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Karys’ Story: Innovation & Collaboration Provide “Nothing but the Best”

Eighteen-year-old Karys Kouba thought her stomach pain was appendicitis. So did her mom, and so did her primary care doctor until the CT scan revealed something else: a massive tumor.

“It was something I didn’t want to think about,” Karys’ mother, Katie, said. “It was hard.”

The team at Children’s eased some concerns by revealing the ganglineuroma tumor was benign; however, its placement in her abdomen presented an entirely new set of challenges. The tumor encircled her aorta, pressed against her spine and was entangled with blood vessels.

“It was in a very dangerous place,” said Patrick Thomas, M.D., medical director of Pediatric Surgery. “It affected not only the blood vessels to the body and the blood vessels that deliver blood to the bowel, but also impacted the kidneys.”

To remove the tumor, Dr. Thomas and the Pediatric Surgery team collaborated with Children’s Innovation Team to 3D print much of Karys’ midsection to better understand the tumor’s placement. Dr. Thomas then took the imaging a step further by creating a virtual reality landscape to plan the surgical procedure.

“As far as I know, even in the Midwest, no one has done that—at least an application in real life,” said Abdulla Zarroug, M.D., division chief of Pediatric Surgery.

Once created, the futuristic virtual reality environment provided insights about Karys’ tumor at the sub-centimeter level.

“You’re actually able to walk around in the anatomical environment and turn yourself into a little robot or surgeon,” Dr. Thomas said.

In February 2023, Children’s surgical team applied that futuristic planning to an 18-hour procedure to break apart and remove Kary’s tumor. Due to the complex nature of the operation, a multi-disciplinary team was on hand, including General Surgery, Neurosurgery, Urology and Cardiothoracic Surgery.

“I think of it like a symphony,” Dr. Thomas said. “Everyone has mastery in their area, but then you all come together and you are able to perform a beautiful masterpiece.”

For Karys, that masterpiece is a healthy future thanks to the collaboration and innovation at Children’s.

“Dr. Zarroug and Dr. Thomas have been amazing, compassionate people,” Katie said. “I felt very comfortable coming here and putting my daughter’s life in their hands because I knew that they were the best.”

Bellamy’s strength: Beating the odds after brachial plexus injury

Dulce and Orlando Pantoja describe their fourth child, Bellamy, as a happy little boy who enjoys being the center of attention. He loves to wave his arms and hands in the air, giggle at his siblings and crawl across the room. For the Pantojas, these milestones mean everything. When Bellamy was born, he could not move his left arm and hand.

“I knew Bellamy was a strong-willed baby from the moment I carried him,” said Dulce. Unlike my [first] three pregnancies, I had a tough time delivering him. On the day of my induction, I began dilating, which was a good sign that the baby was almost here. But as I kept pushing and pushing, Bellamy just didn’t want to come out. Before the next contraction kicked in, my OB/GYN was able to pull the baby out safely.”

On April 14, 2021, Dulce gave birth to Bellamy in Grand Island, Neb. The Pantojas were so happy to see their baby boy as he let out a loud cry. But the constant pushing and excessive force during childbirth caused trauma to the baby, and as a result, Bellamy lacked total movement in his left arm.

Bellamy suffered a brachial plexus injury caused by shoulder dystocia, a birth injury that happens when one or both shoulders get stuck inside the mother’s pelvis during labor and birth. The brachial plexus is a network of intertwined nerves that control movement and sensation in the arm and hand. Injuries to the brachial plexus stem from trauma to the neck, and can cause pain, weakness and numbness in the arm and hand. As a result of his injury, Bellamy could not move his left arm at all.

Coming to Children’s for the very best care

“Bellamy’s pediatrician referred me to Dr. Oluwaseun Adetayo, the head of pediatric Plastic & Reconstructive Surgery at Children’s,” said Dulce. “Dr. Adetayo recommended that I take Bellamy to physical therapy to see if that would help activate movement in his left arm and hands. If that didn’t work, then surgery was our next option. Bellamy started therapy at 8 weeks old, and a month into therapy, he began moving his fingers on his left hand. You had to look at his pinky and not blink to see that tiny, subtle movement. We were pleased with his progress and took that as a good sign, that he would make more progress in the months ahead.”

After several visits to Children’s in Omaha to see Dr. Adetayo and analyze Bellamy’s progress with his arm movement, Dr. Adetayo ordered an MRI. The MRI showed a liquid mass near the neck and shoulder area – and it was possible that the mass was pushing down on his nerves around his left brachial plexus, affecting his ability to move his arm and hand completely. Dr. Adetayo recommended that he undergo surgery to remove the mass of scar tissue on the injured nerve bundle.

“When I heard that my baby had to have surgery, it was nerve wracking, but I knew he was in the best place for care,” said Dulce. “From the moment I met Dr. Adetayo, she was amazing. She answered my questions, helped me and my husband understand what the surgery entailed and reassured us that she would do everything she could to ensure a good outcome. Although a bit nervous, I knew this surgery is what Bellamy needed. My husband and I just prayed and hoped for a successful outcome for our son.”

A surgical solution for a strong outcome

When Bellamy was 7 months old, Dr. Adetayo performed his surgery on Nov. 22, 2021 to remove the mass of scar tissue and restore movement to his left arm. The surgical repair involved brachial plexus exploration and neurolysis.

