March 10, 2015

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Texas Children’s Hospital announced on February 26 a recognition of Chevron Corporation’s long-term support of the hospital’s global health programs with the dedication of “The Chevron Bridge,” the walkway linking the Abercrombie Building and the Feigin Center.

Since 2011, Chevron has invested more than $16 million in Texas Children’s Hospital programs in Africa and Latin America. That funding includes the corporation’s most recent announcement of $5 million to support the Angola Sickle Cell Initiative over the next five years.

“We value the opportunity to support remarkable doctors who provide critical day- to-day pediatric and maternal health care while training in-country care givers to help build a legacy of greater health expertise,” said Ali Moshiri, president of Chevron Africa and Latin America Exploration and Production Company.

Chevron, Texas Children’s Hospital, Baylor College of Medicine and the Angolan Ministry of Health partnered four years ago to establish the Angola Sickle Cell Initiative, the first program of its kind in the country. Angola has one of the world’s highest rates of the genetic blood disease. More than 10,000 babies are born with sickle cell each year.

To watch a video about the Angola Sickle Cell Initiative click here.

“For these babies, Chevron’s support is the difference between life and death,” said Dr. Mark W. Kline, physician-in-chief at Texas Children’s Hospital and founder of the Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital. “Without the sickle cell program, they would have been sick at an early age and very likely would have died before reaching age of five.”

The program, led by Texas Children’s Cancer and Hematology Centers, tests newborn babies, provides treatment, patient and family consultation, and helps train Angolan health care professionals. Through the program more than 96,000 babies have been tested for sickle cell, and the program has trained more than 500 Angolan nurses, lab technicians and social workers.

The company’s funding also has helped expand Texas Children’s Global Health Corps, which recruits and trains American-trained pediatricians and family doctors for long-term assignments in Africa in pursuit of a two-part mission: 1. expanding access to lifesaving care and treatment for some of the world’s poorest and least fortunate children, and 2. training local health professionals to build capacity for pediatric health care that currently does not exist.

Chevron’s contributions helped support the Global Health Corps assignments in Liberia and new programs are being evaluated for Morocco and Argentina.

In 2014, Chevron, Texas Children’s Hospital and Baylor College of Medicine also partnered to create a health program in a remote region of Colombia. The program called SAIL focuses on caring for children under age five and expectant mothers with the goal of reversing the high child and maternal morbidity and mortality rate. Chevron’s funding supports doctors who treat families in the Wayúu indigenous community of the Riohacha and Manaure Municipality in La Guajira state where hospitals and clinics are difficult to reach and food security is an issue.

“We are grateful for Chevron’s continued support, which has helped enormously in our programs to fight devastating diseases and improve child and maternal health care,” said Kline. “The relationship has evolved and I imagine it will evolve further. What is exciting to me is that our partnership represents several different projects on two continents serving thousands of children and families in need. I look forward to where we will be working together next.”

March 3, 2015

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Texas Children’s Hospital recently hosted its first craniosynostosis reunion, bringing together 150 people who have been touched by a condition that causes one or more of the seams between the bones of a baby’s skull to close prematurely.

“For parents of babies with craniosynostosis, it is a scary and stressful time,” said Dr. Sandi Lam, a neurosurgeon and co-director of the Craniosynostosis Surgery Program at Texas Children’s. “Families want to know they are making the right choices for their little loved ones. Connecting them with other parents who are going through the same thing provides a level of support that is irreplaceable.”

At the February 7 reunion, patients who have had craniosynostosis surgery at Texas Children’s Hospital joined their families and gathered at the Meyer Building for a few hours of fun, games and camaraderie. Child Life specialists and volunteers from Neurosurgery and Plastic Surgery hosted sports-themed activities for the children while parents shared stories over coffee and kolaches. A group of mothers who had met and chatted about craniosynostosis online got to meet each other in person at the reunion and were thrilled to be invited to the same event.

“Families tell us this type of patient networking event is amazing because it proves they are not alone,” said Sandra Galvan, coordinator of the program. “They have no doubt we at Texas Children’s will be here for them, delivering superb care for their families, neighbors and friends in Houston and across the nation.”

