June 10, 2014

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Many hospitals have Neonatal Intensive Care Units (NICUs), but not all NICUs are the same.

Texas Children’s Newborn Center is one of the only level IV NICUs in the Houston region that is able to provide babies with the highest level of care. In fact, many area hospitals with less advanced NICUs transfer infants to us when more experience and specialized care is required.

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The American Academy of Pediatrics differentiates between units by defining levels of care based on the complexity of medical conditions the facility is equipped to treat. We hope this will help you better understand the different levels of care in the NICU:

Level I: Regular nursery care available at most hospitals that deliver babies

Level II: Intensive care for sick and premature infants

Level III: Comprehensive care for more seriously ill newborns

Level IV: Major surgery, surgical repair of serious congenital heart and anomalies that require cardiopulmonary bypass and/or extracorporeal membrane oxygenation (ECMO) for medical conditions. Level IV units include the capabilities of level III with additional capabilities and considerable experience in the care of the most complex and critically ill newborn infants and should have pediatric medical and pediatric surgical specialty consultants continuously available 24 hours a day.

Many area hospitals have level II or III NICUs, but are not equipped to provide the most advanced level of care some newborns need. Our combined level II and III NICUs offer specialty care for newborns. An additional level IV NICU located across the connecting bridge gives babies more extensive support and access to dozens of pediatric subspecialists.

Texas Children’s Newborn Center was recently ranked no. 2 in this year’s U.S. News & World Report survey, a gain from last year’s no. 17 ranking. As you know, U.S. News ranks the top 50 pediatric centers in 10 specialty areas, so being recognized within the top two is no small feat.

Our commitment to improving neonatal outcomes is really something to be proud of, and I am grateful that our diligent efforts are making a positive impact in the lives of so many babies.

For more information about Texas Children’s Pavilion for Women and our Neonatal Intensive Care Unit, visit here and to take a video tour of our NICU, visit here.

May 27, 2014

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By Dr. Tiffany McKee-Garrett

When a baby is born, parents want nothing more than to love and protect their child. Part of that protection starts right after birth with the administration of a vitamin K injection. Babies are not born with sufficient vitamin K levels and cannot get adequate amounts of vitamin K from breast milk, so this injection, given within the first hour after birth, is crucial because it helps a baby’s blood to clot normally, which prevents vitamin K deficiency bleeding (VKDB) in newborns.\

A dangerous trend
A recent CDC report confirmed that there has been a nationwide increase in parents refusing the vitamin K shot for their newborns – and this dangerous trend, often based on inaccurate information found online and faulty science, is causing more babies to experience hemorrhaging that is preventable and may cause brain damage or even death in some cases.

In the United States, administration of intramuscular vitamin K at birth to prevent all forms of VKDB has been standard practice since first recommended by the American Academy of Pediatrics in 1961. Without the shot, the incidence of early and classical VKDB ranges from 0.25 percent to 1.7 percent of births and the incidence of late VKDB ranges from 4.4 to 7.2 per 100,000 infants. The relative risk for developing late VKDB has been estimated at 81 times greater among infants who do not receive intramuscular vitamin K than in infants who do receive it.

Early VKBD usually presents in previously healthy appearing infants as unexpected bleeding during the first two weeks of age, usually between the second and fifth day after birth. The bleeding can present as oozing from the umbilical cord area, bleeding from the circumcision site, persistent oozing from puncture sites, gastrointestinal hemorrhage, and/or bleeding into the brain, which can result in significant neurological complications that have a lifelong impact on a child.

Late VKDB is an indication of severe vitamin K deficiency and presents as unexpected bleeding, including brain bleeds in infants 2-12 weeks of age. Complications of late VKDB may be severe, including death. It classically presents in exclusively breastfed infants who received either no or inadequate neonatal vitamin K. It can also present in infants with intestinal malabosorption defects.

The myths
One myth about vitamin-k injections is that they are linked to leukemia, but studies show absolutely no relationship between getting vitamin K as a baby and an increased risk of leukemia. Another myth is that the vitamin K injection increases the risk of jaundice – which is inaccurate. Jaundice associated with vitamin K has been observed only in high risk babies (such as premature babies) in doses 30-60 times higher than the dose we give.

