Richard’s Story: Receiving TZIELD Infusions for Diabetes

Richard is a 10-year-old who loves football and baseball, an avid coin collector and one of 5 boys in a tight-knit family. Most recently, he also became the first pediatric patient in the state of Nebraska to receive TZIELD infusions, a prescription medicine that can delay the onset of type 1 diabetes for approximately 3 years.

After receiving FDA approval, Children’s Nebraska—in collaboration with other hospitals across the region who’ve administered this leading-edge treatment—began developing a protocol for infusion, helping us better serve this patient population in our very own community.

Richard’s family has been in and out of Children’s Endocrine Clinic as his brothers were diagnosed with T1D and, when lab testing revealed he was likely to be diagnosed within the year, too, they took a leap on this new treatment.

“You have to do everything you can for your children, and this was worth a try,” said Richard’s dad, Seth.

“I wanted to try it,” Richard added. “It’s not scary because there are nice people here who are just trying to help you.”

TZIELD is the first disease-modifying therapy for T1D, a disease that occurs when the immune system attacks and destroys the body’s insulin-producing cells, leading to dependence on exogenous insulin therapy for survival. The screening process for this drug is specific, driven by FDA guidelines, and patients must meet certain criteria to begin treatment. Families in the Omaha metro area can be screened for free through Trial Net.

After completing two weeks of daily infusions at Children’s, Richard and his family are excited to see the positive impact this has on his life, helping suppress the physical and emotional tasks of diabetes management for a while longer. He can continue living a normal day-to-day life without worrying about injections throughout the day, checking blood sugar or wearing an insulin pump or continuous glucose monitor just yet.

“Having the option in Omaha was key, I don’t know if we could have done it at another (further away) hospital,” Seth said. “With Children’s, everything is in one system. His doctors, the infusion staff and everything has been amazing.”

At Children’s, we’re proud to continue improving the quality of—and access to—innovative pediatric care for patients like Richard.

To learn more about Endocrinology and Diabetes care at Children’s, click here.

Fighting Cancer Together: Best Friends Celebrate Final Treatment

In October 2020, two families—strangers at the time—received the same overwhelming diagnosis for their daughters: leukemia. Treatment started the following day, landing both young girls at Children’s, where they met and began going on daily walks around the hall. They quickly became best friends and started sporting matching outfits.

Five-year-old Keely and 7-year-old Haylee felt different from their peers, having lost their hair to chemotherapy and needing ports placed in their chests, but both girls had a friend to lean on who was having the same experience. They shared countless special memories, including a pizza party while snowed in at the Carolyn Scott Rainbow House, Children’s hospitality house for patients and families. Their treatments often fell on the same day, giving the girls something to look forward to rather than fear and dread. Coloring, playing and laughing have been powerful medicine for Keely and Haylee.

“Their spirit and temperament during treatment have been inspiring,”
– Jill Beck, M.D., division chief of Pediatric Hematology/Oncology.

This special bond created at Children’s extends to the girls’ families, as well. Keely’s mom, Cami, says, “I don’t know how we would have gotten through this without having that connection. We were going through the exact same thing at the exact same time, and it feels like a lifelong friendship that’s only developed within the last two years.”

Haylee’s mom, Kayla, says, “It’s nice to have someone else who knows what you’re talking about and going through. To other families, I would say it’s important to take it one day at a time, find a good support system and learn to accept the help.”

In December 2022, both girls celebrated their final chemo infusion treament, final spinal tap and port removal. Children’s expert team of doctors and nurses, who have provided them with care and support every step of the way, as well as family members and friends, lined the hallway to clap them out of Children’s Infusion Center one final time—a memorable celebration of true courage and resiliency.

“We have approximately 100 new cancer diagnoses a year and have done hundreds of these clap-outs, but this was the first double walkout I’ve been a part of,” Dr. Beck says. “The girls’ bond was unique because they were so close in age and had the exact same diagnosis at the same time. So much of this journey for them has been side by side, so it made sense for them to finish it together, too.”

Keely and Haylee

Learn more about Hematology and Oncology at Children’s Nebraska.

Jagger’s Story – Home After 548 Days at Children’s

After 548 days at Children’s Nebraska, Jagger goes home for the first time!

Jagger Nathan—born with a rare and serious genetic disease—spent the first 18 months of his life hospitalized at Children’s Nebraska.

Torie Nathan, Jagger’s mother, had no idea there were any complications during pregnancy. It wasn’t until her water unexpectedly broke at 31 weeks that she was rushed to an emergency department in Omaha where an ultrasound revealed Jagger’s congenital heart disease.

Shortly after Jagger was born on April 9, 2022, he was immediately transported to Children’s Nebraska where genetic testing revealed his CHARGE Syndrome diagnosis—an extremely complex syndrome that often involves extensive medical and physical difficulties such as birth defects and problems with the heart, trachea, esophagus and more. The Nathans expected a 6–8 week Neonatal Intensive Care Unit (NICU) stay when they arrived, but that turned into 18 months between the NICU and Cardiac Care Unit (CCU).

