February 23, 2016

22416simulationinside640The neonatal team at Texas Children’s Pavilion for Women is always prepared for special deliveries – taking care of newborns is what they’re trained to do. But earlier this month, the neonatal intensive care unit (NICU) received a special delivery that wasn’t quite what you’d expect.

Texas Children’s Simulation Center hosted an open house to introduce Tory, a high-fidelity infant mannequin, and the newest addition to the first-ever Neonatal Comprehensive In Situ Simulation Program launched at the Pavilion for Women’s Newborn Center. The simulation equipment and supplies were purchased with a generous $200,000 grant from the M.D. Anderson Foundation, which will also support an in situ simulation program for the Emergency Center and Critical Care, as well as one for the NICU in West Tower once a dedicated space for simulation has been identified.

“We’re grateful to our Newborn Center leadership for dedicating a simulation room at the Pavilion,” said Dr. Jennifer Arnold, medical director of the Simulation Center. “Now, our NICU providers can train in their actual practice environments during regular workdays to enhance individual and team performance – particularly in high-risk situations – and improve patient outcomes and safety.”

The in situ simulation program focuses on improving crisis resource management skills, one of which is role clarity. During a code, the potential for confusion and chaos can easily set in as responders attempt to care for a patient in a high-risk medical emergency. Clinicians responding to a code may not always be sure of their roles or the roles of their team members when they arrive, and that’s when in situ simulation training becomes crucial to patient safety and care.

“First, we conducted tests to determine the necessary roles in a crisis, whether it’s a resuscitation or a code,” said Dr. Mona Khattab, one of the in situ simulation program directors for the NICU. “By having the necessary personnel at the code, we alleviate staff overcrowding and ensure optimal efficiency and clear communication are achieved while delivering lifesaving treatment to our NICU patients.”

Inside the simulation room, colored labels – red, yellow and green – are affixed to the floor that encircle the bedside. These labels identify the specific roles of each of the code response participants and directs them to their position on the floor during a medical emergency.

  • The red team consisting of clinicians and nurses stand in the innermost circle closest to the bedside where they provide direct patient care.
  • The yellow team is positioned behind the red team. They support patient care providers by documenting the code, handing over equipment, managing the ventilator and medication and blood prep drawers, and providing mentorship and consultations to the team leader as needed.
  • The green team stands in the back of the room near the code cart and provides overall code and room support to ensure everything is running seamlessly.

“When a text message page is sent, the unit reports to the simulation room as if it were an actual page in the unit to respond to a code,” said Kellie Kainer, assistant director of Nursing for the NICU at the Pavilion for Women. “We give them a brief history of the patient and alert them to the code.”

The in situ simulations will occur every Thursday and last 10 minutes followed by 20 minutes of debriefing. The NICU teams alternate every week and are selected based on their current assignment and the flow of the unit on that particular day.

“We’re focusing on one specific patient case so that everyone gets exposure to that case,” said Dr. Leigh Ann Cates, a neonatal nurse practitioner and a program director for the in situ simulation program. “As our program expands, we hope it will become a model for in situ simulations in other units of the hospital.”

In preparation for this training, all clinicians within the Newborn Center complete an online pre-simulation course through Healthstream. The Simulation Center developed a series of powerpoint presentations covering crisis resource management skills, an orientation to simulation, and what to expect during simulation such as a confidential and psychologically safe learning environment.

February 16, 2016

A year ago, Knatalye and Adeline Mata lay on an operating table at Texas Children’s Hospital conjoined from the chest to the pelvis. For the next 26 hours, a team of surgeons and support staff separated the girls in an historic and intricate procedure meticulously choreographed to ensure that each step of the process would lead to and support the steps to come. Throughout the procedure, the Mata family stood by, waiting and praying for good news.

Just before 10 a.m. on February 18, 2015 the family counted their prayers as answered when they saw their girls, apart for the first time in adjacent rooms in the Pediatric Intensive Care Unit, where they were cared for by a team of specialized nurses. Since then, the almost 2-year-old twins have been discharged from the hospital and are living relatively normal lives in Littlefield, Texas with their parents Elysse and John Eric, 6-year-old brother Azariah and 5-month-old sister, Mia.

