Category Archives: News

The road to recovery: Pediatric cancer services

Each year, close to 12,500 children in the U.S. are diagnosed with cancer. Among them who live in the Upper Midwest, more than 70 percent are treated by Children’s Hospitals and Clinics of Minnesota. This week we shared Jenna Carnes’ cancer journey on Twin Cities Moms Blog. Jenna is one of many teens we see in Children’s Cancer and Blood Disorders Clinic each week, and just like every pediatric cancer patient, her journey is a unique one.

Jenna Carnes (left) and her mother, Barbara, enjoy a Minnesota Twins baseball game at Target Field in Minneapolis. (Photo courtesy of Barbara Carnes)

Jenna Carnes (left) and her mother, Barbara, enjoy a Minnesota Twins baseball game at Target Field in Minneapolis. (Photo courtesy of Barbara Carnes)

“Like all of our patients, we want Jenna to still be a kid and not to have to grow up too quickly because of the disease she’s dealing with,” said Dr. Joanna Perkins, Jenna’s treating physician in the Cancer and Blood Disorders Clinic at Children’s. “With the suite of treatment options we offer, Jenna’s been able to get back to being a normal teen.”

Beginning with the Child Life department, Jenna utilized many of Children’s support services to help her in her healing journey. From how to talk about cancer with her friends at school to going to surprise Minnesota Twins baseball games with her family, Jenna said her child life specialists made each day that she was at the hospital just a little easier. This was a welcome relief for her family.

“What makes Children’s different than any other hospital are the services we offer that go above and beyond standard inpatient care,” said Dr. Perkins. “From the supportive care – ranging from physical therapy, psychology and nutrition specialists, music therapy, massage and pain and palliative care – to special events geared towards the whole family, we try to make the time kids and families have to spend in the hospital as good as it can be. A lot of kids appreciate the simple things, too – big TVs and video games.”

In addition to Children’s in-house services, many patients (including Jenna) go to Camp Courage in Maple Lake, Minn., to “just be a kid” for a week each summer. The camp also provides patients’ families with a much-needed break. With Children’s staff physicians and nurses, onsite, to administer medication and keep close watch on their patients, patients and their siblings take part in time-honored camp traditions and let loose for the week.

“Kids of all ages are there, and we’re all going through something really similar,” said Jenna. “There are no strange looks.”

As Jenna and her family prepare to celebrate the end of her chemotherapy treatments, Jenna’s care team at Children’s will be by her side, cheering her on at her end-of-treatment party on June 12. Soon, Jenna will be a part of Children’s Destination STAR (Surveillance and Testing After Recovery) Clinic, which assists her with the transition to life after cancer therapy. She’ll work with Children’s Health and Wellness Team, consisting of staff members from oncology, nutrition services, physical therapy, psychology and child life, as well as her primary care physician for wellness visits to make sure the cancer does not return.

“Going to the hospital for cancer treatments will never be fun,” said Jenna. “But, I’m honestly going to miss coming to Children’s – it’s almost become a second home.”

Visit Children’s Hospitals and Clinics’ Cancer and Blood Disorders Clinic for more information. Children’s first annual Shine Bright Bash on Sept. 13 is to celebrate and support the advancements in pediatric cancer and blood disorder care.

NBC News: Sharing the story of Children’s cancer and blood disorders expertise

Michael and Megan Flynn with sons Andrew, 7 months, and Thomas, 5, and daughter Olivia, 3 (Photo by Julie Ratkovich Simply Bliss Photography)

NBC News shared the story and collective work of Children’s Hospitals and Clinics of Minnesota’s blood and cancer disorders team, including Dr. Kris Ann Schultz, Dr. Yoav Messinger, Gretchen Williams, CCRP, and Anne Harris, MPH, among others, who have led the way in enabling the early detection and effective treatment of children in families affected by rare genetic cancers.

via NBC News: One rare cancer leads to another: Cancer registry saves baby’s life

In 2009, while trying to understand pleuropulmonary blastoma (or PPB, a rare early childhood lung cancer), researchers leveraging data from Children’s International Pleuropulmonary Blastoma (PPB) Registry uncovered an unexpected cause: a mutation in DICER1, a master controller gene that helps regulate other genes. By leveraging those learnings and coupling it with new data from the International Ovarian and Testicular Stromal (OTST) Registry – a “sister” registry of the International PPB Registry – Children’s has recently discovered that the DICER1 gene mutation may underlie many additional rare childhood genetic cancers and could tell us something fundamental about how most cancers arise.

