Q&A

How new advances at Children's Memorial Hermann Hospital are improving spina bifida outcomes

Spina bifida is the most common neural tube defect in the United States, affecting approximately 2,000 live births in the country every year.

Here, Ramesha Papanna, MD, MPH, answers questions about the condition and innovative treatment options to improve outcomes. Dr. Papanna is a professor of maternal-fetal medicine at McGovern Medical School at UTHealth Houston, and co-director of and affiliated with The Fetal Centerat Children’s Memorial Hermann Hospital.

Question: What is spina bifida, and how does it affect a child’s health?

Answer: Spina bifida is a birth defect that’s essentially an opening in the spine that exposes the spinal cord to the outside. Very early in a pregnancy, there’s a process called neural tube formation, when the brain and spinal cord develop. If that process isn’t complete, you end up with spina bifida.

A child born with spina bifida typically has long-term problems with the function of the spinal cord below the level of the opening. That means problems with walking and sensation in the legs. It can also affect bladder and bowel function. Over time, they may end up needing dialysis or kidney transplants.

Q: How have treatments for spina bifida evolved over the years?

A: The first surgical treatments were done about 100 years ago, when surgeons started closing the defect after birth. That’s when children with this condition started to grow into adulthood, but with significant disability.

More recently, we realized that throughout the pregnancy, the damage to the spine was getting worse. That’s because the spinal cord was being exposed to the amniotic fluid, which is primarily the baby’s urine, and that causes continuous damage. In 2011, a major study showed that if you repaired the bifida before birth, it would lead to better outcomes after birth. That was a major milestone.

But the surgery is risky for the mother. It’s a three-to-four-inch incision in both the abdomen and the uterus, and then a neurosurgeon can close the bifida. It’s a long recovery for the mother, and they can’t deliver vaginally because the scar can rupture. They also have to stay within 30 minutes of the hospital throughout their pregnancy.

And while this approach has helped many patients, it doesn’t entirely eliminate the damage to the baby’s spine. In spite of repair before birth, more than half of these children can’t walk on their own at 30 months, and three in four cannot walk at school age. It’s better than post-natal repair, but it’s not a cure.

Q: What approach do you use at The Fetal Center at Children’s Memorial Hermann Hospital?

A: We are trying to improve outcomes for both the mother and the baby. Using fetoscopic surgery, instead of making a big hole in the uterus, we make three tiny holes. Through those tiny holes, we can close the defect while reducing the risk of uterine rupture. That means the mother can still deliver vaginally and she doesn’t have to stay within 30 minutes of the hospital.

Through our research at UTHealth Houston, we also learned that the reason more than half of the children treated with traditional surgery can’t walk at 30 months is that the surgery creates a scar, and that scarring can damage the spinal cord. So we came up with a solution: a patch made of donated healthy human umbilical cord, which helps reduce scarring and improve regeneration of the tissue.

We did over 10 years of research before studying it in humans — a lot of testing, a lot of practice, a lot of models. The first surgery using an umbilical cord patch was done September 1, 2020, at Children’s Memorial Hermann Hospital. That child is now 18 months old and is already walking, with good bladder and bowel function.

We have done 33 of these surgeries so far and are seeing the children as they grow to assess the success of the patch. We’ll do assessments at one year, 30 months, and 50 months. None have had major complications, such as death, infection or rejection of the patch.

Q: What does the future hold for people with spina bifida?

A: In the world of spina bifida, this is a time of real innovation. We were the first to use this particular approach with the human umbilical cord patch, but there’s research happening around the country and around the world. People are trying to improve treatment in all different ways, and that will make outcomes better and better.

At The Fetal Center, we are making changes in our approach based on what we’ve learned. For one, we’re starting to do these procedures earlier in the pregnancy to minimize the damage to the spine. We’re also moving to a new approach where we don’t have to open the abdomen first, which would make recovery faster for the mother.

Located within the Texas Medical Center, The Fetal Center is affiliated with McGovern Medical School at UTHealth Houston, UT Physicians, and Children’s Memorial Hermann Hospital. For more information, visit memorialhermann.org/fetal.