“The girls are both doing awesome,” said Dr. Darrell Cass, one of the lead surgeons in the separation case. “Neither have experienced any complications and both are making steady progress.”

Knatalye is beginning to walk, talk and eat by mouth. Adeline is meeting milestones as well. Her lungs are continuing to improve and she is slowly being weaned from ventilator support. Both girls are still undergoing physical and occupational therapy.

Several members of the medical staff involved in the girl’s care got to see how much Adeline and Knatalye have grown and how far they’ve come during a recent visit the Mata family made to Texas Children’s for follow-up appointments with pediatric subspecialists monitoring the twins’ health and development.

Aimee Renaudin, one of Adeline and Knatalye’s primary nurses in the Neonatal Intensive Care Unit, said she is amazed that the girls are doing so well.

“You would never know how they started off their lives together,” she said. “Elysee and Eric have taken such good care of them.”

Dr. Oluyinka Olutoye, the other lead surgeon in the separation case, said it’s a blessing to see how far Adeline and Knatalye have come.

“It’s always a joy to see the changes that have gone on,” he said. “They’ve gone from just being little babies to now trying to walk and talk and interact with you.”

John Eric said his daughters have far exceeded his expectations and that he and Elysee are enjoying being able to care for the girls at home.

“It’s nice to be able to have all of us together and to be able to wake up and know that they’re there,” Elysee said. “It’s fun to be able to be mom and dad, which we didn’t get to do for the first 10 months of their lives.”

The Mata family will return to Texas Children’s this summer for a checkup. During that visit, surgeons will operate on Knatalye, removing the metal struts used to stabilize her rib cage and to close her chest wall.

To read more about their journey click here. See photos from the Mata family’s latest visit to Texas Children’s below.

111914NEC640A recent Baylor College of Medicine study led by Texas Children’s neonatologist Dr. Amy Hair, and published in the journal Breastfeeding Medicine, found that premature infants weighing less than 1,250 grams at birth showed improved outcomes after being fed a human milk-based diet.

Texas Children’s and Baylor researchers compared outcomes data of more than 1,500 premature infants in four large centers in the U.S. two years before and two years after implementing an exclusive human milk-based diet in the Neonatal Intensive Care Unit (NICU). They found that babies who were exclusively fed human breast milk had a lower incidence of mortality, late-onset sepsis, retinopathy of prematurity (which can lead to blindness) and bronchopulmonary dysplasia, a form of chronic lung disease in infants.

Hair, who is also an assistant professor of pediatrics at Baylor and director of the Neonatal Nutrition Program at Texas Children’s, says feeding premature infants an exclusive human milk-based diet has also been shown to decrease the risk of necrotizing enterocolitis (NEC), a life-threatening neonatal condition that causes inflammation and death of intestinal tissue.

“Since implementing an exclusive human milk feeding protocol for newborns weighing less than 1,500 grams at birth, not only have we reduced the rate of NEC by 77 percent in our NICU, but we have seen additional benefits with this diet,” Hair said.

An exclusive human milk-based diet consists of a mother’s own milk supplemented with donor human milk and fortifier derived from donor human milk. Babies do not receive any bovine protein as formula or fortifiers. Prior to implementing a human milk feeding protocol, infants were fed mother’s own milk with bovine fortifier or formula.

“We know that human milk has immune factors, antibodies, high levels of important fat and vitamins, so it makes sense that it would work with different processes in the body to improve the overall health in babies,” Hair said.

Click here to read the journal article highlighting their study, which was funded by Texas Children’s Hospital’s Bad Pants Day golf tournament.

September 9, 2015

91015drhairaward640Dr. Amy Hair, a neonatologist and director of neonatal nutrition at Texas Children’s, recently received the Baylor College of Medicine’s 2015 Clinical Faculty of the Year Award for demonstrating “exemplary performance of activities that are above and beyond the scope of assigned responsibilities.”

Baylor colleagues nominated Hair for this prestigious award. In addition to exemplifying strong leadership and mentoring skills in her field, Hair was recognized for her ability to encourage teamwork and foster a culture of respect, integrity and excellence in patient care.