Children’s presented its promising findings this weekend at the American Society of Clinical Oncology (ASCO) Annual Meeting, advancing the potential for early diagnosis and proactive treatment of children in families affected by PPB, as well as other rare genetic cancers such as certain ovarian, nose, eye and thyroid tumors.

With the establishment of the International PPB Registry in 1988 and the International OTST Registry in 2011, Children’s, along with our partners, have become the world’s leading experts on how to care for children with PPB and other cancers marked by the DICER1 genetic defect. As a result, PPB could be among the first cancers routinely curable before it progresses to a deadly form.

Children’s work and ability to follow the science continues to be made possibly entirely by philanthropy, including the St. Baldrick’s Foundation and the Pine Tree Apple Tennis Classic.

Congratulations to the Children’s cancer and blood disorders team!  Thank you for your commitment and your amazing, groundbreaking work.

Trustworthy: Vaccines have earned that title

Two doses of measles-mumps-rubella vaccine will prevent measles in 99 percent of those vaccinated.

By Patsy Stinchfield, PNP

The confirmation of 83 cases of measles in Ohio this month and the recent quick diagnosis of a 19-month-old with measles in Minneapolis, Minnesota’s first case of measles this year, brought a timely reminder that the potentially deadly virus has not been eradicated and of the importance of vaccination. Having just wrapped World Immunization Week and National Infant Immunization Week, the importance of immunization is as great as ever.

In fact, the U.S. Centers for Disease Control and Prevention reported today that the 288 cases of measles in the country so far this year are the highest since 2000. The number of cases reported this year is the highest for the first five months of a year since 1994.

I worry that the numbers are a sign of growing credibility for a small band of celebrities and others who have thrown up an online smoke screen of fear of vaccines against measles, whooping cough and other common childhood diseases.

If even a relatively small percentage of Americans buy into this criticism, it would be disastrous. Measles, one of the most contagious airborne diseases, can be extremely serious, leading in rare cases to pneumonia and fatal brain infections. Infants too young to be vaccinated particularly are at risk.

We’re fortunate that the child in Minnesota, who actually had one of two measles shots and apparently contracted the disease during a visit to India, was diagnosed within minutes at Children’s – Minneapolis. Because the alert medical team picked up the symptoms so quickly, only 16 potentially exposed people had to be notified after the child was quarantined.

Three years ago, as many as 700 contacts had to be reached for some patients during an outbreak at Children’s.

What’s most frustrating is that it’s all so unnecessary.

The virus hasn’t changed all that much. It’s not like the HIV virus, constantly mutating. No; with measles the culprit purely is social – a breakdown in trust of medical experts whose longtime vaccine advocacy made measles and other common childhood infections a footnote.

Fear-mongering online vaccine critics are not winning, in a classical political sense. Thankfully, more than 90 percent of parents still trust their health care providers and nationally recommended vaccines. If they didn’t, we would see frequent headlines about deaths from measles, whooping cough and other diseases.

However, the remaining 10 percent of parents are hesitant, have vague fears and wonder who to trust. They routinely hear or read vehement vaccine bashing in social media circles, which feeds fear and denial – and new outbreaks. New York City and Orange County, Calif., currently are dealing with measles outbreaks.

Measles is so highly contagious that just passing through a clinic waiting room two hours after someone with measles has been there can expose an unvaccinated newborn, which may be devastating.

We all must protect the vulnerable in our community by forming a protective barrier of our own vaccination. That’s a simple point seemingly lost on the peddlers of myth and pseudoscience who have infected too many parents with baseless fear of vaccines that protect their own children and the community at large.

