October 8, 2018

A world-class, multidisciplinary team at Texas Children’s is making huge strides in the care of children with extremely complex tumors.

The Head and Neck Tumor Program, begun in February 2016 as collaboration with partner institutions within the Texas Medical Center, has performed more than 20 major ablation free-flap multidisciplinary cases – a staggering number, considering the rarity and complexity of the tumors, which can be malignant or benign and can affect any combination of the sinuses, skull, jaw, mouth, neck and face. The ability to handle that volume of complex cases, combined with tremendous outcomes in the first two years, puts Texas Children’s Head and Neck Tumor Program among the best such programs in the country.

“Our institutional expertise is in taking care of these kinds of critically ill children, and Texas Children’s does it better than anyone,” said Dr. Daniel Chelius, attending surgeon in the Division of Otolaryngology and co-head of the program. “We’ve built a collaborative, coordinated program on that foundation of expertise in many different areas to provide the best care possible for the sickest children, while also reviewing and analyzing the care from every angle to see what went well and what processes could improve.”

Treatment of children with head and neck tumors around the country has historically been ad hoc, due to the varying functional issues or oncologic needs present from patient to patient and the extreme rarity of the tumors in any given city. Compound these complex physiological issues with the fact that most children these tumors have been treated in adult hospitals and the result has been a largely disjointed approach to care.

Texas Children’s Head and Neck Tumor Program, spearheaded by Chelius and Dr. Edward Buchanan, chief of Plastic Surgery, has developed a coordinated process around a multidisciplinary team approach that builds crucial experience in the treatment of these rare tumors and provides consistent, personalized care for patients – like 15-year-old Kami Wooten.

Last year, Kami began to notice swelling in her gums. Just months later, a benign tumor had covered half her face and threatened her vision. The team at Texas Children’s developed a specialized care plan that included removing the mass and reconstructing a portion of her face including the roof of her mouth and her orbit (eye socket). Additional procedures will be necessary in the future, but Kami and her family are grateful for the care Texas Children’s gave them.

Learn the rest of Kami’s story here.

The collaborative program comprises more than 10 Texas Children’s specialties and subspecialties, including Otolaryngology, Plastic Surgery, Neurosurgery, Oncology, Interventional Radiology and Anesthesiology, as well as a dedicated operating room team – led by Audra Rushing and Kelly Exezidis – that has been instrumental in building robust perioperative protocols. The additions of pediatric head and neck surgeon Dr. Amy Dimachkieh and microvascular reconstructive surgeons Dr. W. Chris Pederson and Dr. Marco Maricevich have increased the program’s abilities and improved the quality of its recommendations.

“It takes a lot of thought and planning to remove these complex tumors completely, while sparing as many nerves and other important structures as possible, and then to reconstruct those structures to provide both a good functional and cosmetic outcome,” Chelius said. “We tell our patients that the process might not be fast because they need the right surgery the first time. That requires recommendations from a team of experts, not just one surgeon. And that means carefully coordinating to make sure everything is as perfect as possible.”

The care required to treat these tumors, particularly if the patient is also undergoing cancer treatment, can also take a massive emotional and psychological toll. The Head and Neck Tumor Program provides additional care support through the department of Clinical Psychology and Child Life Services.

The team also uses technology to enhance the patient experience, from diagnosis to recovery. The program uses 3-D modeling to reconstruct children’s anatomy to help predict the extent of resection and to develop the surgical plan. The team also developed a data-driven protocol for pediatric tracheostomy removal, in close collaboration with Speech and Language Pathology, which uses a pressure monitoring device to signal when the trach is loose enough in the airway to be removed without adverse effects.

As a result of this innovative approach to care, 100 percent of patients treated have left the hospital breathing, eating and swallowing on their own. And the average stay in the hospital: just 14 days.

The program has been steadily building a referral base, drawing patients from across the region and from as far away as Mexico and the Middle East. In the near term, the team will continue to solidify the program, publish data and findings, and work to increase Texas Children’s reputation as the leading referral center for these complex cases. Long-term goals include building a basic science research infrastructure around understanding the underlying causes of these tumors, as well as collaborating with Texas Children’s Cancer Center and other research partners.

