STORY BY

Meredith Raine

 

Hope for Faith

A delicate fetal surgery gives babies a chance for improved outcomes

Part II of a III-part series on
Healthy Futures for our Tiny Treasures

Comforted by the soothing sounds of gospel music, Colette Hagler looked up at the ceiling of the operating room, and, for the first time in weeks, put her fears aside.

“I have prayed about this, and that is all I can do,” she remembers thinking. “I want to give my child the best outcome.”

Only a few weeks earlier, on the day Colette and her husband Ivan learned she was pregnant with a baby girl, they also learned that their unborn child likely had spina bifida, the most common disabling birth defect in the United States.

Physicians in Dallas told the couple about a team of specialists in Houston offering a delicate, life-changing fetal surgery for spina bifida. If Colette and her unborn baby met the criteria, they would become the first in Texas to undergo the procedure.

When the diagnosis was confirmed, the Haglers spoke by phone to specialists with The University of Texas Health Science Center at Houston (UTHealth) Medical School and Children’s Memorial Hermann Hospital. Then, with great hope, faith and anxiety, they packed their bags and made their way from Dallas to the team’s clinical practice, UT Physicians’ Texas Fetal Center.

The surgery would mark a significant advancement for the field of fetal intervention.

Earlier this year, the New England Journal of Medicine published the long-awaited results of a multi-center trial studying the effects of in utero repair compared with standard postnatal repair of spina bifida defects. The groundbreaking research showed that children whose spina bifida defects were repaired surgically before birth were more likely to walk without the assistance of orthotics or devices and many avoided the need for ventriculoperitoneal shunts.

The Texas Fetal Center’s mission is to offer comprehensive care that improves outcomes for pregnant mothers and babies, so with the research findings, the team moved quickly to establish a strong fetal surgery program for spina bifida.

By the time Colette was prepped for surgery, the multi-disciplinary team was well-rehearsed. From the anesthesiologists to the maternal-fetal specialists to the surgeons to the nurses, everyone had a critical role in the care of the mother and her baby.

Once Stephen Larson, DO, professor of anesthesiology, performed the pediatric and obstetric anesthesia, Joan Mastrobattista, MD, and KuoJen Tsao, MD, made an incision on the uterus, exposing the baby. Pediatric neurosurgeons Stephen Fletcher, DO, and John Jones, MD, then performed spinal surgery on the fetus to repair the defect. Afterward, doctors placed the baby back in the womb and closed the incision. They were among nearly two dozen essential medical care team members, plus an even greater number of ancillary support staff that took part in the surgery. All the while, one of the nurses sent Colette’s husband text messages to keep him informed of the progress.

“There obviously are risks with the operation, both for mom and baby. But with early intervention, some of the damage that results from spina bifida as the baby develops neurologically can either be slowed down or potentially reversed,” says Tsao, assistant professor of pediatric surgery at UTHealth Medical School and a co-director of the Texas Fetal Center.

After the surgery, Colette recalls, “I still felt pregnant – because I was.” She laughs about it now, but there were tense times between the surgery and delivery. Volunteers, residents and other members of the health care team made the Haglers feel at home during their extended stay at Children’s Memorial Hermann Hospital and helped them celebrate each milestone. Nearly nine weeks after the fetal surgery—on Independence Day—Colette gave birth.

The couple chose to call her Faith—a fitting name for a feisty baby whose parents say has quite an appetite for life.

While Faith’s overall outcome may not be clear for several years, doctors are confident that she’ll be able to walk instead of requiring a wheelchair.

“Now I think the best is yet to come,” Colette says.

Physicians say the fetal surgery for spina bifida marks the beginning of a new era. Perhaps the best is yet to come not only for Faith but for many more mothers and babies.

Kevin Lally, MD, chairman of the Department of Pediatric Surgery at UTHealth Medical School and surgeon-in-chief at Children’s Memorial Hermann Hospital, says advancements in stem cell research, regenerative medicine and robotics are on the horizon. This could lead to innovative new treatments for unborn babies with cleft lip, cleft palate, diaphragmatic hernia and other birth defects.

Since Faith was born, two internationally recognized physicians have joined the UTHealth/Children’s Memorial Hermann team. Kenneth J. Moise, Jr, MD, and Anthony Johnson, DO, co-directors of the Texas Fetal Center, have extensive experience performing laser procedures in the treatment of severe twin-to-twin transfusion syndrome, open fetal surgery, EXIT procedures and other fetoscopic-based fetal interventions.  Karen Moise, RN, also joined the team in the pivotal role of lead nurse coordinator.

“There are going to be some exciting things in research and surgical care coming down the pike,” says Kenneth J. Moise, Jr, MD.

With the first integrated maternal-fetal pediatric hospital in the region and one of only a select few institutions across the United States that is home to both the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine and Neonatal Networks, the multi-disciplinary team offers its patients a full array of services and access to cutting-edge research.

“Ten or 15 years ago, fetal surgery was the next great hope,” says Lally, the A.G. McNeese Chair in Pediatric Surgery and the Richard Andrassy, MD, Endowed Distinguished Professor.

Now, he says, medicine is translating that hope into better lives for mothers and babies.

For more information, visit www.texasfetalcenter.com or call 1-888-818-4818.

 

 

Last Updated: 11-09-2011

 

The University of Texas Health Science Center at Houston (UTHealth), the most comprehensive academic health center in The UT System and the U.S. Gulf Coast region, is home to schools of biomedical informatics, biomedical sciences, dentistry, medicine, nursing and public health. UTHealth educates more healthcare professionals than any health-related institution in the State of Texas and features the nation’s seventh-largest medical school. It also includes a psychiatric hospital and a growing network of clinics throughout the region. The university’s primary teaching hospitals include Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Lyndon B. Johnson General Hospital. Founded in 1972, UTHealth’s 10,000-plus faculty, staff, students and residents are committed to delivering innovative solutions that create the best hope for a healthier future.

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