Some parents also argue that injections cause babies pain, but this pain is very brief and the benefits of the injection are very much worth a short period of discomfort. Parents are encouraged to mitigate this brief uncomfortable experience by holding baby skin to skin before and after the injection or allowing the baby to breastfeed before, during and/or after getting the injection.

In the not so distant past, infants and children had high rates of dying early in life. During the 20th century alone, the infant mortality rate declined greater than 90 percent and the maternal mortality rate declined 99 percent! Much of this is due to advancements in modern medicine. While it might seem nice to do things completely naturally, modern medicine has saved the lives of countless mothers and babies.

May 13, 2014

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By Elizabeth Shackouls

My precious children,

It’s hard to believe that this Saturday marks one year since we met. Exactly 365 days since I officially assumed the role as mama – the most challenging yet greatest job I have ever had, and the title I will always be the most proud to bare.

Although your daddy and I thought we took all the steps necessary prior to your arrival, nothing truly prepared me for the moment I met you both. On May 17, 2013 at 7:25 p.m. and again at 7:27 p.m., you entered the world and my heart immediately exploded into a million pieces.

51414BWShackhouls640-2Words cannot do justice in describing just how grateful I am God chose me to be your mom. You have changed my life in immeasurable ways and have undoubtedly made me a better person. You have taught me humility, selflessness and patience. Above all, I have learned the meaning of a mother’s love.

This has been the fastest and longest year of my life. Some days never seemed to end, but now it seems as though it has gone by in a flash. I hardly recognize the 5 and 6 pound infants in the newborn photos. It’s crazy to see just how much you’ve grown in size and in personality in such a short time period.

My favorite memories and moments with you are endless but the one that pulls at my heartstrings over and over again is the time I spend outside your nursery door each morning. I just stand there and listen to the two of you “talk.” The cooing, babbling and laughing literally melts my heart. After several seconds I open the door and am always greeted by the biggest smiles. No matter if one of you is sick or hasn’t slept a wink, in those first moments the exchange of adoration and pure happiness is all that is felt (then usually the screaming ensues). And the way you interact with each other is so special. I’m thrilled you both will always have such a unique bond.

The day you were born will always be the best day of my life. Life truly gets better every second you’re here. The road to the one year milestone certainly hasn’t been easy, but I can honestly say it has been wonderful. That’s the thing about motherhood. As difficult as it is, the good far outweighs the hard parts and the challenges are nothing compared to the rewards.

I know the day will come when you roll your eyes behind my back and my overall existence, especially in public, will make you shutter with embarrassment. So I am soaking up every minute of each new stage because I know it won’t last forever. I will use the memories of you needing me, crying for me and actually wanting my kisses for the teenage years when you’ll likely not want much to do with me. But now, and forever more, I will make sure you know and feel just how fiercely you are loved and how honored I am to be your mama.

51414BWShackhouls640-3As your first birthday approaches, I have been left wondering not only how it is even possible for time to pass by so quickly, but what it is I want for you in life. There are many things I look forward to teaching and showing you, and endless dreams I hold for you both. First and foremost, I wish you happiness. I want you to always focus on your blessings and recognize the goodness that surrounds you. Even in the midst of tragedy and heartbreak, learn to find the silver lining. I want you to be open-minded, adventurous, and learn to say “yes” more often than not. Be brave and strong and free. Be compassionate and ever mindful of the needs of others. Keep your hearts wide open. And on the days when this great big world makes you feel small, be calm and still. Remember the values instilled in you and the strength of your roots. These alone will allow you to stretch far.

So, my sweet babies, I want you to go into the world and let your little lights shine. And always remember you are loved and blessed and the littlest ones that ever stole my heart.

All my love forever and always,
Mama

April 15, 2014

“I’m pregnant!” I thought to myself excitedly in December, but the excitement quickly dissipated when I flashed forward to the anxiety laden weeks ahead.