Craniosynostosis affects one in 2,000 babies and usually requires surgery to separate the fused skull bones to achieve a normal appearance and to allow a baby’s brain to continue to grow and develop properly. Here at Texas Children’s, we have a team of specialists dedicated to treating craniosynostosis. Pediatric craniofacial plastic surgeons Dr. Laura Monson, Dr. David Khechoyan and Dr. Edward Buchanan and pediatric neurosurgeons Dr. Sandi Lam and Dr. Robert Dauser work together to provide the best care for children and their families.

In addition to having the highest quality surgeons on hand to correct the defect and a dedicated team to care for the children before and after surgery, Texas Children’s Hospital has formed a parent-to-parent network to match pre-operative patients’ families with post-operative patients’ families to support each other.

“It has been an incredible experience to see how generous, brave and wonderful our families are,” Lam said. “Many parents want to give back and share. The reunion gives them the opportunity to do just that.”

February 24, 2015

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During the early morning hours of February 17, Elysse Mata sat holding her babies tightly, kissing them as tears ran down her face. She was saying goodbye to her girls, conjoined for the last time before undergoing a historical surgery that would offer them their first chance at separate lives.

“We’ve been waiting for this moment for a year,” Elysse said. “Ever since we found out the twins were conjoined, we’ve been praying and hoping this day would come.”

Conjoined twins Knatalye Hope and Adeline Faith Mata – known by their family simply as Hope and Faith – were born at Texas Children’s Pavilion for Women on April 11, 2014 via Caesarean-section at 31 weeks gestation after weeks of extensive prenatal imaging, multidisciplinary consultation and planning at Texas Children’s Fetal Center. The babies each weighed 3 pounds, 7 ounces.

Surgeons allowed the girls to grow and gain strength for 10 months before undertaking the difficult task of separating them. During that time our comprehensive team of surgeons, physicians, nurses and support staff prepared for the day that had finally arrived. The lead surgeons had met and thoughtfully examined every aspect of their procedure, the simulation staff prepared the team for complications, and Critical Care nurses were readying the PICU for the girls post-surgery.

Letting go

In those quiet, prayerful moments before the surgery, Elysse’s husband, John Eric, and their 5-year-old son, Azariah, were also near, kissing the girls’ foreheads and squeezing their tiny hands while they anxiously awaited the start of the surgery that would change the girls’ lives forever. A group of extended family, friends and a Texas Children’s Hospital chaplain joined the Matas for an emotional prayer.

Lead surgeon Dr. Darrell Cass entered the room, gave the family a hug, and with the help of supporting operating room staff, escorted the girls to Texas Children’s Operating Room 12. Members of the girls’ NICU care team, who had been by their sides for almost a year, lined the hallways in an emotional show of support.

Just after 7 a.m., Hope and Faith were wheeled into the operating room where a team of 12 surgeons from seven specialties, six anesthesiologists, eight highly trained nurses and support staff spent nearly 24 hours performing an operation that would eventually separate the twins.

Surgery begins

During the first few hours of the procedure, Anesthesiologist Dr. Helana Karlberg and Surgical Nurse Audra Rushing prepped the girls for surgery. At 1:10 p.m., Chief of Plastic Surgery Dr. Larry Hollier made the first incision. For the next 18 hours, the surgical team worked in shifts to separate the twins, who shared a chest wall, pericardial sac (the lining of the heart), diaphragm, liver, intestines, bladder, uterus and pelvis.

As the surgeons continued the difficult task, family and friends gathered in a large, room praying and supporting the parents while they waited for updates from the surgical team.

“This is the (most difficult) feeling ever,” said John Eric Mata as he and Elysse waited for their first in-person update. “It’s giving me too much time to think. I’ll be a lot more comfortable when they say they are separated. I’m ready for that.”

At one point, the family was told there had been a rocky part in the procedure when the twin’s livers were being operated on. During that process, surgeons explained there was quite a bit of blood loss and that the anesthesiologists and cardiologist in the room had to keep up with that and maintain the girls’ blood pressure.

“At times it was difficult,” Hollier said. “But it was controlled very rapidly, allowing us to move on with the procedure.”

Hours later, Eric and Elysse heard the answer to months of prayers when Pediatric Surgeon Dr. Oluyinka Olutoye met them in a private consult room and delivered the good news – the twins had been successfully separated.

“This is the farthest they’ve been from each other,” Olutoye said when we greeted the family around 1 a.m. “They’re about 30 feet apart right now.”

