September 9, 2014

91014milk640

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

9414conjoinedtwins640

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.

9414TheWomensPlace640

Hormonal changes during and after pregnancy may trigger depression in some women. In fact, between 10 and 15 percent of pregnant women and new mothers may experience some symptoms of depression. But their condition can be far more than simply feeling “blue” or “down.” For many, it can have a debilitating effect on their health, their family, their careers and their relationships.

To address the need for earlier screening and treatment of maternal depression, the Texas Children’s Pavilion for Women launched a pilot program in May to screen patients multiple times throughout their pregnancy and postpartum period. The effort is part of the Women’s Mental Health Delivery System Reform Incentive Payments (DSRIP) program, focusing on expanded access to health care services.

“Our goal is to identify women with maternal depression as soon as possible and get them into care because maternal depression is treatable,” said Dr. Lucy Puryear, medical director of The Women’s Place – Center for Reproductive Psychiatry and Baylor College of Medicine psychiatrist, who oversees the program. “How we deal with this can have a profound impact not only on the physical and emotional well-being of the mother, but on the life of the child and the family overall.”

As part of the program, women are screened for maternal depression using the Edinburgh Postnatal Depression Scale multiple times throughout their pregnancy (during the first and third trimesters) and postpartum (at two weeks in the pediatrician’s office and at six weeks by their obstetrician), and those requiring follow-up mental health services are referred for care.

“Our overriding goal is to learn from the patients we’re currently screening in order to develop a model for the early diagnosis and treatment of maternal depression using several combined strategies,” said Dr. Puryear. “Texas Children’s Pavilion for Women is uniquely positioned to oversee this project because of the unique Reproductive Psychiatry program and faculty at Baylor College of Medicine.”

Dr. Lisa Valentine, a Baylor College of Medicine psychiatrist hired to treat patients as part of this program, practices at The Women’s Place at the Pavilion for Women, The Center for Children and Women at Greenspoint and at Pearland Ob-Gyn. Two Texas Children’s Pediatrics practices, Pearland and Shadow Creek Ranch, are serving as pilot sites for the project. Providers and staff at these pilot sites have been trained to implement standardized screening and referral.

At Texas Children’s Pediatrics Pearland, every new mother is screened for postpartum depression at the initial well-child visit, which occurs approximately two weeks postpartum, referring those needing services. Referrals are processed quickly and most patients are seen within seven days of being screened. Select providers at Texas Children’s Pediatrics Shadow Creek Ranch have also begun standardized screening.

Future plans focus on educating and training staff at obstetric clinics and additional pediatric clinics to implement standardized screening and referral; adding additional providers, including a psychiatrist, therapist and social worker; and expanding to additional sites with the intent of integrating maternal mental health services where women are already seeking treatment.

9414BWNICU640

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 26, 2014

82714dietrichbook640

Reaching puberty is a rite of passage that we’ve all been through, but these days children are entering puberty at younger ages – like 7, 8, or 9 years old – compared to previous generations. It’s a trend that has many health providers and parents scratching their heads.

Precocious puberty, or early puberty, is one of several topics that Dr. Jennifer Dietrich and her colleagues explore in their newly published book titled, “Female Puberty: A Comprehensive Guide for Clinicians.”

“Things have changed compared to 100 years ago,” said Dr. Jennifer Dietrich, chief of pediatric and adolescent gynecology at Texas Children’s. “Our nutrition today is different than it was back then. There are environmental factors, including childhood obesity, that potentially could impact the age at which children reach puberty. Our book explores all of these topics.”

The 159-page comprehensive manual is categorized into three main areas – normal, early and delayed puberty – and covers a spectrum of puberty-related topics and up-to-date clinical recommendations to help physicians better care for their patients, while making this journey through adolescence easier for moms and their daughters.

“Female Puberty: A Comprehensive Guide for Clinicians” examines case studies and current data trends on puberty, the potential impact of environmental factors and childhood body weight on the age of puberty, and whether the age of puberty is changing or is simply being measured and diagnosed differently.

Dietrich says it took years of rigorous research, intensive writing and multiple rounds of edits to bring this project to fruition. She and her colleagues – many of whom completed their fellowship in pediatric and adolescent gynecology at Baylor College of Medicine – were each assigned a chapter to write in six months before all the material was submitted to Springer for final approval.