“When pressure compromises a nerve around the shoulder, the first thing we do is perform a surgical exploration of the brachial plexus to directly visualize the problem, so we know precisely how to repair it,” said Dr. Adetayo. “Once we identify the nerve that is impacted in the plexus, we can perform neurolysis, which is the deliberate destruction of a nerve or a network of interlacing nerves to provide permanent relief from pain and help the patient regain movement to the impacted area. In Bellamy’s case, we were able to help him regain function of his left arm and hands following a brachial plexus injury.”

After Bellamy woke up from surgery, the Pantojas were amazed to see their son move his left arm. He raised his arm up to his chest like he was showing off what he was not able to do before.

In the months since his brachial plexus surgery, Bellamy continues to reach milestones. He goes to physical therapy in Grand Island three times a week, and his physical therapists perform range of motion exercises on him to maximize use of his left arm and keep the joints and muscles moving as normally as possible.

“We are so happy with our son’s progress, and I know that over time, Bellamy will build up more strength to lift his left arm further,” said Dulce. “He inspires me and never gives up. Something that really amazed us recently is that he started crawling, and that’s a blessing for us to witness right after his surgery. I am so glad that our son’s pediatrician recommended Dr. Adetayo to us. She has been a blessing to us. Because of her and our son’s physical therapists, I see a bright future ahead for Bellamy. He has come a long way.”

Plastic & Reconstructive Surgery

At Children’s Hospital & Medical Center, we understand that birth defects or traumas can be difficult and overwhelming — especially when they are visible or affect a child’s development. Our specialists are here to help children ages 0 to 21 through all of their plastic surgery needs.

Learn More

Eli’s Story: Helmet therapy to treat plagiocephaly made a world of difference

Eli Vasquez is a happy 1-year-old who loves to talk, giggle and smile. For parents Andy and Nichole, watching their son grow and reach his developmental milestones – like rolling on his tummy and lifting his head – were exciting moments for them. When Eli was around 2 months old, the Vasquezes noticed their son had a flat spot on his head that seemed to be increasingly noticeable.

“His flat spot was big, and he was not interested in spending time on his tummy,” said Nichole. “If we put him on his tummy, he got angry. He also would not turn his head to the left. When we tried to turn it, he would resist. When Eli was 4 months old, he was diagnosed with torticollis and plagiocephaly.”

Plagiocephaly occurs when a baby develops a flattening on the back or side of the head. This occurs when a baby spends increased time in the same position. If left untreated, babies with plagiocephaly may develop asymmetries of the head, neck and face. Often, plagiocephaly can accompany torticollis, a condition that occurs when the muscles in a baby’s neck become stiff or tight, which causes the head to tilt to one side. It can affect a baby’s posture, causing them to favor one side of their body.

“Our pediatrician was concerned about the muscle tightness in Eli’s neck,” said Nichole. “Some of the stretches we did included positioning Eli’s body so his right side was against a wall whenever we did tummy time so it would make him move his head in the other direction. We kept his toys to the left side, forcing him to look that way. When we fed him, we made sure to feed him where his head would have to turn to the left side as opposed to the right. It was basically getting him used to turning his head to the left side. By the time we got to month four, the stretches had helped him considerably.”

However, the large flat spot on Eli’s head wasn’t getting better. Its growth, combined with its softness from Eli laying on it throughout the night, made the flat spot more pronounced. Helmet therapy became a treatment option for the Vasquezes to consider.

Finding Children’s Helmet Clinic

As the only clinic of its kind in the region, the Helmet Clinic at Children’s Hospital & Medical Center evaluates, diagnoses and treats infants with an abnormal head shape due to a variety of conditions including plagiocephaly. The clinic includes a team of specially-trained physical therapists, who provide PT for patients with torticollis, and orthotists, who assist in getting patients fitted with a special helmet to gently correct the shape of the skull as the baby grows. If a baby has a large flat spot that does not improve by about 4 months of age, helmet therapy is often prescribed. For the helmet to be most effective, treatment usually begins between 4 to 6 months of age.

“We took Eli to his first appointment at the Helmet Clinic,” said Andy. “We met Joanne Wennstrom, who did the initial assessment and evaluation of Eli, and she determined he would be a good candidate for a helmet. She introduced us to Tim, who took Eli’s cranial measurements. He carved out the helmet to specifically encourage the skull in a direction and explained all the logistics of the helmet. He was wonderful – my wife and I trusted him, and he was so good working with babies.”

Eli started wearing his helmet when he was 6 months old. When he first got the helmet, he wore it for an hour on and an hour off, and the number of hours were gradually increased each day over the course of five days. Eli was then able to wear the helmet for 23 hours a day. The Vasquezes took pictures of their son’s head every week. They say it was amazing to see the progression of his head from totally flat to almost perfectly round.

“Our son tolerated the helmet very well,” said Andy and Nichole. “In the months that he has worn it, we have seen a noticeable difference in his head shape. Prior to wearing the helmet, Eli’s asymmetrical measurement of his head was 16.6 millimeters. In the first month of wearing the helmet, Eli’s measurement went down to 9.8. Two and a half months after wearing it, his asymmetry measurement was 6.3 millimeters. If we waited two weeks longer for the helmet, we would have missed a major growth spurt. His head would have grown flatter.”