$\u200bWyatt, a fetoscopic spina bifida repair patient, with Dr. Ramesha Papanna.$

Photo courtesy of Memorial Hermann

Wyatt, a fetoscopic spina bifida repair patient, with Dr. Ramesha Papanna.

health kids promoted

bowled over

Houston artist dishes on Food Bank fundraiser happening this weekend

Picture of several artists at a table with a bunch of handmade ceramic bowls.

Photo courtesy Paula Murphy

Ceramics professor Cori Cryer and her students from Lone Star College Kingwood and the bowls they donated to the 20th Empty Bowls fundraiser

On Saturday, May 16, shoppers have an opportunity to feed those in need by purchasing unique, handcrafted items. The 20th Empty Bowls event takes place at Silver Street Studios at Sawyer Yards from 10 am to 3 pm. A preview party takes place on Friday, May 15 from 6-8 pm (buy tickets here).

The fundraiser is a collaboration between Houston-area ceramists, woodturners, and artists working in all media and Silver Street Studios.

Shoppers can purchase one-of-a-kind bowls for $25 each (larger bowls are priced accordingly). A simple lunch from Salata, a sweet treat from Ben & Jerry’s, and iced coffee from Katz Coffee is served until it runs out. Every dollar of the purchases goes to the Houston Food Bank, which estimates that for every dollar donated, it’s able to provide three meals to Houstonians in need. Since its inception, Empty Bowls Houston has raised $1,208,959 for the Houston Food Bank, which equates to more than 3.6 million meals.

The event also includes live music and art demos. More than 2,000 bowls will be available for purchase, donated by area artists.

Empty Bowls began as a grassroots effort started many years ago at a high school in Michigan and is now held all over the world. Nearly everything for Empty Bowls events, from the food served to the venues hosting events and the bowls for sale are donated.

Cori Cryer, a professor of ceramics at Lone Star College Kingwood, is one of those who, along with her students, donated bowls for the fundraiser. She’s been involved with the effort for all of its 20 years in Houston, and before that in other cities.

“When I started donating, I didn't have a whole lot of money,” Cryer tells CultureMap. “I was a graduate student, and so this was a way for me to give back to the local community. And I think my students today kind of recognize that same feel. You know, they may not have money to send a check off to someone, [but this is] an easy way for them to be able to contribute to the community.”

Cryer teaches Ceramics I and Ceramics II to a variety of dual-credit high school students, college students, and continuing education students. Those in her Ceramics II classes are required to create five bowls to donate to Empty Bowls. But her students in her introductory class often end up donating as well. This year, she and her students provided approximately 150 bowls for the event.

Cryer said that the style of bowls for sale range from something as small as a condiment bowl to much larger serving bowls As each bowl is an individual work, they represent a variety of styles and themes. One of her students this year designed a glazed, ceramic leaf-shaped bowl with ceramic insects on it.

“There's a ladybug and a caterpillar and a spider,” she says, each created out of clay and positioned around the bowl.

Cryer loves seeing how the artists use their imaginations and abilities.

“Most of my students do throw their bowls on the pottery wheel, but that's not required,” she says. “They can hand-build them. It’s completely up to them what kind of construction technique they use.”

Cryer loves knowing that this event is a way for students to see that their artistic efforts can have lasting impact on the community around them. In addition to being able to support the Houston Food Bank, the bowls her class donates, she knows, take on special meaning for those who purchase them.

“I tell my students there is a pot for every person and a person for every pot,” she says.

In fact, one of her personal favorite bowls is one she purchased from an Empty Bowls sale.

“It's a very small bowl, maybe like three inches in diameter, and two inches tall, and it's a little pink pig that I think an elementary student made,” she said. “He has no tail, and he has no ears, but he has a snout, and it is definitely a pig. And I love that little bowl. I have it sitting on my desk at home.”

Cryer knows shoppers attending the Empty Bowls sale will find similar, soon-to-be-beloved items.

The Saturday event is free. Those wishing to attend the preview party on Friday, May 15 from 6-8 pm, which offers light bites, beer and wine, and the first chance to purchase bowls, can purchase a $50 ticket online. In addition, Archway Gallery is hosting an exhibition of 30 one-of-a-kind bowls that can be purchased as part of the Empty Bowls fundraiser. The exhibit runs through May 30.