“We know that families are coming to us shocked and scared,” Chelius said. “We want them to know that we’re building our experience, we’ve walked families through this before, and we’re going to get them through this with the absolute best care available.”

Learn more about Texas Children’s Head and Neck Tumor Program.

Physicians and scientists at Texas Children’s Hospital are known for treating patients with some of the most complex pediatric medical conditions. They’re also known for helping patients with some of the rarest.

From July 18 to 22, 20 individuals with Robinow syndrome and their families came to Houston from across North America for the 25th Robinow Syndrome Foundation Convention and Medical Conference, which was hosted by Texas Children’s Hospital. This group of patients represented a large cohort – about 10 percent – of all currently documented cases of Robinow syndrome, an ultra-rare disorder that affects the development of many parts of the body, usually resulting in distinctive craniofacial features, skeletal and genitourinary abnormalities, and in some cases heart defects.

Because there are several genes associated with Robinow, the physical characteristics and their severity can vary between individuals, affecting their health and quality of life in different ways. To gain a better understanding of specific health needs, and to gain new insight into the genetic reasons behind the variance in symptoms, Texas Children’s physicians held a special research day as part of the conference.

The multidisciplinary effort was two years in the making and driven by the research of Texas Children’s clinical geneticist Dr. V. Reid Sutton and co-investigator, Dr. Claudia Fonseca, adjunct assistant professor of molecular and human genetics at Baylor College of Medicine, whose work together on Robinow recently garnered a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the National Institutes of Health.

“Our work with the Robinow Syndrome Foundation two years ago led to us being able to observe differences in individuals depending on which gene was causing the disorder,” said Sutton. “We were excited to host the event this year at Texas Children’s so we could follow up on initial studies, get new samples for research, and gather more detailed information on the differences in physical symptoms in the hope that we can improve care for these patients.”

Clinical and lab space was set aside specifically for the research day. Texas Children’s Child Life Department was on hand to direct families, assist with procedures, and alleviate any stress or anxiety with activities and fun ways to pass the time. For six hours, the patients and their families met individually with teams of physicians across six different disciplines, including urology, plastic surgery, psychology, endocrinology and genetics.

In addition to collecting new samples, Sutton also measured bone density in about half the patients using DEXA (dual-energy X-ray absorptiometry) scanning and high-resolution peripheral quantitative computed tomography at the Children’s Nutrition Research Center’s Body Composition Lab. Dr. Renata Maricevich from the Department of Plastic Surgery examined patients’ craniofacial symptoms, noting the health implications of structural deformities, particularly breathing and speech problems, and how surgical options could help. Additionally, a team of pediatric urology fellows and residents, led by Dr. Paul Austin, director of Texas Children’s Complex Urologic Reconstruction program and professor of Surgery for the Department of Urology at Baylor, observed patients’ genitourinary abnormalities, which can affect both appearance and function, particularly among males with Robinow.

“I anticipate the collaborative research conducted during the conference will culminate in a landmark reference document for the treatment of Robinow,” Austin said. “The specialty-specific data will help better characterize and delineate the phenotypic features based on the mutation present. So in the case of urology, we will have a better understanding of urologic issues associated with the various genetic forms of Robinow and will be able to develop more specialized treatments.”

In addition to possible surgical interventions, findings from the research day demonstrated that there could be potential non-surgical treatment options for Robinow patients as well. Dr. Shilpi Relan from pediatric endocrinology spoke to families about growth hormone therapies, as well as the possibility of testosterone therapy for males to help mitigate, or perhaps even avoid, some of the genitourinary symptoms. Experts at Texas Children’s also addressed the potential psychological repercussions of living with Robinow. Drs. Marni Axelrad and David Schwartz from Texas Children’s Clinical and Pediatric Health Psychology assessed cognitive and fine motor strengths and weaknesses, and created behavioral and emotional profiles for individual patients.

“Texas Children’s provides fabulous support for individuals living with syndromes like Robinow and their families,” Axelrad said. “Whether they need help for emotional, behavioral or cognitive challenges, our providers work together to better understand each patient and their needs. The information gathered at this conference has the potential to help patients understand how Robinow specifically affects them, as well as providing information about potentially helpful clinical assessment and intervention.”