Besides helmet therapy, Eli was also evaluated by a physical therapist at the time of his clinic appointment and referred for additional treatment of his torticollis. Eli has monthly physical therapy sessions with a Children’s physical therapist to loosen his neck muscles so he can easily turn his head in both directions. The physical therapist showed the Vasquezes a series of exercises to do with Eli at home to get him to roll from his back to his tummy. Once Eli mastered that skill, the next step was teaching him how to sit up.

“Eli will graduate from physical therapy once he starts crawling,” said Nichole. “His physical therapist wants to make sure he doesn’t develop a side preference when crawling or develop a hitch crawl where he crawls and leans on one side to move his body across the floor. Once Eli’s asymmetry measurement of his head drops to 5 millimeters, he will be helmet free. We are excited about his progress in such a short period of time. The Helmet Clinic team at Children’s is a big reason for Eli’s positive outcome.”

Click here for more information about Children’s Helmet Clinic.

Plastic & Reconstructive Surgery

At Children’s Hospital & Medical Center, we understand that birth defects or traumas can be difficult and overwhelming — especially when they are visible or affect a child’s development. Our specialists are here to help children ages 0 to 21 through all of their plastic surgery needs.

Learn More

Karter’s Story: From Trauma to Recovery, Thanks to Teamwork

For Karter, a 4-year-old from Hastings, Neb., a ride on his dad’s lawn mower is nothing out of the ordinary. However, on April 13, 2022, this routine father-son task resulted in an accidental injury that required transport to Children’s via helicopter.

Marissa Stec, Karter’s mom, recalls the terrifying day her son inadvertently got off on the wrong side of the mower and critically injured his foot. “I was scared he was going to lose his foot and was unsure how we were going to manage everything if that was the case,” she says.

When Karter arrived in Children’s Emergency Department, a collaborative crew from Children’s Orthopedic and Plastic and Reconstructive Surgery teams worked together to ensure the best outcome.

Pediatric orthopedic surgeon Brian Hasley, M.D., performed the first operation to stabilize Karter’s fracture and improve the healing potential of his remaining healthy tissue to maximize function of his foot.

From there, plastic and reconstructive surgeon James Vargo, M.D., took over the reconstruction process.

“You never know what to expect walking into cases like this; you need to be prepared for any type of reconstruction,” Dr. Vargo says. “We communicate closely with our orthopedic surgeons. Usually, it involves a phone call and some photos, and then we work together in the operating room to come up with a plan that will optimize outcomes for our patients.”

Since Karter’s injury resulted in multiple severe lacerations on the bottom of his foot and significant tissue loss, along with open fractures, he was susceptible to infection. So Dr. Vargo’s team performed multiple wound washouts and tissue manipulations on his foot.

According to Dr. Vargo, traditional reconstruction would have required a complex flap reconstruction, but the team elected to use an innovative new material on his wound—NovoSorb® BTM (Biologic Temporizing Membrane)—to minimize infection and help Karter’s body heal. Karter was the first patient at Children’s to benefit from this new synthetic product, which enabled him to heal faster with minimal postoperative difficulties.

After 17 surgeries, a 36-night stay in the hospital and ongoing rehabilitation efforts, Karter is back to energetic 4-year-old activities and doing everything he loves—especially fishing. Karter’s incredible resilience has impressed his mom, Marissa. “Nothing can slow this boy down; he surprises us daily,” she says. Marissa, who was able to stay at the Carolyn Scott Rainbow House while Karter was receiving care at Children’s, is thankful for the team effort between multiple services.

“We interacted with almost every department at Children’s—from the Emergency Department when we first arrived, to the surgical staff, security guards, nurses and aids on the Med/Surg floor and even the kitchen and housekeeping staff,” Marissa says. “It felt like we were taken care of, especially being so far from home.”

Although more operations may be needed as his foot continues to grow, Karter has been making strides in physical and occupational therapy, and was recently fitted for a compression garment to help minimize the thickening of his scars and reduce swelling.

From their home in Hastings, Karter’s parents continue to communicate with Dr. Vargo and Dr. Hasley via Children’s Connect—a secure online portal that gives parents and guardians convenient access to their child’s health care information and team. Karter also routinely receives wound care from Debra Reilly, M.D., a plastic and reconstructive surgeon at Children’s.

According to Marissa, Karter hasn’t had any major setbacks in his healing process thanks to the swift decisions of his doctors.

“Everyone worked well together and treated us like family,” Marissa says. “They even made Karter laugh despite how scared he was. Since we were there for 36 days, everyone got to know Karter, and he grew to like everyone. We had a great experience with Children’s.”

Karter
Karter

Mathís’ story: Life-changing progress after craniosynostosis surgery

Kristin and Monét McCullen revel in the indescribable joy that comes with being parents to their 9-year-old daughter, Adrianna, and their 2-year-old twins, son Mathís and daughter Landry.

“The twins love doing everything together,” said Monét. “They have their distinctive personalities. However, when learning to crawl, stand and walk, Mathís was always behind Landry on every milestone. Mathís managed to get there – just not as fast as his twin sister. As parents, we kept reminding ourselves that they are two different humans, and they do everything on their own timelines.”

When Mathís was a little over a year old, the McCullens, who are from Omaha, noticed a ridge on their son’s forehead. It did not seem to bother Mathís, and the McCullens weren’t too concerned. They thought it was a minor imperfection their son was born with, until a family in one of their online parenting groups reached out to them.

