms who need help getting their milk supply established so they can feed their pre-term infants at the appropriate time.”

As a designated Baby Friendly Hospital, the Pavilion for Women has implemented several evidence-based breastfeeding practices which include teaching moms to respond to their infant’s early feeding cues rather than schedule feedings, implementing skin-to-skin contact between mom and baby after delivery and encouraging “rooming in” so mothers and infants can stay together 24 hours a day.

The Pavilion for Women provides other breastfeeding support services which include:

  • Baby Bistro provides one-on-one consultation with an International Board Certified Lactation Consultant. Prenatal and postpartum outpatient visits are available by calling 832-826-8881.
  • The Bistro is located inside Bella Luna Boutique on the third floor of the Pavilion for Women. The Bella Luna provides breast pumps for purchase or rental. Employees pay a monthly rental fee, but have the opportunity to get reimbursed through Texas Children’s Blue Cross Blue Shield insurance provider.
  • Employee pumping locations are located at all Texas Children’s Hospital campuses.
  • Mother’s Milk Bank prepares more than 800 syringes or bottles of milk each day for an average of 100 infants in the neonatal intensive care unit based on instructions provided by physician. Mothers who produce a surplus of breast milk can donate their supply to the Mothers’ Milk Bank.
  • Educational classes on breastfeeding are offered at the Pavilion for Women.

“When I began working at the Pavilion for Women, I was amazed at the amount of support given to breastfeeding moms, not only by the lactation team, but the entire Pavilion staff,” Yarbrough said. “To me, this supportive environment is the ideal place to deliver a baby.”

In recognition of World Breastfeeding Week from July 31 to August 4, the Pavilion for Women’s lactation support team has several activities planned including an event on Wednesday, August 2, at The Auxiliary Bridge that will include games, prizes and a photo booth.

July 18, 2017

Three years ago, Texas Children’s Hospital West Campus opened an eight-bed Pediatric Intensive Care Unit thanks to a generous $1 million donation by the Lauren and Lara Camillo family. This fall, the last chunk of a $50 million capital improvement effort will expand the unit to 22 beds.

Construction on the project hit a midway point this summer and is expected to be complete in October, providing Texas Children’s West Campus and the entire Texas Children’s system with an opportunity to serve more patients and families that need our care.

Initially, 16 of the beds will be used for intensive care and six will be for acute care. Two of the intensive care beds will have negative pressure and can be used for isolation. All of the beds provide more privacy for our patients and families, as well as better visibility and workflow for our nurses and other medical staff.

Located on the fourth floor of the hospital and painted in calming pastels, the unit expansion includes two large nursing stations advanced practice provider workspace, a simulation room, nutrition room, lactation room, call room and conference space.

The patient rooms are spacious and have a private bathroom and seating/sleep area for family. The rooms are lined with windows that face outside, letting in sunlight and allowing for great views of the hospital grounds and surrounding community. The rooms also include several windows that face nursing stations and adjoining rooms, giving medical staff ample visibility at all times.

Equipment in the rooms and on the floor is robust and includes two blood gas machines for respiratory therapy and additional nurse station monitors. In the future, some of the rooms will be able to offer patients who need dialysis the capability of doing so from the comfort of their beds.

Also in the future, six of the rooms will have the ability to be converted into Neonatal Intensive Care Unit rooms. As a result, the unit will incorporate NICU design features such as a family transition room, lactation room and separate entrances to the NICU section of the unit.

“The design of this unit is extremely family friendly,” said Erica Ventura, one of three patient care managers in the PICU. “From the patient rooms to the nursing stations, everything is being constructed with the patient and the medical staff in mind.”

Karen Sripan, assistant clinical director of the PICU, agreed and said the planning and design of the PICU expansion has been going on since March 2016 and was comprehensive.

“We were very thoughtful in our design and engaged staff throughout the entire process,” Sripan said. “We also were mindful of ensuring room design consistency with the Woodlands PICU so that the layout of the rooms are familiar to staff and providers working at both campuses.

PICU Medical Director Dr. Matthew Pesek said he is very excited about the expansion and working in a space that is so geared toward patients, families and medical staff.

“Our staff will have a lot more mobility due to the large size of the patient rooms and families will have a lot more privacy,” Pesek said. “These two things alone will go a long way.”

The PICU expansion is the last project funded by a $50 million capital improvement effort that aimed at growing West Campus’ capacity and capability. To date the following projects have been completed:

  • Additional office and administrative support space for dedicated physicians and providers
  • An 18-bed expansion of the hospital’s acute care capacity, including a special isolation unit designed for children with highly contagious infectious diseases
  • Conversion of offices within ambulatory clinics into additional exam rooms to increase outpatient subspecialty access
  • A dedicated suite for Interventional Radiology service
  • A new 14 exam room clinic for Neurology, Renal & Dermatology

“Since the hospital opened in 2010, West Campus has continued to grow along with its surrounding communities,” said West Campus Assistant Vice President Sara Montenegro. “Texas Children’s is committed to continuing this growth and support of our patients and families in West Houston.”

July 17, 2017

Dr. Huda Zoghbi, director of the Jan and Dan Duncan Neurological Institute at Texas Children’s and professor in the departments of pediatrics, molecular and human genetics, neurology, and neuroscience at Baylor College of Medicine, received the 2017 Switzer Prize from the David Geffen School of Medicine at UCLA for excellence in biological and biomedical sciences research.

The Switzer Prize recognizes discoveries in basic research in the biological and biomedical sciences that have the potential to inspire transformative breakthroughs in medicine. It is awarded annually to an individual investigator whose recent work has revealed new paradigms, illuminated biological processes or pathways, or explained the origins of pathologies or diseases.

The David Geffen School of Medicine at UCLA established the prize to promote the importance of basic sciences research, which advances the understanding of biological systems and human physiology. Such research – a priority at UCLA – is essential to continued improvements in the diagnosis and treatment of a wide variety of illnesses.

The Switzer Prize is named in recognition of the generosity of Irma and Norman Switzer, who made a major gift to the David Geffen School of Medicine at UCLA.

Zoghbi’s research includes identifying a gene mutation that causes Rett syndrome, a severe genetic disorder that mostly affects girls. She will deliver the Switzer Prize lecture at UCLA in February 2018.