Loma Linda University Medical Center news
February 26, 1998
Conjoined twins born at LLU Children's Hospital
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| On February 9, a news conference was held to discuss the impending birth of a set of conjoined twins. Here, W. Augustus Cheatham, MSW, vice president of public affairs and marketing, LLUMC, directs the media's questions to a team of physicians. Pictured are, from left, H. Gibbs Andrews, MD, professor of surgery, pediatrics and emergency medicine, and chief, division of pediatric surgery; Rick D. Murray, MD, associate clinical professor of perinatology; and Gerald A. Nystrom, MD, associate professor of pediatrics, medical director, neonatal intensive care unit, and chief, division of neonatology. |
At a news conference held on Monday, February 9, Loma Linda University Children's Hospital physicians had said there was substantial doubt that both twins could survive birth, and separation seemed unlikely.
On Tuesday, at 8:46 a.m., the girls were delivered by caesarean section by Rick M. Murray, MD, associate clinical professor of perinatology. Together, the twins weighed 8 pounds, 11 ounces.
Karen Crowe, the girls' mother, was conscious for the hour-long caesarean procedure, and the father, Angel Garcia, was at her side.
At a news conference later that afternoon, doctors said they were hopeful that both twins would survive, and were optimistic about the chances of separating them.
The news conference was attended by 13 television news organizations, six newspapers, and two Los Angeles radio stations.
The twins' condition was discovered during a routine ultrasound examination of Ms. Crowe, 21, of Barstow, when her pregnancy was about 13 weeks along. A month later, Loma Linda took over her care.
The twins, named Gabrielle and Micheala, are conjoined from the waist down, side to side, termed "Ischiopagus Bipus." This is a rare condition with only two lower extremities. Organs involved in the conjoined tissue are the liver, a solitary kidney, and intestine. There is only one bladder.
Conjoined twins occur once in every 100,000 to 200,000 births. The Garcia girls have a particularly rare form--side by side and sharing a pair of legs--which encompasses only about six percent of conjoined twins.
When the girls were born, they seemed about as healthy as any other newborns, doctors reported. The only immediate complication--which physicians anticipated based on prenatal testing--appeared to be a blockage in the girls' shared gastrointestinal system. Surgery to correct the problem was anticipated.
Also as expected, Gabrielle, the left-side baby, had weaker blood circulation than her sister, but both were in reasonably stable condition.
"It was music to our ears to hear both babies begin vigorously crying right from birth," says Gerald A. Nystrom, MD, associate professor of pediatrics, medical director of the neonatal intensive care unit (NICU), and chief, division of neonatology, who is overseeing the twins' care while they are in NICU.
"They pinked up quickly," he recalls. "Neither required more than stimulation, suction, and some oxygen.
"All things considered, they're in good shape right now, and are comfortable," though, he adds, "they have a long road ahead of them."
Various tests were begun immediately to determine what the next steps should be.
During the news conference, doctors discussed the possibility of trying to separate the infants.
"They seem separable," comments H. Gibbs Andrews, MD, professor of surgery, pediatrics, and emergency medicine, and chief, division of pediatric surgery.
"I think we can do it successfully, yes, but there are still a good many issues we need to discuss and plan for...involving all the specialities of pediatric surgery."
In 1996, Dr. Andrews led a LLUCH team in successfully separating another pair of conjoined twins. In that case, the girls were connected at the abdomen and shared only part of one organ--the liver.
On Thursday, February 12, diagnostic studies were completed on Gabrielle and Micheala.
Gabrielle was confirmed to have esophageal atresia with distal tracheoesophageal atresia--a congenital obstruction of the upper esophagus...the lower esophagus being connected to the trachea. This condition leads to a chemical pneumonitis due to regurgitation of stomach acid into the lungs and is fatal if untreated.
Micheala was found to have a port-ductal coarctation of the aorta (a strictured area). This condition can lead to cardiac failure and death.
The medical surgical team met Thursday afternoon and discussed two options:
1. Comfort care only, which could lead to natural death because of existing life-threatening anomalies.
2. Surgical repair followed by consideration of surgical separation at a later date.
The family chose the surgical option.
On February 12, Gabrielle underwent successful transection of the tracheoesophageal fistula and repair of the esophageal atresia. This surgery was performed by Dr. Andrews.
The twins remained stable, and therefore, the team proceeded with successful repair of the coarctation of the aorta. This surgery was performed by Anees J. Razzouk, MD, associate professor of cardiothoracic surgery, and director of circulatory support systems.
The surgeries were performed back-to-back, taking a total time of 4 hours, 15 minutes.
At press time, the girls' condition remained critical but stable.
LLUMC home care holds employee
forum
A special employee forum was held for the employees of Loma Linda University Medical Center's home care services in November.
The meeting was led by Terrence Hansen, MPH, executive vice president and chief operating officer.
Subjects discussed included the budget time-off contingency plan, the growth of the home care divisions, and the impact of one upon the other.
Other issues discussed were the information systems support and the basic hiring process.
Additional administrators attending the forum were Marilyn Thunquest, MS, MBA, senior vice president, LLU Community Medical Center, and Dick Garner, administrative director of human resources management.
Following the meeting, Ms. Thunquest, who is responsible for home care, made a site visit to a local patient's home.
"Ms. Thunquest's experience was one of satisfaction," says Mattie Wren, administrative director of home care services. "She was impressed with the level of care and the emphasis on caring shown by the home care nurse."
Ms. Wren says that she is very proud of her employees and the way they take care of their patients with kindness and compassion.
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