May 14, 2019

The stars were out and all-smiles at the Smile Train 20th Anniversary Gala on May 2 in New York City.

The event, sponsored in part by Texas Children’s Hospital, honored the memory of Smile Train founder Charles B. Wang and served as the launch for a year of celebrations of impact across the globe. It featured a performance by Alexa Ray Joel and appearances by many special guests, including NBA legend, former Houston Rocket and Smile Train partner, Dikembe Mutumbo.

Smile Train also recognized three exceptional honorees for their support of the organization and its mission. These were Graham Elliot, the award-winning chef, restaurateur and television personality; Paula Shugart, President of The Miss Universe Organization; and the Chairman of Smile Train’s Medical Advisory Board, Texas Children’s Surgeon-in-Chief Dr. Larry Hollier.

“I would like to thank Charles Wang for the confidence he placed in me by naming me chair of the Medical Advisory Board,” Hollier said in his remarks. “It has been one of the biggest honors of my professional life.”

Smile Train is an international children’s charity and the largest surgical non-governmental organization in the world. Through its sustainable model, Smile Train empowers local medical professionals with training, funding and resources to provide free cleft lip and palate surgery and comprehensive care to children around the world.

A cleft occurs when certain body parts and structures do not fuse together during fetal development. Clefts can involve the lip and/or the roof of the mouth, which is made up of both hard and soft palate. If left untreated, the conditions can cause children to have difficulty eating, breathing, hearing and speaking. Many children with clefts live in isolation, and too many will never receive the reconstructive surgery they need.

Smile Train supervises the quality and safety of surgery on approximately 130,000 children every year and has provided surgery for approximately 1.6 million children in 85 countries over the past 20 years.

Cleft lip and palate care at Texas Children’s

Cleft repair surgery is safe, and the transformation is immediate. Texas Children’s Hospital specializes in the comprehensive care of patients born with these conditions at our Cleft Lip and Palate Clinic. Our multidisciplinary team has over 40 years of experience treating these particular issues, and each patient’s care is tailored to their specific needs.

The team consists of:

  • Pediatrician
  • Plastic surgeon
  • Pediatric dentist
  • Craniofacial orthodontist
  • Otolaryngologist or ear, nose and throat specialist (ENT)
  • Speech pathologist
  • Audiologist
  • Craniofacial nurse
  • Genetic counselor
  • Social worker
  • Nutritionist

Hear more about Texas Children’s world-class cleft lip and palate care from Chief of Plastic Surgery Dr. Edward Buchanan in this month’s featured “Medically Speaking” episode on Connect.

This month’s episode of Medically Speaking features Texas Children’s Chief of Plastic Surgery Dr. Edward Buchanan speaking about Texas Children’s multidisciplinary approach to cleft lip and palate care. In his talk, Buchanan outlines the spectrum of cleft lip and palate presentations, from minor abnormalities to more severe structural issues. He also gives an overview of the steps along the patient’s and family’s therapy and treatment pathway, including:

  • Prenatal counseling and diagnosis
  • Best feeding practices
  • Primary repairs and secondary procedures
  • Final surgeries when the patient is 16 years or older

“Cleft lip and palate care at Texas Children’s is not fragmented,” says Buchanan. “This kind of care can’t be done effectively in a silo by just one person; it takes a team. Our experts follow the child through their entire care journey to make sure we’re optimizing outcomes and that we’re not missing any opportunities.”

Learn more about Texas Children’s expertise in our Cleft Lip and Palate Clinic and about the full suite of services provided by the Division of Plastic Surgery.

About Medically Speaking

Medically Speaking, a video series from Texas Children’s Service Line Marketing, features some of the brightest minds from several Texas Children’s specialty and subspecialty areas. The series is meant to be a helpful educational resource for parents and a convenient way for physicians and other caregivers to stay up-to-date on the latest in pediatric medicine. Viewers can watch talks on a variety of interesting topics, including advancements in surgery, breakthroughs in research, new clinical trials, and novel and back-practice treatments for specific conditions.

Don’t miss future Medically Speaking episodes featured here on Connect, or view additional episodes now.

PLEASE NOTE:
This presentation is not intended to present medical advice or individual treatment recommendations, and does not supplant the practitioner’s independent clinical judgment. Practitioners are advised to consider the management of each patient in view of the clinical information. All content is shared for informational purposes only, and reflects the thoughts and opinions of the original author. No physician-patient relationship is being created by the use of this presentation. The presentation sets out recommendations based upon similar circumstances and is provided as an educational tool. The presenters are not attorneys, and to the extent this presentation provides commentary on current laws and regulations affecting health care activities, it is not intended as legal advice.