“We were so excited to have Jagger in our lives, but we were also so scared of the unknown,” says Torie.

For Jagger, two of the most concerning challenges he faced were his heart defect and a problem with the connection between his food and wind pipes.

“Jagger was born with a hole in his heart,” explains Ram Kumar Subramanyan, M.D., Ph.D., division chief of Cardiothoracic Surgery at Children’s Nebraska. “Additionally, the left side of his heart, which is intended to pump blood to the body, was underdeveloped. The pathway for blood to flow from his heart to the body was also small.

Upon admission, Jagger needed a breathing machine to support his lungs. He also needed medication to ensure his body received enough blood supply to stay alive. “Given all the complexities that Jagger was born with, his chances of survival were very low,” says Dr. Subramanyan.

At any given time, Jagger’s medical team consisted of every specialty from Cardiology, Cardiothoracic Surgery, Gastroenterology, Neurology to Pulmonology and Ophthalmology. “Jagger has been checked over from head to toe in every direction possible,” says Jagger’s father, Justin Nathan.

During his 18-month stay at Children’s Nebraska, Jagger underwent numerous surgeries and needed multiple interventions, medication and support. He was placed on a feeding tube and underwent a tracheostomy so he could continuously be supported by a breathing machine.

When Jagger was 15 months old, tests showed that his heart had grown enough to undergo the final repair he needed. Dr. Subramanyan, an expert in converting complex heart conditions into two-ventricle circulation, worked alongside Children’s Nebraska cardiothoracic surgeon Camille Hancock Friesen, M.D., to close the hole in Jagger’s heart and connect the heart properly to the lungs and body, which resulted in normal circulation and a fully healed heart.

“Jagger’s progress represents the best medical care that modern technology has to offer. Every single team member gave their best to ensure he had the best possible outcome,” says Dr. Subramanyan. “His parents were also integral to the success, partnering with the medical team to ensure things went well.”

After experiencing every emotion from joy to frustration to sadness for 548 days, Torie and Justin received word from their medical team that Jagger was healthy enough to go home for the first time in October.

“Our time at Children’s was amazing. Although it was much longer than we ever imagined, it was worth every second to have our little boy at home with us,” says Torie. “I thank God every day for the many doctors, nurses and team members at Children’s Nebraska and all they did for us. They are truly amazing people, and we are forever grateful to them.”

Omaha mom donates more than 8,600 ounces of breastmilk in honor of late son, George

With support from Children’s Lactation team and Mothers’ Milk Bank, Kelly’s donation has impacted families nationwide.

George

Some people are able to make a profound impact in a short period of time on Earth – and that was certainly the case for baby George.

Born in September 2022 after a seemingly healthy pregnancy, George perplexed his team of doctors right off the bat by not crying or eating for hours. But it’s when his oxygen levels dropped and a nurse witnessed him having a seizure that everything took a turn. Follow-up testing and an MRI revealed a rare condition: polymicrogyria, a condition characterized by abnormal development of the brain before birth.

George was transferred to the Neonatal Intensive Care Unit (NICU) at Children’s Nebraska one month after this diagnosis, where his recurrent seizures continued—lasting anywhere from 10 minutes to two hours. His condition was severe, resulting in seizures that couldn’t be controlled by medication, muscle weakness, problems with swallowing and feeding and more.

Although George’s mom, Kelly, had her heart set on breastfeeding—just like she’d done with her other two children, William and Molly—she pivoted, doing what was best for George. During his NICU stay, Kelly began to pump, and milk was provided through George’s g-tube.

“I was crushed but clung to any part of the plan that I could,” Kelly said. “From the minute he was admitted to the NICU, I kept pumping. I just wanted that for him and wanted to give him the best start I could.”

Kelly soon realized her supply was significant and began freezing milk. With enough for George and other babies, her milk donation journey began. A journey that would continue even after George passed away at eight months old.

Small but mighty, George exceeded doctors’ expectations, spending six months at home with his family. Six months filled with family walks and trips to the zoo, museum and park. “We were told he likely wouldn’t walk, talk or even smile, but he just exceeded everyone’s expectations and thrived in his own way at home,” Kelly said. “And he did smile quite a bit—at least once a day—beating the odds there, too.”

While facing an unimaginable loss, Kelly turned her grief into continued action. With ongoing support from her family and Children’s Lactation team, she donated more than 8,600 ounces to Mothers’ Milk Bank Colorado leading up to George’s 1st birthday. Kelly’s tremendous gift was distributed to 29 facilities in 11 states, impacting nearly 50 families across the country.

Children’s partners with Mother’s Milk Bank Colorado to help collect and transport donated milk from qualified donors in our area. Our Milk Depot accepts donated milk and safely transports it to Mother’s Milk Bank for screening, pasteurization, processing and distribution across the country.