“Since we used an anonymous sperm donor to get pregnant, we signed up for a group where you can connect with other siblings who have used the same donor,” said Monét. “We posted a picture of Mathís and Landry, and one of the moms of the siblings messaged me and told me that she noticed Mathís had a small ridge on his forehead. Her son had the same ridge too. It turns out that five of the sibling boys had a noticeable ridge as well. Based off this information, we brought the concern to our pediatrician, Dr. Sahra Niazi, to get it checked out.”

“Monét and I weren’t too concerned about the ridge,” added Kristin. “When we took him for his well checkup with his pediatrician, Dr. Niazi measured his head circumference like she did at every appointment to ensure it was growing properly. Three months after his prior appointment, we noticed Mathís’ head circumference didn’t grow. Dr. Niazi encouraged us to get a second opinion and referred us to Children’s Hospital & Medical Center.”

Choosing Children’s

In August 2021, Kristin and Monét met with Dr. Oluwaseun (Seun) Adetayo, chief of pediatric plastic surgery, who specializes in pediatric craniofacial surgery. Dr. Adetayo explained that “sutures” are like flexible joints that connect the several bony plates of the skull. The metopic suture connects the two forehead bones and the bridge of the nose. Sutures allow the baby’s head to fit through the birth canal during delivery and the skull to expand as the brain grows.

In Mathís’ case, the two bony plates in front of his skull fused together too early, creating the ridge. Besides the ridge on his forehead, Dr. Adetayo also noticed slight bulging over his ears. She explained that since the metopic suture is the first one to close in the skull, the presence of a metopic ridge does not necessarily mean that a child has metopic craniosynostosis. The latter requires surgery, but the former does not.

After a full examination of Mathís, Dr. Adetayo integrated his history and physical exam findings with his developmental and sibling histories. She also wanted to perform a genetic panel and a CT scan to evaluate the sutures internally, watching for signs that it was metopic craniosynostosis (requiring surgery) versus metopic ridge (no surgery needed). The factor of Mathís’ other donor siblings having metopic ridge also raised a red flag for Dr. Adetayo to ensure there were no other sutures in the skull closing prematurely, because syndromic or genetic craniosynostosis could affect other sutures.

“We were so happy to have wonderful providers who took our concerns seriously,” said Kristin. “They were willing to put in the extra effort to explore Mathís’ condition even if there wasn’t anything glaringly obvious. Although our son was meeting his milestones – though delayed – and his ridge was extremely mild, Dr. Adetayo wanted to confirm that nothing else was wrong with Mathís’ metopic suture or any of his other sutures. She ordered a head scan, and I am so glad that she did.”

The results showed that not only was his metopic suture fused in his forehead, but his sagittal suture that extends from the front of the head towards the back was completely fused.

“Mathís had a condition called sagittal craniosynostosis, a defect that causes the sagittal suture to close earlier than normal, resulting in a head deformity,” explained Dr. Adetayo.

According to Dr. Adetayo, the combination of the conditions limits the skull’s ability to grow. When the bones fuse early, the skull stops growing in those areas, and over time, it puts extra pressure on the brain growth, leading to early developmental delays in otherwise normal children like Mathís. It is even more common in a case like Mathís where the head shape looks normal because there is not enough compensation at other sutures, which is called normocephalic craniosynostosis.

“These are cases that I see that are easily missed because the head shape is not obviously abnormal,” said Dr. Adetayo. “I applaud Mathís’ parents and pediatricians for getting him to our offices. This is why it is so important to have a craniofacial specialist examine such cases.”

“I remember when Dr. Adetayo shared the results of the scan,” said Monét. “She told us that they could see his sagittal completely fused and that he would need surgery. The thought of our son going through this invasive skull reconstruction surgery at such a young age brought me to tears. I was sad, but grateful that we caught this early. We scheduled an appointment to discuss the specifics of the surgery, and we prepared for the worst but hoped for the best. Dr. Adetayo and her team, along with Dr. Arnett Klugh, Children’s chief of pediatric neurosurgery, were both upfront and guided us through every step of the process.”

Collaborating for a life-changing surgery

Just before his second birthday, Mathís had skull surgery on Nov. 3, 2021. The six-hour operation involved making an incision along his scalp, opening up and removing the top half of his skull and separating the skull from the dura and opening to his brain. After removing the affected bone, Dr. Klugh and Dr. Adetayo reshaped and replaced the bone to improve Mathís’ head shape and allow more room for his growing brain to expand normally.

“It is a scary thing for parents when a child must undergo surgery. We did our best to walk the family through the process each step of the way, and they were really brave,” said Dr. Adetayo. “Success takes a team, and we are excited about the team we have assembled at Children’s to take care of children like Mathís. Ranging from our front desk team, nursing staff, surgery schedulers and advanced practice providers, our goal is to provide each child with top-notch care with compassion and innovation.”

“It’s a big deal, removing your 1-year-old child’s skull and literally getting down to the brain,” said Kristin. “After his surgery, Mathís went to the Pediatric Intensive Care Unit to recover. When he heard our voices, he opened his eyes a little. His entire head was completely wrapped. It was hard seeing him in that state, but we were glad that he was doing well after his surgery and got to go home.”