Parents should trust health care professionals who urge vaccination on schedule. At Children’s, we speak from experience. We have seen children die or become permanently impaired from vaccine-preventable disease. Ask our specialists how many unvaccinated, critically ill children they have cared for, and they would answer “too many to count.” And how many they’ve seen with severe vaccine side effect? You’ll get a blank stare, or “I don’t recall any; maybe one at most.”

We have seen children with measles on a ventilator, fighting for their lives. That’s a bitter sight when you recognize that two doses of measles-mumps-rubella vaccine will prevent measles in 99 percent of those vaccinated. There’s no contest between the benefits of vaccines and their extremely rare risks.

Before the measles vaccine was developed in the 1960s, there were 2.6 million measles-related deaths per year worldwide. In 2012, that number was down to 122,000, mostly in children younger than 5 in parts of the world where vaccines are scarce or their parents refuse to allow vaccination. The point is that we can’t afford to let our guard down in the U.S. or elsewhere. In a global society measles is a mere plane ride away for the unprotected.

The safe, effective and trustworthy action for infants, children, adolescents and adults is to get vaccinated on time for all recommended vaccine-preventable diseases.

Aside from sanitary drinking water, vaccines remain the safest, most-life-saving medical intervention we have to protect our children.

Patsy Stinchfield, PNP, is the director of Infection Prevention and Control and the Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota.

Allergies in full swing in spring

Although allergies can develop at any age, they most commonly show up during childhood or early adulthood.

Winter exits, spring enters, and with it come irritants in the environment that can trigger allergies in children and adults.

In the U.S., more than 50 million people (1 in 5) are affected by allergies, which are caused by an overactive immune system, according to the American Academy of Pediatrics.

 

 

Cities 97′s Paul Fletcher to host Baby Steps 3K

Paul Fletcher of Cities 97 will be the emcee for Baby Steps 3K walk and party, taking place on Saturday, May 31, at the Minnesota State Fairgrounds. Paul and his wife, Spencer, their family and friends will walk in honor of their daughter, Elsie, who was born with Hirschsprung’s disease and continues to receive care at Children’s. All proceeds from Baby Steps 3K will go to support the neonatal program. Learn more about or register for Baby Steps 3K.

In 2013, Paul and Spencer shared their story about Elsie and the care they received at Children’s and the Ronald McDonald House:

Photo gallery: 2013 Baby Steps 3K

Minnesota spring means ticks, health risks

Deer ticks are tiny – about the size of a pencil tip – and brown-black in color. Wood ticks are larger and do not carry Lyme disease.

Erin Fritz, RN, CNP

The snow has now melted and the temperatures are rising, allowing our energy and activities to bring us outdoors. Spring weather brings sprouting trees, blooming flowers – and creepy crawly ticks that lurk in the woods, grass and marshy areas.

Whether you are heading up north to the cabin or playing in your backyard, ticks may be present and a tick bite may occur. Due to the extreme seasonal temperature changes and high humidity, Minnesota has a lot of ticks and high rates of tick-borne illness such as Lyme disease, and the risk remains high. Lyme disease is an infection caused by bacteria that is carried by some deer ticks. Deer ticks are tiny – about the size of a pencil tip – and brown-black in color. Wood ticks are larger and do not carry Lyme disease.

Prevention

Playing outdoors increases the risk of encountering a tick, but there are ways to prevent a tick from attaching and biting. The American Academy of Pediatrics recommends the following for tick and Lyme disease prevention:

  • Cover arms and legs by wearing long-sleeved shirts and pants tucked into socks
  • Wear a hat to cover hair
  • Wear light-colored clothing in order to see ticks more clearly
  • Wear enclosed shoes, use insect repellent with DEET
  • Stay on cleared trails whenever possible
  • Routinely check for ticks immediately after coming indoors

When you find a tick

Most ticks are noticed when crawling around on clothing or skin and easily can be removed by taking it off before it attaches to the body. If a tick already has attached, removal is rather easy and should be removed as soon as possible. While prompt removal is important to decrease the risk of developing Lyme disease, be aware that most medical experts agree that the tick must be attached for at least 24-36 hours before Lyme disease is transmitted.