The event was incredibly well received by the families who attended.

“The response from our families was very positive,” said Kimberly Kremeier, executive director of the Robinow Syndrome Foundation. “The physicians at Texas Children’s took time to explain in detail their findings and potential treatment plans. Our families were pleased to get answers, and some needing treatment now have a plan of care that hadn’t been available in their local communities. We welcome future collaboration with Texas Children’s in the future.”

The multidisciplinary research team will reconvene in the coming months to compile their findings from the research day, as well as presenting subsequent ideas for treatment and therapies, into manuscripts for joint publication.

“Ultimately we want to understand all the physical manifestations of Robinow in detail, as well as correlating the genetic basis in individual patients,” Sutton said. “Knowing why we’re seeing the physical differences is going to help us improve the care we can provide.”

September 25, 2018

For months, teams have been preparing for the opening of the new Texas Children’s Heart Center® in Legacy Tower. The outpatient clinic went live on September 18. And this week, Move Day into our inpatient space has finally arrived.

Before the flurry of activity, we had the opportunity to sit down with new Chief of Congenital Heart Surgery Dr. Christopher Caldarone, who shared a little about his background and his vision for the No. 1 heart center in the nation.

Tell us a little about yourself. Where’d you grow up?

“I was born in Boston and grew up in Upstate New York and New Jersey. We still have a lot of family in Boston and spend time there in the summer.”

Were you always interested in medicine as a career?

“I had a predisposition toward engineering and science as a kid. I ruptured my spleen in a high school wrestling match and spent a few months in hospitals. I was fascinated by the environment and I think that’s when it really started for me. I went to college at Johns Hopkins for bioengineering but found the subject matter to be too dry. I realized I really liked the medical part of my studies, so I switched over to pre-med.”

How did that lead to your interest in surgery?

“Sometimes people find that they just fit in a field. You just feel like there are places in life where you belong and others you don’t, and I always felt like I belonged in surgery.”

How does it feel to be a part of the team at Texas Children’s?

“It feels amazing. I think that for those of us who’ve been at other institutions, it’s easy to appreciate how special this place is. It’s a spectacular environment.”

What was it about Texas Children’s that attracted you?

“It was all about fit and impact. I spent fifteen years in Toronto with a great team. But from the very first call from Texas Children’s, I felt that we shared a common vision and I felt that I was a good fit for what they were looking for in a very genuine way. That was very compelling. Secondly, the potential here to make a difference is vast. There is an opportunity to take what I learned in my previous role as surgeon-in-chief and refocus on congenital heart disease, which is the area that interests me the most.”

Why is multidisciplinary collaboration so important?

“Being part of a team and functioning as a team is my preferred environment. I just enjoy it more. But that isn’t the reason why it’s important. It’s important because the congenital heart program at Texas Children’s is already competing at the Olympic level. The gradations between the best pediatric hospitals are so fine that to compete at this level, you have to optimize every aspect of the entire program. People can’t work harder and there are no better people to hire. The only option we have is to create an organizational structure that functions more efficiently than other programs, if we want to improve faster than they’re improving. That’s why a multidisciplinary team approach is important. It’s literally the only way to compete at this level.”

How does the layout of the new Heart Center help facilitate improved interaction?

“Architecture influences culture. It can enhance or detract from it. Locating cardiology, cardiac surgery, anesthesia, perfusion, the advanced practice providers and our administrative staff in one environment helps make magic. Having everyone in close proximity on the same floors is enormously beneficial for our patients and our care providers.”

You have an active translational research background. Will you continue to build on that?

“I want to continue my own research, but my main objective here is to support other clinician’s translational science efforts throughout the Heart Center. I’ve found that if you get a team together, find resources and focus on a target, you can produce powerful results. My role is to support an environment where multidisciplinary teams routinely get together, target specific areas and create impact. I think of it as translational science ‘one step removed’. I think that’s one of the reasons I’m here.”

What’s something you want people reading this to know about the leadership team’s vision for the Heart Center?