“My donation was because of him. It was hard, but George kept me going to donate for other babies,” Kelly said. “Without him, I wouldn’t have been able to do it. Even after he passed, I continued to donate for him and I just kept thinking of how he’s making a difference for his friends in the NICU or anyone struggling with breastfeeding. That meant the world to me.”

“It became a family thing for us too,” she added. “My other two children would see me pumping and ask if I was going to give the milk to other little babies. I got to teach them about what I was doing.”

Kelly’s generosity, perseverance and resilience are inspiring. She has gifted other babies and families not only with nourishment but with strength and love—all in honor and memory of George.

“Pumping is hard work but there’s so much support from Children’s Lactation team and Mothers’ Milk Bank that you don’t have to worry about the other stuff,” Kelly said. “Mothers’ Milk Bank provides free bags if you’re donating and Children’s took care of all the logistics. I just did drop-offs and they made the experience so positive. It was easy to see the love and consideration they put into their work.”

If you’re interested in donating or want to learn more about the resources and support available through Children’s Lactation team and Milk Depot, contact our team today by calling 402-955-6152 or emailing [email protected].

Angelina’s Sudden Cardiac Arrest Survival Story

No one knows the impact school preparedness can have better than the Witcher/Schrader family from Lincoln, Neb. In January 2023, 9-year-old Angelina, a student at Kooser Elementary School, collapsed in her fourth-grade classroom during math.

Kooser School
Angelina experienced ventricular fibrillation (VF), a life-threatening arrhythmia that’s considered the most serious abnormal heart rhythm. It’s extremely dangerous because it can lead to sudden cardiac arrest if not treated immediately.

Although rare in pediatric patients, sudden cardiac arrest can’t be prevented.

“The best thing we can do for now is to prepare for these events by having life-saving medical equipment nearby and people trained to use the equipment,” says Matt Sorensen, M.D., pediatric electrophysiologist at Children’s.

CPR was administered immediately to Angelina by the school nurse. When the paramedics arrives, they continued CPR, defibrillated Angelina’s heart and intubated her. Once stable, she was transported to a hospital in Lincoln before being flown to Children’s.

“This was by far the worst day of our lives. Our fear of losing her or a poor outcome was overwhelming,” says Jeffrey, Angelina’s great-uncle and guardian.

According to Christopher Erickson, M.D., a cardiologist at Children’s, VF is a life-threatening and often fatal heart rhythm that occurs when the lower pumping chambers of the heart have no coordinated heartbeat. Instead, due to many rapid electrical impulses, the bottom chambers just quiver with no effective pumping. To remedy this abnormality, surgery is often needed.

The Children’s team of Ali Ibrahimiye, M.D., a cardiothoracic surgeon; Jeffrey Robinson, M.D., an electrophysiologist; and Peter Hunt, PA-C, worked together to place an implantable cardioverter-defibrillator (ICD) in Angelina’s chest. ICDs are often used as the treatment of choice for potentially life-threatening ventricular arrythmias.

Angelina’s ICD, which is about two-thirds the size of a hockey puck and half as thick, tracks her heart rhythm. Dr. Erickson says that for most patients, the ICD observes and analyzes the heart. If Angelina experiences an irregular life-threatening rhythm, it will deliver a shock to her heart if needed. Her physicians and family feel confident that her ICD will keep her safe while they wait for genetic testing results to further explain the cause of her arrhythmia.

Prior to collapsing, Angelia was a healthy child who participated in dance, volleyball and basketball and took piano and violin lessons. She exhibited no signs or symptoms of a heart condition.

While VF is not common in pediatric patients, doctors at Children’s often treat up to four cardiac arrest cases each year; some patients have had cardiac arrest before, while others exhibit identified risk factors for cardiac arrest.

Unfortunately, the first symptom of VF is cardiac arrest. Some patients may experience fainting spells or even seizure-like symptoms, while others have noticed palpitations.

According to Dr. Erickson, VF can be caused by multiple factors, including genetic syndromes that make the heart more vulnerable to the condition. Other factors may include infections of the heart and poor blood flow to the heart that results in muscle injury.

Angelina’s future is bright because of the swift actions of her school nurse and the medical intervention of the paramedics and the expert team at Children’s. Since her procedure, Angelina has returned to school full time and has resumed her piano and violin lessons. In May, her school received a Heart Safe School designation through Children’s Project ADAM program, signifying a commitment to having a response plan, CPR and automated external defibrillator (AED) training and advanced preparedness to keep students, staff and visitors safer in the event of an unexpected cardiac event on campus.

“CPR and AEDs save lives! Angelina would not be here today had it not been for the quick response from her teachers and school nursing staff and the expert care from Children’s,” says Kevin, Angelina’s great-uncle and guardian.

Click here to learn more about Children’s Criss Heart Center Team.

Angelina

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., Director of Digital Innovation in 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 Nebraska, 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 Nebraska 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 Nebraska, 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 Nebraska.”

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 Nebraska, 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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