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New Texas Children’s Fetal Center advancements
exemplify Vision 2010 model of ‘Excellence to Eminence’
By Dale Brown Jr., M.D.
To continue in Texas Children’s mission for saving lives and
enhancing fetal outcomes is the impetus for the establishment of
the new Texas Children’s Fetal Center.
As Texas Children’s Hospital moves to new initiatives
encompassing maternal care with the technology of the future,
many babies who may have died or would have sustained
life-threatening handicaps may now have the opportunity to
overcome these obstacles. Having the knowledge that good
maternal care results in healthy babies has led to plans for
building a maternity center at Texas Children’s Hospital.
Focusing on high-risk pregnancies and attempting to lessen their
morbidity resulted in the recruitment of two outstanding fetal
interventionists from the University of North Carolina – Anthony
Johnson, D.O., and Kenneth J. Moise Jr., M.D.– to the Department
of Obstetrics and Gynecology at Baylor College of Medicine.
These physicians will be the cornerstones for the maternal-fetal
portion of fetal intervention.
Filling the geographic gap in fetal intervention and surgery
care
Conditions such as twin-to-twin transfusion that occur in
identical twins between 10 and 15 percent and usually result in
a greater than 90 percent mortality now allow twins to survive,
reversing the statistics up to a 90 percent survival rate.
Treatment for the twin-to-twin transfusion consists of lasering
and coagulation of abnormal fetal vessels in utero usually
between the fourth and fifth months of pregnancy. Intubation and
insertion of balloons into the lungs to prevent advancement of
pulmonary hypoplasia in those babies with severe diaphragmatic
hernias now gives those infants a chance for survival, where
previously there had been none. Angioplasty in utero in infants
with severe aortic arch stenosis will enable babies to be born
alive and subsequently undergo necessary appropriate cardiac
surgery by the fetal surgeons. Future technology will allow
possibility of stem cell transplant.
All of these procedures are done while the baby is in the
amniotic sac in the uterus. These are just a few of the
potential treatments that will be available in the Texas
Children’s Fetal Center, which will make Texas Children’s
Hospital a national and international leader of fetal
intervention and pediatric surgery. The only fetal intervention
center that exists today in the south is in Florida; none exist
in the Midwest or southeast regions of the country. Before now,
fetal intervention centers existed only on the East and West
Coasts. Patients’ mothers who previously had babies affected
with significant abnormalities necessitated referral to centers
in these venues for appropriate treatment. This will no longer
be the case. They will be cared for by the Texas Children’s
Fetal Center. One can easily foresee this will entice and enable
recruitment for some of the best academic physicians in the
future.
This is the first step in the development over the ensuing years
of the future Texas Children’s maternity center. Academic
research with appropriate outcomes determining care of patients
will become a milestone for institutions throughout the country.
Translational research will deal with hypertension in pregnancy,
diabetes in pregnancy, cardiovascular disease hemoglobinopathies,
and other severe morbid conditions.
Advancing in leaps and bounds
When considering the potential for fetal intervention, one has
to imagine a “Star Wars” approach in that there are innumerable
opportunities in the future as technology advances. For example,
with the advancement of mini robotic instrumentation fetal
surgeons will be able to perform intricate fetal surgery in
utero.
Medicine is reaching a level in which technology is becoming so
advanced that if you can imagine something that you would like
to have done, with time it will be possible to accomplish. Genetic
therapy with the potential of absolution of certain diseases
exists. Collaboration with the genetics department at Baylor
will further the horizon for improvement of medical care. This
is why so much excitement exists with the fetal intervention and
pediatric surgery program, which is moving ahead in leaps and
bounds. Those who are involved with development and realization
of such life-saving and life-changing procedures truly
exemplify the Vision 2010 model of “Excellence to Eminence.”
Dale Brown Jr., M.D., is acting chief of Obstetrics and
Gynecology at Texas Children’s Hospital and interim
chairman and professor of Obstetrics and Gynecology at Baylor College of
Medicine.
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