“I want people to know that the Heart Center leadership is dedicated to creating a shared stewardship model, through which we work together to identify specific targets, pool our resources and act upon those targets as a unified group. The model makes collaboration the expectation rather than the occasional nice outcome. In most other institutions, collaboration can happen; there’s nothing to restrict it. But if it doesn’t happen, it’s a silent failure and a missed opportunity.

“Here, we have a group of leaders that is accountable to see that our resources are deployed in a meaningful way that drives change. This creates the dynamic that is necessary to provide that Olympic level of care. If the patient is truly our focus, then every little thing we do here has to be better. Everything has to keep improving. And every single person in the Heart Center has a role and the potential to influence how we extend our lead and, more importantly, how we can improve care for our patients.”

Time for rapid fire: What’s your favorite film?

“The Year of Living Dangerously.”

Favorite sport?

“I don’t really have a favorite. I appreciate a good contest, regardless of the sport.”

Favorite place you’ve traveled?

“Thailand.”

What are you listening to right now on the way to work?

“NPR.”

Beatles or Rolling Stones?

“Tough one! It’s a toss-up. Depends on my mood.”

Caldarone is an internationally recognized leader in congenital heart surgery and most recently served as surgeon-in-chief at The Hospital for Sick Children in Toronto. He received his undergraduate degree from Johns Hopkins University and his medical degree from Columbia University, and he completed his general surgery and cardiothoracic surgery residencies at Beth Israel Deaconess Medical Center/Harvard Medical School. He also completed a fellowship in congenital heart surgery at The Hospital for Sick Children. Caldarone is a member of the American Association for Thoracic Surgery, the Society of Thoracic Surgeons and the Congenital Heart Surgeons’ Society. His specific research interests include the role of apoptosis related mitochondrial dysfunction and remote ischemic preconditioning as mediators of reperfusion injury. Most recently, Caldarone has focused on pulmonary vein stenosis and tissue engineering of pulmonary valves.

September 18, 2018

Imagine you’re the parent of a newborn with an arm injury. During your admission you’re told not to move the arm and to protect it all times. Now imagine coming back for your clinic appointment and hearing that it’s time to start moving the arm at home – unsupervised. For parents of children with brachial plexus birth palsy, this moment can be daunting.

Brachial plexus birth palsy occurs when there’s a stretch or tear in the bundle of nerves known as the brachial plexus, located near the neck and upper arm area. These injuries may cause weakness, pain, sensory loss and functional impairment. Sometimes the nerves need time to recover, anywhere from a few days to a year. Other times surgery might be required. Regardless, a focus on treatment during the waiting period can help prevent the shoulder joint from becoming stiff. The only way to keep the joint loose is through passive exercises, which must be performed early and often by the patient’s family.

“If we can find a way to keep these shoulders loose, we can eliminate many of the problems we see down the road,” said Dr. Chris Pederson, head of Texas Children’s Pediatric Hand and Microvascular Surgery programs. “Unfortunately, for a lot of parents performing the exercises can be an intimidating task.”

To help empower parents, Texas Children’s brachial plexus clinic recently teamed up with engineering students at the Oshman Engineering Design Kitchen at Rice University to develop a model that allows parents to practice movement exercises in clinic before performing them on their children at home. The project was part of an ongoing collaboration with Rice begun in 2014 by Texas Children’s Brachial Plexus Clinic Coordinator James Northcutt.

“I originally pitched the idea for the brachial plexus model to the freshman design class at Rice in the fall of 2017,” Northcutt said. “Using the model, I wanted parents to be able to identify the different parts of the shoulder and shoulder blade and feel the difference between a stiff shoulder and a healthy shoulder. And ultimately, I wanted to help alleviate the anxiety parents feel about moving their child’s arm by giving them the opportunity to practice the exercises on the model first.”

Northcutt met with the students monthly to serve as clinical lead on the project, providing information about anatomy, biomechanics, caregiver needs, therapy concerns and overall device application. Less than a year later, design team “Can’t Brachius,” produced a professional and well-functioning prototype. But it needed to be tested by parents. Mayra Oliver was the first.

When she was first told she’d need to perform exercises on her infant son, Raphael, Oliver was nervous and worried. But a demonstration of the model and the opportunity to use it herself had her feeling much more confident.