“I am glad that Springer published our book,” said Dietrich. “I believe this will be an invaluable resource tool for all clinicians who specialize in female reproductive health including obstetrician gynecologists, reproductive endocrine specialists, pediatricians, family practitioners and allied health professionals.”

Dietrich’s book will be highlighted at upcoming conferences of The American Society for Reproductive Medicine, North American Society for Reproductive Medicine, North American Society for Pediatric and Adolescent Gynecology, and The American College of Obstetrics and Gynecology.

If you’re interested in purchasing the book online, click here for more information.

82714fooddesensitization620

For kids with allergies, a trace amount of a food substance can trigger deadly anaphylaxis within minutes of ingestion – the fear of which can be life altering for many families.

Researchers at Texas Children’s Hospital are looking to give hope to some of these families through a landmark peanut immunotherapy trial. Using a process known as desensitization where patients swallow tiny, increasing amounts of peanut over time, Dr. Carla Davis, a specialist in the Allergy and Immunology Section of the Department of Pediatrics at Baylor College of Medicine, will begin a trial this month that treats children with peanut allergy to help lower the risk of severe allergic reactions and eventually cause them to lose their allergy to peanuts. The study also will determine the mechanism by which the body develops tolerance, as well as measure the effect of viral infections on the ability of peanut allergic children to take peanut flour.

In Europe, a recent oral immunization trail (OIT) showed promise, and both the Consortium for Food Allergy Research and Stanford University are conducting studies in the U.S. But so far desensitization is not the standard of care, and no study has determined the mechanism by which the body develops tolerance. Davis’ plan to monitor how and why the immunotherapy works is revolutionary, and could help allergists ID patients who are good candidates for immunotherapy.

“No other immunotherapy trial in this area has used the state of the art laboratory testing of immune cells to improve the process of desensitization,” said Davis. “We believe the information gained from this trial will help make the process of desensitization faster and more efficient in the future.”

Davis and her team, in collaboration with Dr. Jordan Orange’s Center for Human Immunobiology and the Center for Cell and Gene Therapy, will be evaluating more than 25 markers of cells called lymphocytes, which are central to controlling immune responses. Patients will have blood drawn, and these markers will be evaluated by a process called flow cytometry. The markers will provide insight into how the immune system works to cause food allergy.

“Our study is evaluating clinical measures but in conjunction with the lymphocyte markers that will give us a better way to treat and potentially cure food allergy,” said Davis.

One in 13 U.S. children has a food allergy according to recent data from national organization FARE (Food Allergy Research and Education). This reflects a nearly 50 percent increase in childhood food allergies between 1997 and 2011, leading to 25 billion dollars per year in related health costs to treatment and diagnosis.

People can be allergic to any type of food, but eight foods account for nearly 90 percent of all allergic reactions to food in the U.S., with peanuts being the food that is most associated with life threatening food related anaphylaxis. More than 400,000 school-aged children in the United States have this allergy, according to the American College of Allergy, Asthma and Immunology.

“We chose this food (peanuts) to make the largest difference in safety for our patients,” said Davis.

Texas Children’s is the first center in the southwest region to have approval by the FDA to dispense peanut flour as an investigational new drug. The study will be funded by donations to the Food Allergy Program, with the majority of funds from a private group of individuals in the Food Allergy Advisory Group. Initially, 20 patients will be enrolled, with the potential to enroll hundreds more over the next three years, with the help of expanded funding.

August 19, 2014
82014FinegoldScholarship640
Dr. Milton Finegold (right), chief emeritus, Department of Texas Children’s Pathology, congratulates Finegold Award recipients Cherish Sullivan (from left), daughter of Yovaletta Sullivan, Labor and Delivery; Kayla Evans, daughter of Danyalle Evans, Nursing Float Pool; and Paolo De Jesus, son of Ruby De Jesus, 10 WT/Neurology/Neurosurgery/Epilepsy Monitoring Unit.

Finegold established the scholarship in 1985 in memory of his wife, Joan, a nurse, to help the children of Texas Children’s registered nurses fulfill their educational goals. The applicant (registered nurse) must be an employee of Texas Children’s for a minimum of two years on or before May 1 of the year of application.