Fulfilling her clinical duties in the neonatal intensive care unit (NICU) – like providing superior care to her patients, leading weekly rounds with the NICU intestinal rehabilitation team and collaborating with dietitians to meet the nutritional needs of premature infants – Hair also devotes much of her time to advancing neonatal nutrition research to improve patient outcomes in the NICU.

A groundbreaking study led by Hair and published in the Journal of Pediatrics found that adding a human milk-based cream to the exclusive human milk diets of premature infants significantly improved their growth outcomes in the NICU. As a result of Hair’s findings, Texas Children’s is the first hospital in the world to add human milk-based cream to the diets of premature babies weighing less than 3.3 pounds.

Besides publishing her research studies in numerous premier scientific journals, Hair continually demonstrates her commitment to her tiniest patients by delivering presentations at pediatric research conferences worldwide promoting the health benefits of exclusive human milk feeding, which has significantly reduced the rate of necrotizing enterocolitis (NEC) in our NICU by 77 percent. Potentially life-threatening, NEC is a neonatal condition that causes intestinal inflammation.

An active member of several professional organizations – Academy of Pediatrics, Texas Pediatric Society, Texas Medical Association and Harris County Medical Society – Hair also serves as a scientific advisor to the NEC Society, a non-profit organization where she helps promote community awareness about the life-saving benefits of human milk, while encouraging more mothers to donate their breast milk to protect babies from NEC.

“I am extremely humbled to receive this award,” said Hair, who added that being nominated by her peers is an honor that is extremely validating. “Receiving feedback from my colleagues is one of the best forms of positive reinforcement. It demonstrates the work that I am doing has a profound impact on everyone, including the patients and families I serve. I love my job and I am fortunate to work with an excellent multidisciplinary team in the Newborn Center at Texas Children’s.”

August 4, 2015

8515breastfeeding640While August is National Breastfeeding Awareness Month, educating new mothers about the importance of breastfeeding happens every day at Texas Children’s Pavilion for Women.

“A natural, life-saving gift mothers can give their newborns is their own breast milk,” said Women’s Support Services Director Nancy Hurst. “Unlike formula, human milk contains powerful antibodies that protect infants against disease and infection, while strengthening the indelible bond between a mother and her baby from the earliest moments of life.”

The Pavilion for Women has implemented numerous breastfeeding practices to ensure our nurses, obstetricians and pediatricians are well trained to teach mothers how to breastfeed and maintain lactation. Even when separated from their infants, which can occur when premature babies are confined to the neonatal intensive care unit (NICU) for long-term care, mothers are shown how to initiate and maintain lactation. A nursing and medical staff that is educated in evidence-based breastfeeding practices is one of the many requirements to achieve the designation of Baby Friendly Hospital.

On July 22 and 23, surveyors from Baby Friendly USA visited Texas Children’s Hospital to evaluate our adherence to the Ten Steps for Successful Breastfeeding. These steps – which the Pavilion for Women has successfully implemented – include teaching mothers to respond to their infant’s early feeding cues rather than schedule feedings, avoiding the use of pacifiers and bottles until breastfeeding is well established which normally occurs during the first two weeks, feeding infants only breast milk and providing mothers with resources for lactation support prior to leaving the hospital.

Other breastfeeding efforts initiated at the Pavilion for Women include:

  • Helping mothers breastfeed within one hour of birth
  • Encouraging “rooming in” so mothers and infants can stay together 24 hours a day
  • Implementing immediate skin-to-skin contact between mother and baby following delivery, even after cesarean birth
  • Standardizing prenatal education to educate women about the benefits of breastfeeding
  • Providing 20 hours of didactic and skills-based education and instruction to all nursing staff caring for mothers and babies at the Pavilion for Women, including three hours of breastfeeding education to our obstetricians and pediatrics providers
  • Promoting the Breastfeeding Champions Program to inspire nurses to become role models for other nurses by reminding them why it is important to encourage women to breastfeed

“New mothers often times do not succeed in breastfeeding because there are no systems in place to support them,” said Prenatal Education Program Manager Anne Wright. “Since 88 percent of the mothers who deliver at the Pavilion for Women want to breastfeed, it is important that we implement and sustain practices that ensure their success.”