Seven months after his procedure, Mathís is doing remarkably well. Soon after surgery, Kristin and Monét noticed a big difference in his language and speech. Mathís was talking and eating better, and he carried himself more confidently. His curly hair grew back after the surgeons used a zig zag cut to help camouflage the scalp incision, which is now barely visible. For the McCullens, they are thankful to the wonderful team who took exceptional care of them and their son.

“Dr. Adetayo and Dr. Klugh took every moment and opportunity to educate us, which went a long way in building our trust and confidence in them,” said the McCullens. “We could tell how much Dr. Adetayo was plugged into the latest research on our son’s condition. That cemented our final decision to go to Children’s for the procedure, as we had also consulted with another hospital for a second opinion.

“The nurses here were so accommodating and attuned to the process and met our needs along the way. The team made it clear to us that their focus was not just taking care of Mathís, but also taking care of our family. Our confidence in the care we received could not have been higher. We are their biggest fans. In my mind, we could have gone across the world, but the absolute best care team for our son was just down the street.”

Click here to learn more about Children’s Plastic & Reconstructive Surgery Team.

Plastic & Reconstructive Surgery

At Children’s Hospital & Medical Center, we understand that birth defects or traumas can be difficult and overwhelming — especially when they are visible or affect a child’s development. Our specialists are here to help children ages 0 to 21 through all of their plastic surgery needs.

Learn More

A new beginning: Jesse’s cleft lip and palate success story

When Jessica first laid eyes on her son, Jesse, he was the most beautiful baby in the world — but she knew he would face some challenges. Jesse was born with a bilateral cleft lip and palate, with a split in his upper lip and a palate (roof of mouth) that did not fuse properly during development.

“His facial anomalies never changed the way I felt about him,” said Jessica. “Jesse stole my heart from the moment he was born – all 9 pounds of him. He was precious and perfect in every way. When he made his grand debut on Aug. 1, 2020, I just couldn’t wait to be his mommy. I couldn’t wait to love on him and give him the best possible life any mother wants for their child.”

About 1 in every 1,600 babies is born with cleft lip and palate in the United States, according to the Centers for Disease Control and Prevention (CDC). If these conditions are left untreated, children may experience feeding and speech development difficulties, ear infections, hearing loss and dental problems. Luckily, the conditions can be treated with surgery.

One month after Jesse was born, Jessica was referred to Children’s Hospital & Medical Center, where she met Dr. Oluwaseun Adetayo, Chief of Pediatric Plastic Surgery, for the first time. Dr. Adetayo discussed how she and the multidisciplinary craniofacial team would help restore function to Jesse’s lips and mouth, providing a more typical physical appearance.

“I was nervous about my baby going through his first surgery,” said Jessica. “But Dr. Adetayo had this way of calming my nerves and reassured me that everything would be okay. She broke things down in simple terms for me to understand and even drew helpful diagrams for me. Dr. Adetayo put all of my fears at ease and explained to me step-by-step how she would repair Jesse’s facial anomalies. From the moment I met her, I knew Jesse would be in good hands.”

Changing Jesse’s life, one surgery at a time

In December 2020, 4-month-old Jesse had surgery to correct his cleft lip. During this delicate procedure, Dr. Adetayo closed the opening in Jesse’s cleft lip and performed cleft rhinoplasty to reshape his nose so he could breathe better. Often, patients with a similar condition have an uneven nasal appearance due to their cleft lip and palate and need to undergo nasal reconstruction surgery.

“I was amazed when I saw Jesse after surgery,” said Jessica. “Dr. Adetayo and her team did a beautiful job. He looked different, and you couldn’t tell he had the deformity. Jesse spent a few days in the hospital until he was able to eat. Since he couldn’t suck because of his cleft palate, I fed Jesse with a big syringe.”

Shortly after celebrating his first birthday, Jesse was ready for his second surgery to repair his cleft palate. Cleft palate repairs are done when the child is older, between 9 months and 1 year old, to allow the palate to change as the baby grows and prevent further speech problems as the child develops. Dr. Adetayo also wanted Jesse to enjoy his first birthday cake and his favorite foods before his next surgery.

As with the first surgery, Dr. Adetayo drew a diagram for Jessica of what the surgery would look like before and after. In September 2021, Dr. Adetayo performed Jesse’s cleft palate repair. She closed the opening in the roof of his mouth, rearranged and repaired the muscles of the soft palate and made two incisions on each side of the palate to ease tension.

“Our plastic surgery team understands that birth anomalies can be difficult and overwhelming, especially when they are visible or affect a child’s development,” said Dr. Adetayo. “Our team is dedicated to helping children like Jesse function at their highest level. Jesse’s lip and palate repairs will improve his ability to eat, speak, hear and breathe. He can do the things now that any other child can do.”

To promote healing, Jesse had to wear arm splints to keep him from putting his fingers and sharp, pointy objects in his mouth, which could damage the sensitive tissues in his palate. Now that his palate has healed completely, Jesse is a happy baby who loves to eat and talk.

“He is lovable and is the perfect addition to our family,” said Jessica. “He loves holding on to me and vies for all of my affection all the time. I wouldn’t have it any other way. His siblings adore him as well. While it has been a trying journey for our family, one thing that helped me a lot was joining support groups and engaging with other families of children with cleft lip and palate. It was great to share stories, listen to each other and have someone to lean on. I am thankful to Dr. Adetayo and her team for taking great care of Jesse and for the positive changes they made in my baby’s life. I see a bright future ahead of him.”