They are two

Separate for the first time, the twins were taken to different operating rooms where surgeons continued to work on the girls’ critical organs. Just before 10 a.m., the surgery was complete, and the family visited their girls, apart for the first time in rooms next to each other in the PICU, where they are being cared for by a team of their NICU primary nurses and their new PICU nurses.

Elysse said she and her family are extremely grateful for the team that separated her babies, and the countless hours they put into understanding the girls’ condition, and how best to treat and care for them.

Cass and several of the other surgeons, including plastic surgeon Dr. Ed Buchanan, met the family in Adeline’s room to share in the family’s joy and relief. They gave the family a summary of the monumental procedure and explained what they should expect in the next few days.

“Thank you for your trust,” Cass said to the Mata family. “We are going to keep doing everything we can to get them through this. So far, so good.”

Hollier said that to the best we know this is the first time a case of this magnitude – conjoined twins connected at the chest, abdomen and pelvis – has ever been done.

“It could not have gone better,” he said. “It was phenomenal team work and great preparation on the part of the institution.”

Click on the photo to view a gallery showing the Mata’s journey to separation.
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A dream realized

By late morning Wednesday, February 19, Elysse and John Eric were again with their babies, watching over their girls, now in two beds, in adjoining PICU rooms. It was a moment they had been waiting for since more than a year ago when a routine ultrasound revealed that Elysse was carrying conjoined twins. They traveled from their hometown of Lubbock to Texas Children’s Fetal Center, where the next chapter of their journey began.

Today, their family has a promising new chapter, thanks to the compassionate expertise of our physicians, nurses and countless staff and employees.

“We love them,” Elysse said of the girls’ medical team. “They mean the world to us, and they will forever hold a special place in our hearts.”

Conjoined Twins Separation Surgical Team

  • Plastic Surgeon Dr. Ed Buchanan
  • Lead Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Darrell Cass
  • Chief of Pediatric Gynecology Dr. Jennifer Dietrich
  • Pediatric Urologist Dr. Patricio Gargollo
  • Transplant Services Surgeon Dr. John Goss
  • Anesthesiologist Dr. Kalyani Govindan
  • Chief of Plastic Surgery Dr. Larry Hollier
  • Lead Anesthesiologist Dr. Helena Karlberg
  • Plastic Surgeon Dr. David Khechoyan
  • Pediatric Urologist Dr. Chester Koh
  • Cardiovascular Surgeon Dr. Dean McKenzie
  • Pediatric Surgeon and Co-Director of Texas Children’s Fetal Center Dr. Oluyinka Olutoye
  • Anesthesiologist Dr. Olutoyin Olutoye
  • Chief of Orthopedics Dr. William Phillips
  • Lead Surgical Nurse Audra Rushing
  • Anesthesiologist Dr. Steve Stayer

Learn more about the Mata twins and the preparation Texas Children’s team took on to care for the girls:
Mata conjoined twins born at Texas Children’s
Tissue expander surgery allows twins to prepare for separation surgery
Mata twins’ care team helps create swing for baby girls
Radiology team helps prepare surgeons for separation surgery with 3D model

February 17, 2015

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Around 100 BC acupuncture simulation was used and recorded in China. The long history of simulation has helped health care workers learn difficult procedures and manage high risk or complex patient care situations before they’re done on actual patients. It’s a sort of “practice” for real life situations in the clinical world. In 1910 life-like simulators were created. While Texas Children’s has been practicing simulations for many years, five years ago, under the leadership of Dr. Jennifer Arnold, neonatologist and medical director of Texas Children’s Simulation Center, the simulation center was created. It is a dedicated space in the Feigin Center which gives caregivers a safe space to practice life-like situations with simulators which react just as humans would.

In November, simulation experts from the Center for Medical Simulation (CMS) at Massachusetts General Hospital and Harvard Medical School held a four-day course, the Institute for Medical Simulation (IMS) course, for health care providers interested in or already leading simulation efforts across Texas Children’s. The course is one of the most comprehensive and immersive simulation training programs available and focuses on how to implement best practice simulation for improving quality, patient safety, and education. Four days of theory, practice, and reflective feedback create a truly experiential education where our simulationists develop a strong and comprehensive understanding of how to most effectively use simulation within their departments and educational programs.

“The goal of bringing the IMS course to Texas Children’s is to transform our simulationists to be outstanding simulation educators,” Arnold said.