The Baby Friendly Hospital designation is important to Texas Children’s because it complements our commitment to delivering high-quality care to improve long-term outcomes for our neonatal patients.

Since Texas Children’s Newborn Center implemented the exclusive human milk feeding protocol six years ago, the rate of necrotizing enterocolitis – a devastating intestinal disease that affects premature infants – has dropped by 77 percent in our NICU. This remarkable feat is attributed to the generous mothers, many of whom are Texas Children’s and Baylor College of Medicine employees, who donate their excess breast milk to Texas Children’s Mother’s Milk Bank.

“Every ounce of donor breast milk improves outcomes for our NICU babies,” said Texas Children’s Neonatal Nutrition Director Dr. Amy Hair. “Mothers who donate their excess supply to our milk bank ensures our tiniest, most vulnerable patients receive a constant supply of nourishment and protection to build their developing immune system.”

While achieving the Baby Friendly Hospital designation is a lengthy four-phase process, Hurst says it could take up to 10 weeks to find out if Texas Children’s joins the roster of hospitals that proudly display this coveted distinction.

“Right now, it’s a waiting game for us,” Hurst said. “But, I am confident that we will achieve this designation because we’ve worked so hard to meet the rigorous criteria for implementing successful breastfeeding practices at the Pavilion for Women.”

For more information about Baby Friendly USA, click here. To learn more about Texas Children’s Mother’s Milk Bank, click here.

June 2, 2015

6315NICUreunion640

On Saturday, May 30, more than 350 patient families and neonatal staff packed the Bayou City Event Center. The reunion celebrated former patients who graduated from Texas Children’s Newborn Center in 2014 after spending 21 days or more in our neonatal intensive care unit (NICU).

Parents shared stories of hope and triumph with other NICU families, and reconnected with the nurses and doctors who cared for their critically ill babies.

“Many of these families spent weeks or even months with our NICU staff,” said Pattie Bondurant, vice president of nursing at Texas Children’s Newborn Center. “It is very rewarding to see these children healthy and full of energy, especially when these thriving kids were once very sick.”

Highlights from the NICU reunion included opening remarks from Bondurant and Texas Children’s Chief of Neonatology Dr. Stephen Welty, guest speakers Katy Haynes and Desiree Collins-Bradley, and blessings from Texas Children’s chaplains Johnna Faber and Kirsten Springmeyer.

Texas Children’s NICU reunion also offered exciting entertainment for the children including coloring, face painting, inflatable pony races and balloon art.

May 12, 2015

51315Knatalyematainside640

Less than three months after being separated from her twin sister in a 26-hour operation at Texas Children’s Hospital, Knatalye Hope Mata was released to the care of her family.

Knatalye was discharged from the hospital on May 8, just in time for Mother’s Day. Her family lives in Lubbock but will remain in Houston until Knatalye’s sister, Adeline Faith, is able to go home. Doctors anticipate that homecoming to be within the next few months.

Formerly conjoined twins Knatalye and Adeline 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.

Surgeons allowed the girls to grow and gain strength for 10 months before undertaking the difficult task of separating them. During the procedure, the surgical team worked in shifts to separate the twins, who shared a chest wall, pericardial sac, diaphragm, liver, intestines, bladder, uterus and pelvis. Since then, Knatalye and Adeline have been healing quickly and are continuing to progress well as two little girls.

Many of their caregivers, including Dr. Darrell Cass, lead surgeon and co-director of Texas Children’s Fetal Center, and Dr. Oluyinka Olutoye, lead surgeon and co-director of the Texas Fetal Center, came by Knatalye’s room last week to bid her farewell.

Smiles and hugs were exchanged before the 1-year-old was strapped into a car seat in the back of her family’s SUV. Shortly afterward, Knatalye left the only place she has ever known. Although she will be back for follow-up care, Texas Children’s is no longer her primary home. It’s her home away from home, which is exactly what everyone hoped it would become.