Click here to learn more about Children’s Plastic & Reconstructive Surgery team and the Craniofacial Center.

Plastic & Reconstructive Surgery

At Children’s Hospital & Medical Center, we understand that birth defects or traumas can be difficult and overwhelming — especially when they are visible or affect a child’s development. Our specialists are here to help children ages 0 to 21 through all of their plastic surgery needs.

Learn More

“Counting our blessings”: Eva’s miraculous heart journey after multiple surgeries

Monae and Phillip Johnson dreamed of having children. Eleven years ago, they welcomed their beautiful daughter, Simone. During the pregnancy, Monae developed lupus, an autoimmune condition that also affected the child’s heart, leading Monae to wonder what her chances were of developing the condition again in future pregnancies.

Monae and Phillip wanted to give Simone a sibling, and after multiple attempts to have another baby – and enduring a miscarriage along the way – the Johnsons learned they were expecting again.

“We were surprised, happy, and nervous at the same time,” said Monae. “When I was nine weeks along, I worked with Dr. Michael Barsoom, the same high-risk OB-GYN who delivered Simone. Because of my prior experience, and since I had the tendency of developing lupus during pregnancy, our baby, Eva, and I were monitored closely with weekly ultrasounds.”

At 20 weeks, Eva’s heart went from normal to second-degree heart block to complete heart block, prompting Children’s Cardiology team to recommend fetal heart ultrasounds every week. Fetal cardiologist Dr. Jennifer Winters was assigned to Eva’s case, reading the ultrasounds, and Dr. Jeffrey Robinson became her primary cardiologist.

Welcoming Baby Eva into the World

On Sept. 23, 2020, the Johnsons welcomed Eva into the world. She weighed 4 pounds, 12 ounces and was delivered via C-section at 36 weeks.

Later that evening, Eva — at less than one day old — had her first heart surgery. Her cardiac surgeon installed temporary pacemaker wires since Eva wasn’t big enough for a permanent pacemaker.

Setbacks along the way required additional surgeries. Finally, when Eva was 2 months old, she reached her goal weight of 6.6 pounds and underwent another surgery in November to receive her permanent pacemaker.

“Everything was going well,” said Monae. “She wasn’t on a ventilator, and she wore clothes for the first time, which was an exciting ‘normal baby’ moment for us. Her doctors even told us that she was on her pathway home, which was very reassuring.

“Then, as I was changing my daughter’s diaper, I noticed drainage from her sternal incision. Her pacemaker got infected, and she was heading back to surgery. This was the ultimate high to low for our family. We broke down many times. We put our hope in God and in the hands of her medical team.”

More Surgeries – and a different approach

On Jan. 4, 2021, Dr. Ali Ibrahimiye, a pediatric cardiothoracic surgeon, and Dr. Oluwaseun Adetayo, Children’s Division Chief of Plastic Surgery, were involved in Eva’s fifth surgery, in which they cleaned up the incision and began investigative surgery to identify the cause of the recurring infections. Following the procedure, it was decided that the permanent pacemaker would need to be removed. It was left in place and gradually turned down over the next couple of days; however, Eva started to show signs that she couldn’t tolerate the low heart rate, so her pacemaker was turned on again.

Eva was then taken back for her sixth surgery. The permanent pacemaker and leads connected to the heart were removed, and new temporary pacemaker wires were placed and turned on again. This allowed the infected “pocket” to heal so the Cardiothoracic Surgery team could safely place a permanent pacemaker later without ongoing infection risk.

Though Eva was back to square one – wearing a temporary pacemaker again until she was ready for a permanent one – Dr. Ibrahimiye and Dr. Adetayo learned what was causing the multiple infections. They noticed the wires from the permanent pacemaker to the heart had worked their way up toward the skin. Eva’s body did not respond well to the sutures, which also contributed to the recurring infection. With the mystery solved, Dr. Ibrahimiye and Dr. Adetayo worked together to plan and perform Eva’s permanent pacemaker surgery.

“We took a different approach to this surgery,” said Dr. Ibrahimiye. “We first made a small incision in the abdomen to insert the pacemaker leads and connect it to the outside surface of the heart. The device was placed on the right side of Eva’s abdomen because there was too much scar tissue on her left side from her previous surgery. Together with the Plastic Surgery team, we elevated a safe, deep place of muscle flap, so we were able to create a new pocket of muscle to secure the pacemaker.”

“When I opened Eva’s sternal wound, I noticed several of her muscles were no longer properly attached to the sternum or her upper abdomen,” said Dr. Adetayo. “Due to the infection, the muscles had retracted, and the scar had shortened, similar to when anyone’s body tries to heal with a scar. In addition, her tissues were very stiff with poor blood flow because it had been infected so many times.”

The goal of surgery was two-fold: fix the recurrent problems Eva had experienced over several months and prevent subsequent reoccurrence. The scarred and stiff muscles were repositioned and reconstructed in the chest and abdomen to restore both function and appearance in their normal anatomic position. For a female patient, the team must consider breast development later in life, so the approach for closing the chest with muscle flaps is done with meticulous attention to detail. The Plastic Surgery team took several layers of tissue and closed each incision securely to reconstruct Eva’s chest wall and close her abdomen.