“When I first knew that Raphael was hurt, I was scared I’d do the exercises wrong and hurt him or somehow make his injury worse,” Oliver said. “Being able to feel the different parts of the shoulder on the model and then on Raphael, and then feeling the way the healthy shoulder should move freely, as opposed to the stiffness of an injured shoulder, was very helpful. I think this model will be very useful in helping families feel less nervous about doing the exercises.”

Using a survey developed in conjunction with the Rice design team, Northcutt will begin conducting a randomized control study over the coming months to determine the device’s efficacy both in educating families and in preparing them for the performing the exercises at home.

“I look forward to finding out more about our parents’ needs in helping these infants grow up to function at the highest level,” Northcutt said. “This project represents an attempt to improve patients’ futures by equipping parents to be informed, active care team members.”

The Brachial Plexus Clinic is part of Texas Children’s Brachial Plexus Program, which comprises plastic surgery, orthopedic surgery, physical medicine and rehabilitation, and occupational therapy. The clinic provides comprehensive care for brachial plexus injuries including specialized assessment, developmental and functional screening, primary nerve surgery when indicated, secondary orthopedic surgery for the shoulder and lower arm when indicated, and preoperative and postoperative care in the therapy setting. The brachial plexus team provides high-level, evidenced-based care, utilizing ultrasound to monitor shoulder integrity in infants recovering from brachial plexus injury, providing specialized splinting for prevention of joint contractures in the arm, and implementing best surgical practices for primary nerve and secondary orthopedic procedures.

August 27, 2018

Texas Children’s Pavilion for Women and two of its surgeons recently received superior patient care designations from the Surgical Review Corporation, which develops and administers best-in-class accreditation programs for surgeons, hospitals and freestanding outpatient facilities throughout the world.

After a rigorous review process, the SRC accredited the Pavilion for Women as a Center of Excellence for Minimally Invasive Gynecology and two of its surgeons – Dr. David Zepeda and Dr. Xiaoming Guan – as Surgeons of Excellence in Minimally Invasive Gynecology.

The Pavilion for Women is now one of three hospitals in Houston and one of five in Texas with the Center of Excellence designation.

“Earning this accreditation signifies our ability to consistently deliver the safest, high-quality care to our patients,” said Nakeisha Archer, director of perioperative services for the Pavilion for Women. “Our program fosters quality improvement in surgery, and commitment to this process has focused our team on exceeding clinical benchmarks and guidelines. Most importantly, our commitment to excellence will improve the health and well-being of our patients. We are so proud to be leaders in quality care for women.”

Minimally invasive gynecologic surgery includes hysteroscopic, laparoscopic and/or vaginal procedures such as hysterectomies, fibroid removals and myomectomy excisions. Surgeons at the Pavilion for Women did almost 500 minimally invasive surgeries in 2017 and are on track to do more this year.

Karen Rosser recently had a minimally invasive procedure done with Zepeda and said her experience with the surgeon and the Pavilion for Women was incredible.

“I felt comfortable every step of the way,” said Rosser, who suffered chronic pain for years due to adenomyosis. “I never flinched at moving forward with surgery and am confident I received the best care.”

Zepeda said he is proud of the designations and believes they distinguish the Pavilion for Women as a leader in minimally invasive surgery.

“SRC’s accreditation program recognizes surgeons and facilities that demonstrate an unparalleled commitment and ability to consistently deliver safe, effective, evidence-based care,” he said. “This has always been our focus at the Pavilion for Women and always will be.”

Guan agreed and said he hopes patients looking for quality care can now be even more assured that the Pavilion for Women is the place to be knowing we have met rigorous standards for delivering high-quality perioperative and long-term follow-up care.