April 29, 2019

On April 26, superheroes of all sizes assembled on The Auxiliary Bridge to celebrate National Pediatric Transplant Week, observed each year during the last full week of National Donate Life Month in April.

The event, hosted by Texas Children’s Transplant Services, marked the end of a week that focuses on the powerful message of ending the pediatric transplant waiting list. There were plenty of fun activities for children, including karaoke, hula-hooping, coloring and crafts, a photo wall, and a visit from Elsa, one of Texas Children’s three therapy dogs. There were also educational materials available on organ donation and transplantation.

The event also honored real-life superheroes – the donor families whose children have saved and healed lives through organ, eye and tissue donation.

The gift of an organ transplant comes to one family as another family is enduring the most difficult time of their lives. The team in Transplant Services works hand in hand with Texas Children’s Spiritual Care Department during these times to provide donor families with compassionate support, to honor the choice to donate an organ, and to honor the legacy of the patient.

There are several ways we recognize the legacies of these children and their families, including:

  • The observance of moments of honor, small ceremonies during which the gift of the organ donation is acknowledged and celebrated through readings and a blessing or prayer
  • Flag ceremonies, at which a Donate Life Flag is displayed and family, Texas Children’s staff and chaplains, and our LifeGift partners gather to tell stories about the patient, let the family touch the flag, share a group reading, and then the flag is then passed around the unit to be signed with messages of support and recognition from Transplant Services staff
  • National Donor Sabbath, an annual three-day observance where members of local faith communities participate in services and programs to honor donor families and to educate the public about the need for lifesaving transplants

In addition to these heartfelt moments of acknowledgement and remembrance, Texas Children’s Hospital has begun a new tradition to honor our donor families.

As the sun went down on April 22, Lester and Sue Smith Legacy Tower was illuminated in green and white. The tower was lit each evening for the rest of the week, both in commemoration of National Donate Life Month and Pediatric Transplant Week, and also as a tribute to our donor families. Going forward, the lighting of the tower will serve as yet another way Texas Children’s acknowledges them.

“Nothing we do would be possible without our donor families, and we wanted to find another way to honor them,” said Dr. John Goss, medical director of Transplant Services. “Now when people see Lester and Sue Smith Legacy Tower lit in green and white, they will know there’s a hero here at Texas Children’s who has just given the gift of life.”

About Transplant Services at Texas Children’s

Transplant Services at Texas Children’s was the nation’s largest pediatric transplant program in 2018, performing a remarkable 107 solid organ transplants including the highest volumes of pediatric liver, lung and kidney transplants.

Transplant Services provides a comprehensive, multidisciplinary approach to care through all aspects of the transplant process, from initial referral to hospitalization and outpatient management. Our team of experts includes physicians and surgical advanced practice providers, transplant coordinators, pediatric ventricular assist device coordinators, perfusionists, child life specialists, dieticians, social workers, financial counselors, pharmacists, inpatient and outpatient nursing and support staff, Perioperative Services, physical and occupational therapists, Radiology, Pathology, our LifeGift partners, and many others.

Our depth of skill and service enables us to offer world-class care for patients, from newborns to young adults, in need of heart, kidney, liver and lung transplants. That expertise has allowed us to successfully treat some cases that other national and international programs might consider untreatable.

Learn more about Transplant Services at Texas Children’s Hospital.

April 9, 2019

Texas Children’s Heart Center was once again the site of a groundbreaking novel treatment that gives experts in our new catheterization laboratories yet another method at their disposal in the treatment of complex heart conditions.

Dr. Henri Justino, co-director of the center’s cardiac catheterization labs and director of cardiac innovation, recently developed and performed a first-of-its-kind procedure in which a young patient’s lung veins were reached directly through the chest wall.

Hope for Bronx

Three-year-old Bronx Delarosa was born with total anomalous pulmonary venous return, a critical heart defect that causes oxygen-rich blood returning from the lungs to be pumped into the right atrium instead of the left atrium, as it normally should. There, the oxygen-rich blood mixes with oxygen-poor blood, which means the body doesn’t get the oxygen it needs.

At just 8 days old, Bronx underwent a surgery to repair the defect that was initially thought to be a success. However, following a second surgery, doctors told his parents he’d developed a secondary condition – pulmonary vein stenosis, a condition that caused severe narrowing in his surgically repaired veins. The Delarosas were heartbroken when they learned there was nothing else that could be done for Bronx in their hometown.