Pregnancy after a miscarriage is scary. Exciting, but scary. It’s filled with the unknowns and the “what ifs.” For me, finding out I was pregnant again, after many losses left me with a roller coaster of emotions. Each little ache and pain I had stirred a barrage of questions in my head. Adding to the anxiety was deciding on when to tell others, which felt like the most momentous decision ever. It’s not that you’re trying to hide anything; it’s just a self-protective measure. Why allow yourself and others to get excited, knowing what the outcome has been so many times before…right? My husband and I were to the point that we would just laugh and tell each other we’d see how long this one lasted. You realize you become desensitized to the whole situation and develop some odd ways of coping with the uncertainty. Unfortunately, pregnancy loss takes the innocence out of being pregnant.

Over the past year and a half, for mine and my family’s sake, I had to start placing less emphasis on my losses and more on what I do have in life. The last step for us was to seek some medical advice on what else could be causing our losses. So in the pursuit to find answers and make some decisions, my husband and I were presented with some fertility options that were too outside of our comfort zone. At that time we decided if we only had our son Dillon, he would be more of a blessing than we ever deserve. So I kept myself busy and resigned to the “que sera sera” mantra regarding the whole pregnancy thing. Well, wouldn’t you know, lo and behold, a whole week later, I found out I was pregnant! I told my husband New Year’s Day and so far 2014 has been good to us. With each ultrasound and flutter of movement I feel, I get more excited and more hopeful. I am now 17 weeks along and things are going great.

41614BWfamily640After my fist loss at 16 weeks, I was connected with the Woman’s Place at the Pavilion which offers assistance during reproductive loss and grief.  After my subsequent losses at nine weeks and three at only five weeks, I was referred to the Maternal Fetal Medicine Department for further testing, where everything checked out ok.  Along my journey to this pregnancy, I have had the best care from the Pavilion. From the Family Fertility Center, to the additional ultrasounds with the Maternal Fetal Medicine department, they have all helped put my mind at ease that much more.  Knowing the care I need is literally around the corner is so comforting.

The reason I wanted to share my story was to try and offer hope to the many women out there whose stories are like mine and need some encouragement. I wanted to let these women know there is hope, and they should never feel ashamed, or feel like a failure for a pregnancy not going to term. It took me many months to figure this out and to start letting go of some of the guilt, sadness, anger, and heartbreak that are common after a miscarriage. My healing came through reading the stories of women online, or talking with coworkers who suffered miscarriages and know what pregnancy loss feels like. That it feels like the loss of hopes and dreams you’ve made for your baby, or the loss of a bond you formed the moment you knew you were going to be a mom. Please know time will make the pain easier but never make you forget, and that’s ok…why would you want to forget about your baby? Above all else, I wrote this post so women will know there is hope after loss…if they choose to keep their heart open to the possibility.

So how do you handle being pregnant again after a loss? For me, it’s getting through one day and one milestone at a time. Surpassing the time of my first miscarriage was the biggest challenge of all, and now that I have, I can take a deep breath and enjoy this pregnancy. I think about how differently this pregnancy feels, and try to focus on that. I don’t know what the future holds, but I know worrying all the time won’t help my little one. So therefore, I choose to accept each day with this baby as a gift; a very special gift that has the ability to make the heartache less and less, and make my heart fill abundantly with joy being it’s mommy.

Rhea HoSang Celestin is a staff nurse in the Clinical Care Center.

April 8, 2014

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Nine years ago, I was sitting in a meeting with the St. Luke’s CEO when I learned that they were looking to get out of obstetrics and gynecology and maternal fetal medicine. I raised my hand and let them know we were interested to take over. I knew we were about to do something that would change women’s health care in Houston forever. Texas Children’s would assume responsibility for St. Luke’s ob/gyn and MFM services until we were able to build our own facility.

Texas Children’s Pavilion for Women opened its doors for inpatient services on March 26, 2012. It was a monumental day for everyone who had been a part of planning and executing this new state-of-the-art hospital. I knew it would make a difference in the lives of countless women. What I didn’t know then was that I would one day have a personal experience at the Pavilion as a family member.

On February 10, 2014 at 6:29 p.m., Clark Wallace was born at Texas Children’s Pavilion for Women. What a full circle moment. From the day I raised my hand in that meeting with St. Luke’s, to my own grandbaby being born here, it was surreal. This was a very special and exciting experience from a number of different perspectives.