“This course is a chance to have top experts in the field teach us about debriefing after a simulation exercise,” said Cara Doughty, Emergency Center physician.

Debriefing during or after simulation is singularly the most critical aspect to a successful simulation activity. It is where the learning occurs. Debriefing involves a discussion led by a trained expert reviewing what went right, how each person performed, what should have been done differently and how this situation could be improved in the case of a real-life scenario. It also is the most challenging aspect of implementing simulation, typically debriefing techniques are not instinctive to most healthcare providers and require rigorous practice.

Simulations can take place both at the Simulation Center and in real patient care settings like the operating rooms. Bonnie Eaton, a nurse in the operating rooms, has seen a great benefit with being involved in these courses as well as encouraging more simulations for operating room staff.

“It’s reassuring to the staff to have the ability to practice these scenarios before they are experiencing them with real patients,” said Eaton. “In the ORs, we are trying to develop a program to get all of the staff involved in simulations.”

Arnold has been a major advocate of bringing more simulation training activities to all areas of the hospital. Currently, simulations are done with clinicians from almost every area of the hospital and simulation scenarios have helped the staff prepare for major surgeries like the Mata conjoined twins separation surgery, and even for the possibility of a patient with Ebola visiting the hospital. Simulations play a key role in preparing the staff for these rare cases and helping determine the best course of action.

The simulation experts from CMS come from diverse backgrounds, but all have simulation educational expertise in common. Dan Raemer, PhD, has a background in bioengineering and is an expert in teamwork and crisis resource management. Walter Eppich, MD, Med, is a pediatric emergency medicine physician and is an expert in debriefing and faculty development. Kate Morse, PhD, MSN, RN, is a critical care advanced practice nurse and an expert in interprofessional education.

“Having Drs. Raemer, Eppich, and Morse here really re-energized the overall simulation program at Texas Children’s Hospital,” said Kelly Wallin, assistant director of Texas Children’s Simulation Center. “It is vital that we continue to develop and support a strong expert team of simulationists across the institution so we can implement simulation activities in all patient care areas.”

Not only did the visiting faculty lead a 4 day course for 20 simulationists here at Texas Children’s Hospital, but Dr. Raemer gave two innovative grand round presentations, one to pediatric surgery and the other to pediatrics. Simulation is becoming a more recognized and even standardized quality and safety tool across the nation and even internationally.

“We need to support and develop simulation activities not only to be a leader in quality, safety and education, but also to better serve our patients,” Arnold said. “The simulation center resides within the Quality and Safety Department at Texas Children’s Hospital because we recognize the value of it to patient care outcomes and safety.”

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Due to our success in treating the most severe cases of morbidly adherent placenta, Texas Children’s Pavilion for Women continues to attract numerous patients from across the country. With the rise of caesarean births in the U.S., this potentially life-threatening condition is becoming more common among pregnant women.

Morbidly adherent placenta – known as placenta accreta, increta or percreta, depending on the depth of uterine invasion – occurs when the placenta and its blood vessels grow deeply into the wall of the uterus and is unable to detach after childbirth. Women who have had prior caesarean sections (C-sections) or other uterine surgeries are more at risk for this pregnancy complication since the placenta latches on to the surgical scar too firmly. About 5 to 7 percent of women die due to massive hemorrhage.

“The number of women with morbidly adherent placenta that we care for is rapidly escalating as our outcomes continue to attract a growing number of referrals,” said Texas Children’s OB-GYN Chief Dr. Michael Belfort, a world-renowned placenta accreta expert and founder of the Morbidly Adherent Placenta Program at Baylor College of Medicine. “Our success is rooted in our ability to work as a team.”

Women with morbidly adherent placenta receive multidisciplinary care from a diverse group of specialists representing maternal-fetal medicine, gynecologic oncology, anesthesiology, urology, neonatology, radiology and blood bank services.

“Our multidisciplinary team works closely with the hospital’s blood bank to ensure adequate supply of blood products is available for surgery and to help manage transfusions,” said Texas Children’s Maternal-Fetal Medicine specialist Dr. Karin Fox. “We rely on our anesthesiology team to administer blood and draw labs to ensure electrolytes remain stable in addition to keeping the patient comfortable. Urologists provide expertise when the placenta embeds itself into the urinary system.”