To give their son a fighting chance, they turned to Texas Children’s Hospital.

Breaking new ground

Justino performed Bronx’s first catheterization procedure in February 2018, during which he placed a metal stent in the blocked upper vein in Bronx’s right lung. However, he was unable to relieve the blockage in the lower vein.

After a personal friend underwent a lung biopsy, where a tissue sample was taken directly through the chest wall, Justino wondered if a similar approach could be applied in cases like Bronx’s – entering the veins of the lungs through the chest.

After thorough research, Justino decided to move forward with the unique approach to relieve the blockage in Bronx’s right lung.

Bronx was taken to the catheterization lab where the team performed a CT scan to identify the exact location where the blocked vein was sufficiently far apart from artery, yet close enough to the chest wall, to allow a needle to enter the vein directly between the ribs. Justino and his team also generated a 3-D computerized model to pinpoint the exact location where the needle would enter Bronx’s chest. To ensure the utmost accuracy, a laser crosshair was beamed on his chest at the entry point.

Justino carefully made his way into Bronx’s lung and placed a tiny catheter, the thickness of a raw spaghetti noodle. He then used a special wire to deliver radiofrequency energy to get across the blocked vein and into the heart. From there, the wire was threaded down through Bronx’s leg. This allowed a stent to be placed in the blocked vein via a catheter in the leg.

Bronx recovered well and a follow-up echocardiogram proved the experimental approach was a success. The first-of-its-kind procedure, which lasted more than eight hours, was performed in one of the Heart Center’s new state-of-the-art, 1,000-square-foot cardiac catheterization labs, which Justino helped design with this type of procedure in mind.

“We are proud that Dr. Justino was able to develop this completely novel procedure for Bronx,” said Texas Children’s Chief of Pediatric Cardiology Dr. Daniel Penny. “Pulmonary vein stenosis in children is an extremely difficult problem to treat and tests the limits of our abilities to innovate. We see this new procedure as another advancement in the treatment of these children, which will be applied more widely in the future and help us improve the care we offer for complex cardiac conditions.”

Learn more about Texas Children’s Heart Center, ranked No. 1 in the nation by U.S. News & World Report.

March 25, 2019
Almost seven years ago, surgeons with Texas Children’s Fetal Center performed their first in-utero neural tube defect repair surgery. Just a few months ago, some of those same surgeons reached a milestone when they completed their 100th neural tube defect repair.

Of the 100 total cases, more than half were performed fetoscopically, an experimental, minimally-invasive surgical approach pioneered at Texas Children’s in 2014 by Obstetrician and Gynecologist-in-Chief Dr. Michael Belfort and Pediatric Neurosurgeon Dr. William Whitehead.

Texas Children’s was the first center in the U.S. to correct neural tube defects, also known as spina bifida defects, fetoscopically and is among just a few centers in the country that offers fetoscopic repair of spina bifida. Texas Children’s continues to offer open fetal surgery for spina bifida, the standard of care since 2012, for patients who do not qualify for or opt not to undergo a fetoscopic repair.

“This milestone shows that we are a mature program, that we have done a lot of these cases, and that our results are equivalent if not better, than anybody else out there doing this,” Belfort said. “We have a level of experience now whereby we can assure patients and families that what we offer is the best in terms of quality and safety.”

Neural tube defect repair surgeries are performed on babies with Myelomeningocele, a developmental defect in which the spine is improperly formed and the spinal cord is open to and fused with the skin. The condition, also known as spina bifida or an open neural tube defect (NTD), occurs in 3.4 out of every 10,000 live births in the U.S. and is the most common permanently disabling birth defect for which there is no known cure.

NTDs are usually associated with motor impairment and hydrocephalus, or the buildup of cerebrospinal fluid in the brain, which requires surgical treatment to drain the fluid via an implanted device called a shunt. It’s common for children with spina bifida to have abnormal function of their bladder, bowels and legs. The goal of fetal surgical repair of spina bifida is to preserve leg function and reduce the need for a postnatal shunt.

The standard of care for spina bifida is neurosurgical closure of the defect in the first days of life, however, advances in fetal surgery and the landmark clinical trial, known as the Management of Myelomeningocele Study (MOMS Trial), proved that a fetal surgical repair leads to decreased rates of hydrocephalus and improved leg function compared to a postnatal repair.

Through their research and outcomes data, Belfort and his team have shown that performing the surgery fetoscopically yields the same outcome for the baby as the open repair, while being significantly less invasive for the mother.

