Caring for the Smallest of Patients
On January 24, 2013, the life of Iris Vega-Figueroa changed completely.
That’s the day she gave birth to her twin girls, Iris and Geraldine. The twins were monoamniotic-monochorionic, meaning they shared one amniotic sack and one placenta in the womb. These rare pregnancies are considered high risk because of the uneven blood flow that occurs between the infants through the placenta.
Other serious complications include cord entanglement or compression, which one of Vega-Figueroa’s daughters had already begun experiencing. Due to the tightness of one of the girls’ umbilical cords, the identical twins were born at 27 weeks and 4 days.
According to the Centers for Disease Control and Prevention (CDC), a preterm birth occurs when an infant is born before 37 weeks of pregnancy. Although preterm births happen for different reasons, one thing these babies do have in common is their need for constant care and attention during this critical stage of life.
“These little babies’ lives are about connection the moment they come out,” says Andrea Duncan, M.D., UT Physicians pediatrician and associate professor in the Department of Pediatrics, Division of Neonatology at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
In the last weeks of pregnancy, organs such as the brain, lungs, and liver are still being developed. For babies who are born before 30 weeks, the chances of lung disease, heart complications, brain injury, cerebral palsy and other developmental delays are increased. Premature births also increase the chances of the child repeating a grade or struggling in school.
The very premature are often facing an even greater chance of long-term neurological disabilities, breathing and feeding difficulties, and possibly even death.
“The difference between 24 and 26 weeks can be huge,” Dr. Duncan says.
Even though these issues can be the results of preterm birth, thanks to the resources and expertise available at UT Physicians Neonatal High Risk Clinic and the new Tiny Tot Neurodevelopmental and Behavioral Health Clinic, parents can find medical and neurobehavioral help.
“These smallest of patients have to have very close follow-up,” Dr. Duncan says.
Both clinics focus on treating premature children who are at high risk of having complications from their early birth. The Neonatal High Risk Clinic sees patients as soon as they are discharged from the neonatal intensive care unit (NICU) until they are 2 years old. The Tiny Tot Clinic, which recently opened July 15, treats patients from the Neonatal High Risk Clinic and other at-risk children starting at four months until they are five years old. Supported in part by Children’s Memorial Hermann Hospital, it extends the medical services traditionally offered in primary and developmental care to help children with neurodevelopmental and behavioral issues.
“The clinics are special because of the comprehensive nature of the care,” says Dr. Duncan, who is the medical director of both clinics and an attending physician in the NICU at Children’s Memorial Hermann Hospital. “Patients in the Neonatal High Risk Clinic have 24/7 access to their clinic medical provider, and the Tiny Tot staff knows the patients and families from the NICU on. They really need specialized care for both medical and neurodevelopmental challenges, and most high-risk kids don’t get this degree of specialized long-term follow-up in the same place.”
Vera-Figueroa learned soon after her twins’ birth how much she would need that help. Her mother had planned on traveling from Puerto Rico to Houston to help care for the twin girls. However, she died unexpectedly from a heart attack just nine days after the birth of her granddaughters. This unexpected tragedy meant Vega-Figueroa had to mourn her mother’s death while learning to rely on others for help, including how to feed the twins, change their diapers, and care for them.
“The clinic staff took care of me. They taught me how to do everything,” Vega-Figueroa says of the clinic staff and physicians. “They became my family.”
Iris and Geraldine spent 70 days in the NICU at Children’s Memorial Hermann Hospital, where they were monitored by UT Physicians specialists. After making significant progress, they went home when they were about 2 months old on April 15, 2013. Although the twins still visit high-risk doctors who closely monitor their growth and development, they are doing really well at 3 years old, Vega-Figueroa said. Other than being treated for respiratory issues, including asthma, the girls are healthy and active. They take ballet and do a good job at keeping mom on her toes.
Frightening for a first-time mom
Like Vega-Figueroa, Lara Broussard was diagnosed with a high-risk pregnancy. At 13 weeks, an ultrasound revealed that her twin daughters, Rachel and Rebekah, had twin-to-twin transfusion syndrome (TTTS), a disease that affects identical twins and causes uneven blood flow and nutrient sharing.
“Rachel was getting really big, while Rebekah was small,” Broussard says.
Because there is no specific cause for TTTS, this made the diagnosis even more frightening for Broussard, who was a first-time mom.
“It was hard,” Broussard recalls with tears. “No one I knew had ever had identical twins.”
Broussard went to UT Physicians and The Fetal Center at Children’s Memorial Hermann Hospital weekly for close monitoring by a team of maternal-fetal physicians that included Kenneth Moise, M.D.; Ramesha Papanna, M.D.; and Anthony Johnson, M.D.
At 32 weeks, doctors determined it was time for Broussard to deliver. One of the twins wasn’t getting any blood flow through her umbilical cord, so through a caesarian section, Broussard gave birth to two tiny baby girls on May 4, 2014. Rebekah was 2 pounds, 2 ounces while Rachel weighed 3 pounds, 12 ounces.
“I didn’t know you could be that small and still survive,” Broussard says.
Even though Broussard describes this part of her life as the “best experience rolled into the worst experience,” she credits the NICU nurses and doctors at Children’s Memorial Hermann who worked tirelessly to provide the best care possible.
“How they took care of Rebekah and Rachel was incredible,” Broussard says. “They were always available for the girls. They never made me feel like I was an annoyance to them.”
Rebekah has a slight speech delay, and there is a two-pound difference between them, but they both share an insatiable love for dinosaurs. Broussard says she’s thankful to everyone who helped her twins transition to this point. Her treatment team included Tina S. Reddy, M.D., and Fatima Boricha, M.D., with the High Risk clinic.
“I’m so grateful to live in Houston and to be in such a great medical community,” Broussard says. “I love the high-risk clinic, I love the NICU nurses. How do you say thank you to people who literally saved your daughters’ lives?”