More about the surgeons

Dr. David Zepeda was born and raised in Houston and attended The University of Texas at Austin. Zepeda received his medical degree at the University of Texas at San Antonio Health Science Center in 1974. He completed obstetrics and gynecology residency at Baylor College of Medicine in Houston in 1978. Zepeda maintains an academic appointment as clinical associate professor at Baylor College of Medicine, where he is involved in residency and medical student education. He’s recognized in the Texas Medical Center for his expertise in gynecologic surgery, including pelvic reconstruction, DaVinci Robotic Surgery and advanced laparoscopic and hysteroscopic procedures. He is board-certified by the American College of Obstetrics and Gynecology and has voluntarily recertified numerous times. He has been awarded the Distinguished Surgeon of the Year in Houston and has been voted among the Best Doctors of America. In addition to teaching, Zepeda has been involved with National Scientific Meetings in Ob/Gyn and has published on laparoscopic surgery. He is actively involved in continuing medical education through the medical center and national meetings in the specialty as well as numerous professional societies.

Dr. Xiaoming Guan
Dr. Xiaoming Guan is the Section Chief and Fellowship Director of Minimally Invasive Gynecologic Surgery at Texas Children’s and is an associate professor in the Department of Obstetrics and Gynecology at Baylor College of Medicine. Dr. Guan earned his medical degree at Fujian Medical College, Fuzhou in Fujian, China. He completed his Obstetrics and Gynecology residency at St. Joseph’s Hospital, a Mount Sinai School of Medicine affiliated hospital, in Paterson, NJ, followed by a fellowship in Minimally Invasive Gynecologic Surgery at Baylor College of Medicine in Houston. Dr. Guan brings extensive experience in treating complex and challenging cases of endometriosis, uterine fibroids, and pelvic masses. He is a leader in minimally invasive gynecologic surgery and a pioneer in the use of state-of-the-art robotic single-site technology and traditional single site and transvaginal Natural Orifice Endoscopy Surgery (NOTES) for advanced pelvic surgery. He also applies single-site or NOTES surgical technique in treatments of cervical incompetence with abdominal cerclage, urinary incontinence with sling, and pelvic organ prolapse with sacrocolpopexy. He serves on the editorial boards of the Journal of Minimally Invasive Gynecology and he is the author of numerous more than 40 publications.

More about SRC
Established in 2003, SRC is an internationally recognized patient safety organization dedicated to recognizing and refining surgical care. SRC is the leading administrator of quality improvement and accreditation programs for surgeons and hospitals worldwide. SRC’s proven methodology, known as the “Cycle of Excellence,” results in quantifiable and unparalleled improvement in the outcomes, patient safety and costs across surgical specialties. To measure improvement and develop best practices, SRC offers a multispecialty outcomes database that is the world’s largest repository of clinical patient data for minimally invasive gynecologic and bariatric surgery.

August 13, 2018

Creating viable, long-term health care solutions for children and mothers worldwide has always been a part of Texas Children’s mission. To further that charge, a new division has been created within the Department of Surgery – the Division of Global Surgery. The division will be led by Dr. Jed Nuchtern, who has been Texas Children’s chief of Pediatric Surgery since 2012.

“This is a wonderful new opportunity for Texas Children’s Hospital, the Department of Surgery and Dr. Nuchtern, said Surgeon-in-Chief Dr. Larry Hollier. “Providing surgical expertise in underserved areas has been a great passion for Dr. Nuchtern, and he has traveled extensively bringing surgical care to children around the world. I would like to thank him for his continued commitment to patient care and surgical excellence.”

Through Global Health programs, Texas Children’s collaborates with international governments and health organizations to share its expertise and best practices, with a strong focus on sustainability. This collaboration includes providing surgical training and direct care and treatment in many underserved nations, such as Argentina, Haiti, Malawi, Mexico, Pakistan, Tanzania and Uganda. Due to lack of resources, facilities, education and support, surgical interventions thought of as routine here in the United States, such as repairing a broken bone or simply suturing a wound, are difficult to perform and thus much less common in these countries. A more complicated procedure like a C-section becomes altogether life-threatening.

The creation of the new Division of Global Surgery will help Texas Children’s forge new partnerships, offer providers opportunities for exposure, and facilitate care and capacity building to improve the lives of children and women across the globe, beginning in sub-Saharan Africa.