“We are thrilled to offer this innovative and minimally-invasive surgical approach to our patients and their babies,” Belfort said. “We thank the mothers and families who put their trust in our team and have the courage to undergo an experimental procedure.”

First fetoscopic case

The first mother to undergo fetoscopic neural tube repair at Texas Children’s Fetal Center was Althea Canezaro. At 23 weeks pregnant, Althea learned during a routine ultrasound that her son, Grayson, had spina bifida. The Louisiana resident came to Texas Children’s shortly thereafter and met with Belfort and his team.

“After talking with them, it was like, OK, there’s something they can do for us, and if it didn’t work out everyone would be safe,” Althea recalled. “We knew that this was an opportunity to give him the best life that he could have. So, going forward, it was kind of like the ball was in their park. The weight was taken off our shoulders.”

A little more than four years later, Althea and Grayson are thriving. The blonde haired, blue-eyed boy never developed hydrocephalus and was born with full movement of his legs. He is hitting all of his developmental milestones and walks with and without the assistance of crutches.

“He’s a fighter,” Althea said. “You can’t tell him he can’t do anything. He has more determination than you ever want to believe.”

Reaching a milestone

Belfort and his team performed the 100th neural tube defect repair late last year and delivered the healthy little girl, Parker Kate, on March 5. Taylor Avera, the newborn’s mother, said when she and her husband found out their child had spina bifida they were scared to death, but that what they learned at Texas Children’s put them at ease.

“Neither one of us questioned that this was what we needed to do,” Taylor said. “We were excited that we were candidates for the surgery and that we were going to be able to give our baby the best outcome she could have.”

The experimental surgery Althea and Taylor underwent continues to be subject to rigorous oversight by the U.S. Food and Drug Administration, was developed by Texas Children’s Fetal Center in partnership with Texas Children’s division of neurosurgery. The teams practiced on a child’s kickball that replicated the mother’s uterus. Inside the kickball, a doll acted as the fetus. By hoisting the ball into the air hung by various levers and pulleys, the team simulated the movement in the womb and practiced closing the spinal cord.

“The multidisciplinary collaboration with the Fetal Center on this surgical effort is an extraordinary example of the innovative spirit at Texas Children’s Hospital,” Whitehead said. “From a medical standpoint, we believe by closing the defect both in-utero and fetoscopically, is a less invasive procedure for the mother, reduces her risk of preterm delivery and reduces the need for shunts.”

View photos of both Grayson and Parker Kate below.

Texas Children’s Fetal Center is among the nation’s leaders in providing high-risk maternal care and the diagnosis and treatment of abnormalities in unborn and newborn infants. For more information, visit women.texaschildrens.org/fetal.

March 18, 2019

Just months after successfully expanding our spine surgery program outside the medical center, the Department of Surgery and Texas Children’s Hospital The Woodlands are celebrating another important milestone – the expansion of our bariatric surgery services.

“We are very pleased about the collaboration between all services in opening up the bariatric surgery program at our campus in The Woodlands,” said Surgeon-in-Chief Dr. Larry Hollier. “The Department of Surgery is committed to bringing the surgical services that families need closer to their homes.”

Previously, access to bariatric surgery was relegated to our Texas Medical Center campus. However, a review of comparative patient data and geographic analysis revealed that a large number of patients coming to Texas Children’s for bariatric surgery were coming from The Woodlands and other communities outside Houston. With support from Texas Children’s executive leadership and Department of Surgery leadership, a multidisciplinary team in The Woodlands began laying the groundwork to expand the program.

“Successfully setting up bariatric surgery in The Woodlands required extensive planning and coordination on many fronts,” said Ketrese White, assistant vice president at Texas Children’s Hospital The Woodlands. “In addition to putting necessary infrastructure in place – such as personnel, equipment and surgical space – and running simulations, this amazing team spent months mapping out optimum workflow processes, including solidifying how we identify patients and establishing a rigorous assessment plan.”

The pre-surgery assessment period for bariatric surgery is lengthy – usually six to eight months. In addition to meeting physical criteria, candidates must also undergo diagnostic testing, attend regular clinic visits, and receive lifestyle and diet education.

“We’ve been very thoughtful in developing our assessment criteria,” White said. “The team performed due diligence, reviewing best practices and consulting experts both inside and outside the Texas Children’s system, which has also helped us build relationships in the community.”

The hard work paid off. Last month, pediatric surgeon Dr. Shawn Stafford performed the first bariatric surgeries at Texas Children’s Hospital The Woodlands, the culmination of months of collaboration and preparation.