In order to remove the tick:

  • Simply grasp the tick with a tweezers as close to the skin as possible
  • Without squeezing the tick’s body, slowly pull the tick away from the skin
  • Clean the bitten area with soap and water
  • Apply an antiseptic ointment

Be on the lookout

After tick removal, it’s important to monitor the site for expanding redness that might suggest a “bull’s eye” rash. This particular rash can be the first and most obvious sign of Lyme disease.  The rash usually doesn’t cause other symptoms, but burning or itching is a possibility. Further examination by a health care professional is needed if there is a bull’s eye rash, headaches, chills, fever, fatigue or muscle aches. If Lyme disease is suspected, a health care professional probably will prescribe an oral antibiotic for treatment. There’s no benefit in testing for Lyme disease at the time of the tick bite; even people that become infected will not have a positive blood test until approximately two to six weeks after the infection post-tick bite. Early identification and treatment is important to reduce the risk of worsening illness.

While ticks and tick-borne illness easily can be overlooked, prevention is vital. This is the time of year to take full advantage of the long-awaited summer. Get outside and play safely.

Erin Fritz is a certified nurse practitioner at Children’s Hospitals and Clinics of Minnesota.

Kangaroo Care a tranquil experience for parent, child

Newborn Azarias has skin-to-skin contact with his mother, Veronica Engel, as part of a Kangaroo Care exercise. Thursday, May 15, is International Kangaroo Care Day.

This month, the Neonatal units in St. Paul and Minneapolis are celebrating the importance of Kangaroo Care, a technique where an infant is held skin to skin with mom or dad. Kangaroo Care promotes bonding, provides comfort for the baby and parent and has potential to improve a baby’s medical condition. In honor of International Kangaroo Care Awareness Day, a mother shares her experience holding her newborn son skin to skin.

Veronica Engel of Chippewa Falls, Wis., holds newborn son Azarias skin to skin as part of Kangaroo Care.

By Veronica Engel

My husband and I found out at my 10-week ultrasound that we were having a baby boy, but we also found out that our son, Azarias, had a birth defect called gastroschisis.

Due to his condition, doctors informed me that I wouldn’t be able to hold Azarias until after his surgery. This had me worried because I was afraid of missing out on that special bonding time that you immediately have with your newborn. When he was born, I was able to put him on my chest momentarily but then he had to be rushed off in an isolette to be prepared for his stay at the hospital until the doctors could perform the surgery he needed.  He was staying in the neonatal intensive care unit (NICU) at Children’s – St. Paul, which has private rooms. I am grateful for this because it allowed me to stay in the room with him around the clock.

I wasn’t able to hold him for the first week of his life due to his condition; however, I was able to hold his hands and feet or rub his head. After his surgery, I was able to hold him the next day. This was special because I got to hold him skin to skin; I held him for three hours straight. It was relaxing and soothing for both of us to be able to have this closeness, which we weren’t able to do at the beginning of his life. I continued to stay with Azarias in the NICU, and each day I would hold him once or twice using skin-to-skin – anywhere from an hour to three hours at a time.

The doctors told me that he was doing excellent for his condition. Not only was he gaining weight at a good pace, but he also was moving along quickly for what he was able to consume and digest.

When I’m holding Azarias skin to skin, I don’t even notice the time fly by; it’s such a relief to be able to help calm and comfort him just by this simple action. Kangaroo Care truly is a tranquil experience for parent and child and has helped us build a lasting bond with each other. I believe that being here and holding him skin to skin has made a difference in Azarias’ ability to recover and heal from this whole ordeal.

Children’s, Allina Health break ground at Mercy Hospital

Leaders from Children's and Mercy Hospital break ground on the new Mother Baby Center at Mercy on Wednesday, May 14, 2014.