“I appreciated the strong collaboration of the Plastic Surgery and Cardiothoracic Surgery teams to give Eva the best outcome,” added Dr. Adetayo. “Multidisciplinary specialty collaborations are crucial in complex patients to help improve their outcomes, and we were able to accomplish this for Eva by working together as a team.”

Bringing Eva Home

After a month of considerable progress post-surgery, 7-month-old Eva was ready to join her sister, Simone, at home. Monae says she is grateful to Eva’s entire care team, spanning Pulmonology, Gastroenterology, Plastics, Cardiology, Physical and Occupational Therapy, Endocrinology and Wound Care, for taking great care of her daughter and providing a support system for their family.

“The care team at Children’s was a saving grace for me,” said Monae. “The love they had for Eva melted our hearts. Dr. Adetayo was a ray of sunshine, and she did an amazing job reconstructing Eva’s abdominal muscles so they can function properly. As for Dr. Ibrahimiye, he was a gentle spirit and so calm and collected and gave me the confidence to know Eva was in good hands with the medical and surgical teams. Dr. Barsoom and the Wound Care team were great to work with, too. Besides the outpouring of support from her care team, our faith and hope in God helped us stay strong for our daughter.”

Plastic & Reconstructive Surgery

At Children’s Hospital & Medical Center, we understand that birth defects or traumas can be difficult and overwhelming — especially when they are visible or affect a child’s development. Our specialists are here to help children ages 0 to 21 through all of their plastic surgery needs.

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Cardiology & Heart Surgery

From minor murmurs to major defects, disorders, and diseases, Children’s Hospital & Medical Center offers comprehensive cardiac care programs for both children and adults with congenital heart issues.

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First-of-its-kind Surgery at Children’s Provides Hope, Seizure Relief

Jonathan’s Story

Waiting on a miracle.

That’s how Omaha mother, Neysi Mendez-Tadeo, described the last eight years as her son battled debilitating seizures. Diagnosed with Rasmussen’s Encephalitis, a rare neurological condition, 15-year-old Jonathan had regressed to a state of constant twitching on his right side.

Then, in the summer of 2021, pediatric neurologist Sookyong Koh, M.D., Ph.D. joined Children’s Hospital & Medical Center as Division Chief of Neurology. Months later, she was joined by pediatric neurosurgeon Afshin Salehi, M.D., M.S. Through collaboration, Children’s pediatric neurosciences team determined surgical intervention was the only option for Jonathan, and it would require a procedure believed to be the first of its kind in the state of Nebraska.

“The surgery we did is called a functional hemispherotomy. Essentially, it entails disconnecting the involved hemisphere from the rest of the brain,” explained Dr. Salehi. “The amazing thing was that, on the day of surgery, Jonathan went to sleep seizing and when he woke up from surgery, he’s not seized since then. It was kind of like a light switch.”

Not only did the seizures stop, but in the months that followed, Jonathan regained some function on the right side of his body, and even surprised the neurosciences team by walking with limited assistance.

“It’s been said for Rasmussen’s Encephalitis that if you cannot walk before surgery, you cannot walk after surgery, “ Dr. Koh said. “For Jonathan, not being able to walk before, but being able to walk following surgery after half of his brain has been disconnected, is really a miracle.”

Neurology

At Children’s Hospital & Medical Center, we provide the most comprehensive, personalized, continuum of care in the region to treat complex pediatric neurological conditions.
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Innovation Improving the Lives of Kids with Epilepsy

Teddy’s Story

In April 2019, at almost 17 months old, Teddy Bronson experienced what would be the first of countless seizures.

“I went to get him out of bed, and it was like the lights were on, but nobody was home,” says his mother, Liz Bronson.

Liz and her husband Matt would later learn their son suffers from DUP15Q syndrome—a neurodevelopmental disorder which often results in epilepsy, autism and intellectual disabilities.

In early 2022 at Children’s Hospital & Medical Center, Teddy received a life-changing, leading-edge procedure designed to treat pediatric patients who suffer from a genetically associated form of epilepsy.

Prior to surgery, Teddy was experiencing up to 50 seizures a day; some lasted minutes while others came as a cluster of spasms. When medications and other treatments failed to alleviate Teddy’s seizures, his parents decided to give surgery a chance.

Children’s multidisciplinary epilepsy team— led by Division Chief of Neurosurgery Arnett Klugh, III, M.D., Division Chief of Pediatric Neurology Sookyong Koh, M.D., Ph.D., and pediatric neurosurgeon Afshin Salehi, M.D., M.S.—worked in collaboration to provide this groundbreaking surgery for Teddy.

Dr. Salehi implanted an RNS® system device in the bilateral thalami, which acts like a pacemaker for the brain by monitoring brain waves and responding to seizure activity. Using the guidance of the ROSA® Robot, Children’s robotic operating surgical assistant, this surgery was the first pediatric procedure of its kind in Nebraska.

As for Teddy, he was discharged the day after the device was implanted. Following surgery, Children’s epileptologist, Dr. Koh, continues to fine-tune the setting on the RNS® system device, which has already resulted in a significant reduction in seizure frequency for Teddy.

Since surgery, Teddy has had just eight seizures—one of which was captured on his room monitor that showed the device stopping his seizure. According to his mother, Liz, Teddy has had better and more efficient sleep since surgery, which is a game changer for both him and his family.