First, it was our son Ben’s first baby. Emily, our daughter, has four sons and one daughter, but they live in Chicago, so this was also our first Texas-born grandbaby. Of course it was also impressive to experience the Pavilion as a grandparent and to be here for such a special moment in my personal life.

My wife, Shannon, and I patiently waited at home to get the news of Clark’s arrival and came to the hospital the following morning to meet the newest grandbaby. To see our Pavilion team in action – from Dr. Belfort to everyone in the delivery suite, the floor nurses, diagnostic and therapeutic services, radiology and pathology, food and nutrition – was incredible. To see it all come together in such a beautiful way and know that it wasn’t just for Clark Wallace but that it’s what all our patients are experiencing was a proud moment for me, both as President and CEO and as a grandfather.

I knew we had the right vision for this new hospital and for the thousands of babies born here every year, including my grandson. I have great pride in knowing that our grandson and daughter-in-law had the very best care. Seeing that care firsthand as member of a patient’s family and knowing it’s the same care every mother and baby receives here was truly an incredible feeling.

Now it might be hard to believe, but I promise I saw Clark smile as soon as he saw me and I might have even heard him say “TCH.” He looked exactly like Ben did when he was born, a really good looking fella with a big head and fat cheeks.

Watching the team at work from a patient family perspective and seeing the quality of care and service – from valet to the delivery room and room service – made me swell with pride for what we’ve created at the Pavilion for Women. It’s one of a kind, and there’s nothing like it in Texas, the U.S. or the world.

March 25, 2014

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Lindsey Gillespie, a Dallas nurse and mom of three young boys, was expecting a routine pregnancy to deliver her fourth child. But during a scheduled ultrasound to determine the gender of the baby, the nurse noticed something odd. After being fully evaluated, doctors suspected placenta percreta, the rarest and most severe form of placenta accreta. When Lindsey could not find a group who routinely treated cases like hers in the Dallas/Ft. Worth area, she eventually transferred her care to Texas Children’s Pavilion for Women in Houston.

And she’s not the only one. The Pavilion for Women has the largest and busiest program in the country for this condition, treating more than 60 cases in the last three years.

“What’s unique to others has now become routine to us,” said Dr. Michael A. Belfort, OB/GYN-in-Chief at Texas Children’s Pavilion for Women. “That strengthens the case for having this type of surgery done by a team that does it all the time and knows how to do it.”

Placenta percreta, the rarest and most severe form of placenta accreta, is a potentially life-threatening condition that can affect any neighboring uterine structure. Placenta percreta (5 percent of all placenta accreta cases) happens when the placenta grows entirely through the uterine wall and attaches to another organ like the bladder. When it involves the urinary bladder, a multidisciplinary approach utilizing a team of physicians and surgeons representing urology, radiology, and obstetrics/gynecology is the key to successful management. Moms who have had previous cesarean deliveries are at an increased risk to developing the condition.

According to the American College of Obstetricians and Gynecologists, in the 1980s placenta accreta affected 1 in 4,000 pregnancies. Today the rate has spiked, affecting 1 in 533 pregnancies – in large part due to the increased number of c-section deliveries.

This year alone, Belfort estimates that Texas Children’s Pavilion for Women will treat about 30-40 patients with placenta percreta, including Lindsey Gillespie. Five patients are currently awaiting surgery.

While Lindsey was at first nervous to leave her home and give birth in Houston, her husband reassured her she was making the right choice, saying “Wow, you couldn’t be at a better place. The hospital you are delivering at is connected to a children’s hospital, so if anything goes wrong it is right there. That is phenomenal!”

On March 14, Belfort led a team of physicians and neonatologists who performed an Indicated preterm Classical Cesarean section followed by Modified radical hysterectomy on Lindsey. She gave birth to a healthy baby girl and pulled through the surgeries without needing a blood transfusion. While the risks were high, Belfort and his staff were confident and well prepared, with a room full of high-risk physicians, neonatologists and a huge supply of blood, should she have needed a transfusion.

“The safest place to have this kind of surgery is in a place where they do it all the time, have a protocol, have a well equipped and practiced team and are comfortable with this issue,” said Belfort.