The approach that gynecologic oncology surgeons use to remove uterine cancer inspired the technique used to treat placenta percreta since the abnormal placenta acts like a cancer invading the outside of where it is supposed to be growing.

“We take a wider approach when we perform a hysterectomy to reduce the potential for blood loss,” said Texas Children’s gynecologic oncologist and surgeon Dr. Concepcion Diaz-Arrastia. “We remove the uterus and cervix in a modified radical hysterectomy along with a small amount of the tissue that attaches the uterus to the pelvis as if it were cancerous.”

Khadajah Winchester credits the Pavilion for Women’s highly skilled team of physicians who meticulously prepared and planned for her emergency surgery. She was airlifted from a hospital in Alexandria, Louisiana to the Pavilion for Women.

Winchester – who had two previous caesarean deliveries – had placenta percreta where the placenta invaded part of her bladder. Physicians made an incision high on Winchester’s uterus to avoid touching her placenta. Despite minimal bleeding during the actual delivery of her 6-pound 7-ounce baby girl Brooklyn, Winchester began bleeding profusely from the numerous vessels that had fed her invasive placenta and required a 25-pint massive blood transfusion.

“I hardly had blood pumping through my veins and if I had not gone to the Pavilion for Women, I would have died,” Winchester said. “Hospitals in smaller communities don’t carry the large volume of blood that I needed to survive.”

The Pavilion for Women – world renowned for its comprehensive, multidisciplinary care and focus on high-risk pregnancies – has treated 27 cases of placenta accreta in the last 12 months.

“Patients with risk factors for placenta accreta should consult with specialists early – ideally by 24 to 28 weeks of pregnancy,” said Texas Children’s Maternal-Fetal specialist Dr. Alireza Shamshirsaz. “Early diagnosis prior to delivery is crucial to allow time for planning and preparation to enhance the best possible outcomes for mother and baby.”

Click here for more information about Baylor’s Morbidly Adherent Placenta Program at the Pavilion for Women.

February 10, 2015

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Living with pelvic health issues isn’t easy. Many women are too embarrassed to talk about it. Some simply don’t know where to turn, while others struggle to find a physician who will listen to them.

Texas Children’s Pavilion for Women is changing that, and the lives of our patients.

In partnership with Baylor College of Medicine Department of Obstetrics and Gynecology, Texas Children’s Pavilion for Women recently launched the Pelvic Health and Wellness Program to improve the quality of life for women suffering from pelvic disorders and sexual dysfunction.

While incontinence, overactive bladder, pelvic organ prolapse and low libido are more common in women over 50, these conditions affect women of all ages. Studies estimate more than 40 percent of women will experience symptoms related to incontinence, prolapse, or pain with intercourse in their lifetime.

“We understand the toll these disorders can take on a woman’s physical and emotional well-being,” said Dr. Anuja Vyas, a Texas Children’s gynecologist and obstetrician who specializes in the diagnosis and treatment of vulvovaginal disorders. “Our team takes the time to listen to our patients’ needs and tailor a customized treatment plan for every patient to achieve the best possible outcomes.”

Many patients who are referred to the Pavilion for Women have already seen countless physicians who have unsuccessfully treated their condition. When they come to our facility, they receive comprehensive care from a multidisciplinary team of specialists representing diverse areas of expertise:

  • Urogynecology
  • Vulvovaginal health
  • Menopause health care
  • Reproductive psychiatry
  • Obstetrics and gynecology
  • Physical therapy
  • Surgery (cutting-edge technology)

The Pelvic Health and Wellness team also includes nurse practitioners, licensed biofeedback therapists, massage therapists and sexual counselors, all collaborating to improve the health of women during every stage of their reproductive lives.

From diagnosis to treatment – whether it is physical therapy, mental health, or minimally invasive surgery – women receive the full complement of services in one centralized location.

“We know what our patients are going through and we want to help them,” said Texas Children’s surgeon Dr. Francisco Orejuela, a urogynecologist who is board certified in female pelvic medicine and reproductive surgery, and specializes in treating women with pelvic floor disorders. “The sooner they come to us, the greater our success in treating them, and the faster they can return to their normal lifestyle.”

For more information about the Pelvic Health and Wellness program, click here.

Click here to watch a video spotlighting the world-class, gynecologic care provided to women of all ages at the Pavilion for Women.

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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.