“We continue to work hard to further push the boundaries for a comprehensive treatment plan so our patients don’t have to leave Nebraska for neurosurgical treatments,” Dr. Salehi says.

Liz, a nurse practitioner at Children’s, first met Dr. Salehi while working a night shift. She feels a sense of relief that her son is in the hands of her trusted colleagues.

“Offering this kind of innovative epilepsy surgery at Children’s is something that is going to impact lives and our community for a very long time,” Liz says. “To know that Teddy’s surgery has set forth a path for surgical intervention for epilepsy at Children’s— that’s priceless.”

Neurosurgery

At Children’s Hospital & Medical Center, our neurosurgery team offers advanced surgical treatments to children with disorders or injuries of the brain, spinal cord, and peripheral nerve system (the nerves outside of the brain and spine).

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Sophia

Sophia’s Story: Small but Mighty Micro-Preemie Overcomes Obstacles

With two young boys, ages 4 and 2, Diana Gallegos and her husband learned they were expecting yet again; and this time, it was a baby girl. They were overjoyed about expanding their family. Diana’s first two pregnancies were full-term with no issues, and there was no indication that this third pregnancy would be any different.

During the second trimester, things began to change. She experienced back pain, kidney stones and hair loss. Then, when she was 23 weeks, her water broke. Diana and her husband rushed to the hospital. She was monitored as high risk and placed on bedrest.

Two weeks later, she became dilated to three centimeters, which cued her doctor to intervene. Diana was taken into the labor and delivery room for a C-section. The risks were very real for Diana and her family, as only 75 to 85% of babies born at 25 weeks survive. Diana also faced a very serious risk to her health while giving birth.

“I was really scared. They gave me the epidural, but I was still feeling the pain and screaming. So, they put me to sleep during the delivery because I was in so much pain,” said Diana. “I woke up in the recovery room, and I was asking, ‘Where is my baby? How is she?’ And they wouldn’t give me details until the doctor came. When the doctor showed up, she said that I had lost lots of blood and that Sophia was doing good… but not too good.”

Diana was able to finally see her baby girl for the first time the next morning, but nothing could prepare her for just how small her micro-preemie baby really was.

“She had all these monitors. It was scary to see all that, and she was so tiny,” said Diana. “It was so emotional. I had never thought that I would have a premature baby. It never had even crossed my mind. In my family and my partner’s family, there has never been a premature baby. So, it was a whole new experience.”

Sophia was born February 6, 2021, weighing just one pound, six ounces. She still faced many hurdles ahead.

Issues included intrauterine Growth Restriction (or failing to grow during pregnancy), bronchopulmonary dysplasia (a chronic lung disease that causes long-term breathing problems in premature babies), a subglottic cyst (a fluid-filled lesion in the lower part of the larynx below the vocal cords), difficulties with aspiration and more.

“The first few weeks I couldn’t hold her. I could only touch her, but just for very short periods of time. So, we would just stay there looking at her and just amazed that she was still living,” said Diana.

Sophia also began getting mysterious fevers, which delayed a hospital transfer. When she was two months old, she was able to transfer to the Neonatal Intensive Care Unit at Children’s Hospital & Medical Center in Omaha. As the only Level IV NICU in Nebraska, Children’s offers the most advanced level of neonatal care available. Their highly specialized, expert medical professionals treat nearly every condition a newborn baby may have.

“They told us they would do everything they could to keep her alive. She was losing so much blood, and so they were giving her blood transfusions. And then she had issues with her heart, kidney and liver. So, they were waiting to see how everything came out on their tests,” remembered Diana.

Fortunately, many of the issues resolved on their own as Sophia grew. Then came the moment when Diana could finally hold her baby girl in her arms for the very first time.

“I was so scared to hold her with the breathing tube and all the IVs she had. I just had to be very careful. She was so fragile,” said Diana. “But holding her, skin-to-skin, was the best feeling ever.”

Doctors determined that Sophia had issues with her vocal cords, and. because she was aspirating quite a bit, they decided she needed a G-tube placed to help her get proper nutrition.

“Over the last couple months in the NICU, she began to gradually improve, and she was starting to come off the oxygen. She started feeding with formula, but we had to be very careful how it was done since she had significant issues with her vocal cords,” said Diana.

Sophia was five months old when she was ready to go home. This milestone came only after Diana received extensive training on proper outpatient care for a micro-preemie baby.

“In the last couple weeks, I started working with the feeding team, learning how to make the formula the safest way for her to drink it,” said Diana.

Diana spent the last couple nights in the hospital practicing with assistance from nurses before she was given the clear to take Sophia home.

Now, in November 2021, during National Prematurity Awareness Month, Sophia is nine months old—happy, healthy and thriving. She’s expected to finally be taken off oxygen after a sleep study later this month. Diana said there do not seem to be any long-term issues, thanks to the medical team who helped her micro-preemie baby grow stronger. Sophia will be visiting the feeding therapy team in the outpatient clinic every few weeks to help her learn to eat properly and will follow up with the cardiology team and respiratory team to make sure she’s on track in those areas as well.

“I want to say thank you for everything the doctors and nurses did for my baby. The care was excellent,” said Diana. “There’s no other place I would rather her be than at Children’s.”

Sophia NICU

Sophia NICU

Sophia NICU

Sophia NICU

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