May 2004
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Fetal surgery center first of its kind in Southwest
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| Dr. Olutoye, left, and Dr. Cass review a patient chart to determine a diagnosis. |
Sometimes, ordinary testing before an infant is born reveals an abnormality. The finding frightens parents and puts them in a dilemma.
Where do they find the kind of diagnostic and treatment expertise they will need to insure that their children receive the best care possible? The ideal would be a center where fetal diagnostics, maternal-fetal medicine and pediatric surgery are available under one roof. In April, that kind of care became accessible in the U.S. Southwest with the opening of The Texas Center for Fetal Surgery, a joint project of the Texas Children’s Hospital, St. Luke’s Episcopal Hospital and Baylor College of Medicine in Houston.
The Texas Center for Fetal Surgery is one of only four in the nation and a handful in the world. The first such center was in San Francisco at the University of California, San Francisco. The second was at the Children’s Hospital of Philadelphia and the third at Children’s Hospital in Boston.
“We have been working for three years to build the center,” said Darrell L. Cass, MD, co-director of the center. He is a fetal surgeon and pediatric surgeon at Texas Children’s Hospital and an assistant professor in the Michael E. DeBakey department of surgery at Baylor College of Medicine.
“Complex birth defects, which affect nearly 150,000 babies annually, are the leading cause of death in babies’ first year of life; however, new surgical techniques can reduce the potentially devastating consequences of some birth defects,” said Cass.
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| Dr. Cass, left, and his surgical team |
“When there is a diagnosis of a structural disorder in a fetus, the problem is that the care can be fragmented and misinformation may be provided. With our program, the mother is referred to us, and a comprehensive evaluation and assessment is made. Fetal MRI and echocardiography may be performed; an accurate diagnosis and prognosis is provided, and a well-coordinated plan of care is developed. We then counsel the mother and family so that they may know what to expect for the rest of the pregnancy, and then after the child’s birth,” he said. In most cases, treatment such as surgery is done after the baby’s birth.
“In only one in 10 to one in 20 cases is fetal surgery appropriate,” he said.
“In our experience and in that of our colleagues, it helps the families and puts their minds at ease to know what to expect and to understand what will happen with their baby later on,” he said.
“We are thrilled to open a dedicated center offering the full spectrum of fetal surgical services,” added Oluyinka Olutoye, MD, PhD, a co-director of the center, a fetal and pediatric surgeon at Texas Children’s and a BCM assistant professor of surgery. “The center offers prenatal evaluation, diagnosis, invasive fetal therapy and open fetal surgery for many genetic or anatomic birth defects that require therapy before or after birth.”
Cass and Olutoye, working with Mary P. O’Day, MD, assistant professor of obstetrics and gynecology, as well as other members of the division of maternal-fetal medicine in the BCM department of obstetrics & gynecology, already have performed successful ex utero intrapartum treatment (EXIT) procedures on patients from Houston, Austin and Dallas.
“This EXIT procedure allows us to create an airway in unborn children who have giant neck masses which compress the child’s trachea and make it very difficult or impossible to breathe,” Cass said. “In all six cases to date, mother and baby have done well.”
This procedure is performed during a modified Cesarean delivery. Surgeons partially remove the fetus from the womb and perform surgery while the fetus remains attached to the umbilical cord. When the procedure is complete, they cut the baby’s umbilical cord and deliver the baby.
Following surgery, the infant is cared for at the Texas Children’s Newborn Center, a 140-bed center that is the largest neonatal intensive care unit in the United States. The mothers receive their pre-natal and post-surgical care in the Center for Mothers and Babies at St. Luke’s, which specializes in providing high-risk obstetric care.
In addition to this, specialists at the center offer diagnosis and/or treatment for more than a dozen fetal disorders, including lung masses such as cystic adenomatoid malformation. This occurs when the part of a lung in the fetus develops abnormally with a few large or several small cysts. In some cases, this abnormal tissue must be removed before birth. They also provide diagnosis and counseling about congenital diaphragmatic hernia, a condition in which the diaphragm does not form properly, allowing organs normally found in the abdomen to crowd into the chest, reducing the space for lungs and heart.
There are other rare fetal conditions for which the team of specialists
can provide diagnosis and treatment. The Texas Center for Fetal Surgery
team of 18 specialists are trained and experienced in specialized pediatric
fields, including fetal surgery, maternal fetal medicine, anesthesiology,
fetal radiology, fetal cardiology, neonatology, fetal urology and neurosurgery.
"Early fetal diagnosis and surgery gives hope to babies who might
otherwise suffer serious complications from certain birth defects,"
Olutoye said. "Our center offers a centralized point of care in which
specialists can provide highly-skilled, integrated care for both mother
and child."
| A Matter of Health | |
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Mothers all |