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Very Special Team Assembles For a Very Uncommon Birth JAIMIE KUWAHARA WAS IN HER 14th week of pregnancy when the results of a routine blood test showed elevated levels of maternal alpha-fetoproteins. Her obstetrician called her in for a detailed prenatal ultrasound. “They saw that the baby had some kind of mass by her stomach,” the first-time mom from Hilo recalls. “Along the way, all of my doctors were really great in explaining to me how things would go. They were very comforting.” —Jaimie Kuwahara A team effort The discovery set in motion a sequence of events leading to the assembly of a highly specialized team of doctors and nurses who were on hand for the birth of little Mya Lisa. She was born in Honolulu at Kapi`olani Medical Center for Women & Children earlier this year with gastroschisis, an uncommon birth defect that produces an opening in the abdominal wall. As a result, the baby’s intestines were on the outside of her body. Sid Johnson, M.D. The cause for gastroschisis is unknown, but its treatment is immediate. In this case, Pediatric Surgeon Sid Johnson, M.D., a neonatologist, a pediatric anesthesiologist and many others with special training, equipment and instruments were ready and waiting in Kapi`olani’s Labor, Delivery and Recovery suite. Dr. Johnson performed the surgery right in the delivery room, carefully placing the infant’s intestines back inside. “I like to be there when the baby is born,” he says. “With Mya Lisa, I placed the intestines in a special bag on the abdomen to keep them sterile and connected to her body. The bag allows me to slowly place the intestines back into the abdominal cavity. I did the final reconstruction of her abdominal wall the following day,” says Dr. Johnson. Education leads to understanding Although it was an eye-popping diagnosis, Kuwahara became well-informed about the defect and what was ahead. “I went on the Internet and looked it up like any parent would do, just to educate myself.” Several weeks before her due date, Kuwahara came to Oahu, where she stayed with her grandparents. She was referred to Dr. Johnson, who talked to her about the pediatric surgical procedures to come. “Along the way, all of my doctors were really great in explaining to me how things would go,” recalls Kuwahara. “They were very comforting. They helped me to understand that gastroschisis is just a birth defect that happens and they don’t know why.” Mya Lisa was born with her intestines outside of her abdomen. Dr. Johnson performed the surgery right in the delivery room, carefully placing the infant’s intestines back inside. Experience makes a difference Jaimie Kuwahara holds her daughter, Mya Lisa. Mya was born at Kapi`olani Medical Center for Women & Children, where she received lifesaving surgery and specialized neonatal intensive care. While Kuwahara had several months to learn about her baby’s special condition, Dr. Johnson has spent more than a decade preparing to help infants with all kinds of conditions. He joined Kapi`olani in 2005 after completing a pediatric surgery fellowship and critical care fellowship at the Harvard School of Medicine, which required three years. He spent another year there to complete a fellowship in clinical bioethics. Prior to Harvard, Dr. Johnson had spent five years to complete a general surgery residency at the University of Utah, after four years of study to receive his medical degree at Utah. In all, Dr. Johnson prepared with 13 years of post-graduate study in order to be in the delivery room on the early evening of Jan. 31 when Mya Lisa arrived in need of his care. “A pediatric surgeon is essentially a general surgeon who has done specialty training to devote his practice to surgical problems of babies and children,” he explains. “A neonatologist is essentially a pediatrician or medical doctor with training devoted to high-risk neonates, or very small babies. I focus on the babies with problems I can fix surgically. There are maybe 12,000 or so births every year in Hawaii. As such, there are frequently babies with some congenital problem who need an operation.” “Kapi`olani is the largest facility dedicated to the care of infants in Hawaii. It’s designated as a Level III hospital — one of the most sophisticated you can get.” —Sid Johnson, M.D., pediatric surgeon Dr. Johnson says that physicians like him “need to be at places where we have people with special training in pediatric care. They also need instruments and tools that are small. An instrument you might use for a gallbladder with an adult might be four or five times smaller for an infant. Kapi`olani is the largest facility dedicated to the care of infants in Hawaii. It’s designated as a Level III hospital — one of the most sophisticated you can get.” The critical moment Kuwahara’s water broke at about 11 p.m. Jan. 30, and she was checked into Kapi`olani by midnight. When Mya Lisa was born at 5:37 p.m, “everyone was crowded around her and everything happened so fast,” Kuwahara recounts. “There was a whole bunch of staff there — neonatology staff, lots of nurses. I couldn’t really see what was going on, but as soon as she came out they took her to a table. The neonatologist assessed her, and then Dr. Johnson did his part. My mom, dad, husband, grandma — everybody was there.” A happy ending Soon after the surgery, Mya Lisa was able to leave the neonatal intensive care unit and move to Kapi`olani’s Intermediate Nursery, where she made a full recovery. Kuwahara was thrilled to take her baby home, and was grateful for all the care provided during Mya’s first weeks of life. “They can care for her a hundred times better than I could have at home. I thought I would be an emotional wreck, but I wasn’t. Being prepared was one of the best things. The doctors and nursing staff are great. I don’t think I would have taken all this as well if it weren’t for them. It’s been a crazy couple of months, but it’s really important they educated me. Being prepared made all the difference,” says Kuwahara. For more information on having a baby and the specialized care for newborns and children only available at Kapi`olani, call 808-535-7000. Kapi`olani Kids is printed by Kapi`olani Medical Center for Women & Children. This is the May 2006 issue. Kapi`olani Kids is published twice a year as a service to parents in the community served by Kapi`olani Medical Center for Women & Children, 1319 Punahou Street, Honolulu, HI 96826. The information is provided as education about physical, mental and psychosocial health. It is not intended as a substitute for consultation with a physician. If you have questions or concerns about specific items that appear in Kapi`olani Kids, please contact your child’s doctor. To advise us of changes to your mailing address, please contact us at 808-535-7554.