Meeting the challenge head on

The expansion of our bariatric surgery services in The Woodlands helps us meet a major need in the community. Obesity-related health problems doctors once saw only in middle-aged people are now being seen in teenagers. These conditions include high blood pressure, type 2 diabetes, polycystic ovarian syndrome, obstructive sleep apnea, severe bone and joint issues, and hepatosteatosis (fatty liver), not to mention increased risk of heart attack and cancer.

“We have a unique opportunity to intervene and head off potentially debilitating, or even fatal chronic medical conditions, and ultimately to help make a lasting difference in these kids’ lives,” Stafford said.

Because each of these cases is so different, Texas Children’s experts put special emphasis on building a program of care around each unique patients’ needs, even helping tailor an exercise regimen based on their lifestyle and interests.

“Our goal is to communicate with each patient and find things they enjoy doing so that the changes they’re making to their lifestyle will be durable,” Stafford said.

While bariatric surgery isn’t a cure for obesity, Stafford says it is a valuable tool that makes victory against obesity a possibility. But changing a lifestyle still requires effort.

“I like to describe it as if they are trying to get over a wall: I can’t make them go over, but I can give them a boost so that, if they choose, they can pull themselves over.”

Learn more about bariatric surgery at Texas Children’s.

March 11, 2019
 

Transplant Services at Texas Children’s once again led the way as the nations’ largest pediatric transplant program, performing a remarkable 107 solid organ transplants in 2018. That figure includes the highest volume of pediatric liver, lung and kidney transplants in the United States.

For the year, we performed:

  • 44 pediatric liver transplants
  • 12 lung transplants
  • 31 kidney transplants
  • 20 heart transplants

“I want to congratulate everyone on our outstanding Transplant Services team, which continues to provide excellent care and support for our transplant patients and families,” said Texas Children’s Surgeon-in-Chief Dr. Larry Hollier. “I would also like to thank the leaders of our transplant programs – Dr. John Goss, Dr. Jeffrey Heinle, Dr. Jeff Dreyer, Dr. Tina Melicoff, Dr. Daniel Leung, Dr. Christine O’Mahony, Dr. Eileen Brewer and Dr. Ryan Himes – who go above and beyond to uphold high standards.”

Transplant Services provides a comprehensive, multidisciplinary approach to care through all aspects of the transplant process, from initial referral to hospitalization and outpatient management. Our team of experts includes physicians and surgical advanced practice providers, transplant coordinators, pediatric ventricular assist device coordinators, perfusionists, child life specialists, dieticians, social workers, financial counselors, pharmacists, inpatient and outpatient nursing and support staff, Perioperative Services, physical and occupational therapists, Radiology, Pathology, our LifeGift partners, and many others.

Our depth of skill and service enables us to offer world-class care for patients, from newborns to young adults, in need of heart, kidney, liver and lung transplants. That expertise has allowed us to successfully treat some cases that other national and international programs might consider untreatable.

“This is another tremendous milestone for our program,” said Dr. John Goss, medical director of Transplant Services. “I couldn’t be prouder of our team for their commitment toward achieving positive outcomes and for the dedication they show our patients every day.”

One of those patients is Jameson Finney.

For the first 12 years of his life, Jameson was an active little boy that always moved at 100 miles an hour, his parents said. There was never the slightest indication that he might have a heart condition. On Christmas Day 2017, while opening presents with his family, Jameson suddenly became ill. Two days later, he was admitted to Texas Children’s heart failure intensive care unit and diagnosed with dilated cardiomyopathy, a condition in which the heart muscle – typically starting in the left ventricle – begins to stretch and become thin. The dilation makes the muscle unable to contract properly, which weakens the heart and can lead to heart failure.

Jameson was experiencing severe heart failure and needed life-saving surgery as soon as possible. Texas Children’s congenital heart surgeon Dr. Iki Adachi implanted a ventricular assist device on December 31, which improved Jameson’s condition so much that we was able to go home after less than a month. But his journey wasn’t over. Jameson’s best chance at survival now was a heart transplant, and he was placed on the list on March 30, 2018 – Good Friday. Less than two months later, Jameson received the miraculous gift of a new heart. Adachi, who also performed the transplant, said Jameson has been doing very well since his surgery.

Jameson’s story is just one example of the amazing work done by Transplant Services in 2018. But none of the work we do would be possible without the selfless decisions that our donor families make during the most difficult time of their lives.

“Our donor families are heroes, said Goss. “They truly give our patients a second chance at life.”

Learn more about Transplant Services at Texas Children’s.