Leveraging resources, infrastructure and successful global medical programs already in place in the region – including Baylor International Pediatric AIDS Initiative (BIPAI) Network, Texas Children’s Cancer and Hematology Centers’ Global HOPE (Hematology Oncology Pediatric Excellence), and existing efforts by the Department of OB/GYN – Nuchtern and his team will first focus on surgical care for pediatric cancer patients, 50 percent of which require some form of surgical intervention, to increase surgical capacity. Ultimately, the approach will have the combined effect of improving care of children with cancer as well as those suffering from other pediatric surgical diseases.

“While the initial focus is on cancer surgery, our approach is to help build capacity in children’s surgery overall,” Nuchtern said. “Our goal is to marshal all of the talent and energy of Texas Children’s department of surgery toward the goal of serving children throughout the world.”

Preliminary objectives include identifying individuals interested in participating, working with partners to develop the infrastructure necessary to provide quality care, and organizing a special group tasked with developing training opportunities, a central focus of this initiative. Building on successes and lessons learned, and through continued collaboration with Global HOPE, the long-term vision includes a surgical facility for women and children in Lilongwe, Malawi, expansion of care capacity in Central America, and, ultimately, recognition for Texas Children’s as a leader in global surgical outreach.

“We’re one family, and this is a team effort that requires substantial perioperative support from nursing, anesthesia, pediatrics, radiology and pathology,” Hollier said. “Dr. Nuchtern and the new Division of Global Surgery will coordinate with all hospital services to ensure that Texas Children’s is well-represented when going abroad and that these children and women receive the best possible care.”

Nuchtern will retain his duties as chief of Pediatric Surgery until a successor is found. A national search is currently underway. Pediatric Surgery at Texas Children’s has grown to include outstanding programs in surgical oncology, surgical critical care, colorectal and pelvic health, and basic science research. The GI Surgery program has consistently been recognized as one of the top five children’s hospital programs for GI & GI Surgery in U.S. News & World Report. Under Nuchtern’s leadership, the division also has received national and international acclaim for the separation of conjoined twins’ cases and many cutting-edge fetal surgeries. Additionally, the Trauma program was re-designated as a Level I trauma center and has expanded educational offerings to the state and region.

August 2, 2018

Dr. Allen Milewicz, chief surgical officer at Texas Children’s Hospital West Campus and chief of Community Surgery, recently assumed a new role within the Department of Surgery – associate chief of Clinical Affairs.

“Dr. Milewicz is uniquely positioned for this important new role,” said Surgeon-in-Chief Dr. Larry Hollier. “After operating at Texas Children’s for more than 25 years, he has experienced the growth of both the hospital and the Department of Surgery, has helped guide community outreach efforts for the department, and has a keen understanding of the needs of our referring providers.”

Aligning activities for one of the nation’s largest and most comprehensive pediatric surgery programs – with 120 surgeons, over 130 highly skilled advanced practice providers and 800 staff working across three different campuses – requires continuous oversight and attention to detail. In his new position, Milewicz will work closely with Hollier and other hospital leadership to provide that high level of oversight, as well as enhanced medical, operational and strategic leadership across the entire surgical enterprise, ensuring continuity of the efficient, high-quality care for which Texas Children’s Department of Surgery is known.

“I have had the good fortune to spend my entire career at Texas Children’s Hospital, and the growth of the organization has been tremendous and inspiring,” Milewicz said. “We want our Department of Surgery to be top of mind as the standard whenever a parent, pediatrician, health care specialist, resident, medical student or medical school faculty member thinks about surgical challenges in children.”

Additional aspects of the position will be the continued professional development of Texas Children’s surgeons and advanced practice providers, and improved patient and family experiences.

“I am thrilled to have the opportunity to help guide and serve,” Milewicz said. “We have so many talented, motivated people in our department that I think the best thing I can do is make it easier for everyone to do the job they come here to do. This means simplifying processes, facilitating flow and communication, and utilizing technology to improve access and help patients navigate our large organization. Of course, this must all be done under the umbrellas of safety and compassion. In everything we do here, whether it’s a highly complicated procedure or a condition that requires a simpler solution, I’m proud that we always remember that the child and the family are our focus.”

In addition to his new role, Milewicz will retain his duties as chief surgical officer at Texas Children’s Hospital West Campus and chief of Community Surgery.