Allina Health and Children’s Hospitals and Clinics of Minnesota are growing their birthing center partnership with the ground breaking of The Mother Baby Center at Mercy, part of Allina Health, in Coon Rapids, Minn. The new Center, targeted to open mid-2015, will provide all mothers and families in the north Twin Cities metro area – including Coon Rapids, Anoka, Buffalo, Maple Grove and neighboring communities – access to a network of world-class, family-centered birthing options closer to home.

The Mother Baby Center at Mercy, a $30 million initiative, will feature the only Level II special care nursery in the north metro with private patient rooms, providing in-room accommodations for families to stay together with their baby. For babies born at less than 34 weeks gestation, or for those who require a higher level of care, there will also be a seamless transition to and from The Mother Baby Center at Abbott Northwestern Hospital and Children’s in Minneapolis.

The ceremonial dig site for The Mother Baby Center at Mercy Hospital in Coon Rapids is seen Wednesday, May 14, 2014.

“Adding more specialized services at Mercy, especially for high-risk mothers and babies will mean fewer will need to go farther from home for care. We want to keep mothers and babies as close together as possible. Patients are happier when they can receive the care they need close to home. That is what Allina Health aspires to do in all of the communities we serve,” said Penny Wheeler, MD, president and chief clinical officer, Allina Health.

Mercy Hospital will ultimately move its current birth center to a new 62,200-square-foot, two-story Mother Baby Center attached to the hospital. For high-risk patients, a skyway will grant connection to the hospital’s main operating room. Initial capacity of The Mother Baby Center delivered by Mercy and Children’s will accommodate 2,700 births annually, with shelled space for growth for up to 3,500 births annually.

“Mothers and families want a personalized and safe birthing experience in a space that is thoughtfully designed, features state of the art technology and is staffed by the highest trained professionals. With Children’s as a partner, The Mother Baby Center at Mercy will optimize the quality of care for all mothers and babies in the north metro,” said Alan L. Goldbloom, MD, chief executive officer, Children’s. “Building on the experience and success of The Mother Baby Center at Children’s and Abbott Northwestern in Minneapolis, I’m confident this expansion will continue to advance the standards of maternal, fetal and newborn care across the state.”

Additional features of The Mother Baby Center at Mercy will include:

  • A designated entrance with valet services and immediate access to triage
  • 10 labor and delivery rooms
  • 22 post-partum rooms
  • Two large operating rooms
  • An infant resuscitation room
  • A 10-room Level II special care nursery with 14 bassinets
  • A newborn nursery
  • Five triage rooms
  • All private patient rooms with full bathrooms, luggage carts, hospitality amenities (hairdryers, large screen TV, iPod docking station, fold-out sleeper sofa, etc.)
  • A family lounge dedicated to families whose baby requires neonatal care
  • Provider call rooms

The announcement of the ceremonial groundbreaking of The Mother Baby Center delivered by Mercy and Children’s comes just over a year after the grand opening of The Mother Baby Center at Abbott Northwestern Hospital and Children’s, which opened in February 2013.

Austin’s story: A pioneering surgery provides hope

For 3-year-old Austin Graue, his short life has been anything but typical.

At birth, he was delivered via emergency C-section after doctors determined he wouldn’t be able to breathe on his own. He was rushed from the hospital in his family’s hometown of Northfield, Minnesota, to Children’s – St. Paul.

Austin Graue, of Northfield, Minnesota, was born in August 2010.

“It was disbelief and shock,” said Mary Graue, Austin’s mother, when she thinks back to her baby’s first days. “What we thought was happening [having a healthy baby boy] was exactly the opposite. We asked ourselves: ‘Is he even going to survive?’ ”

Confusion and doubt swirled.

After discharge and a precious few days at home, Austin was readmitted to Children’s when he continued to experience breathing problems and near-constant vomiting prevented him from gaining weight. Diagnosed with pyloric stenosis (a narrowing of the pylorus, the opening from the stomach into the small intestine), Austin would require surgery.

Surgery was a success and Austin was discharged, albeit with a tracheostomy (a hole made in his neck that went through to his windpipe) to help him breathe (“His nasal passages were the size of pencil tips,” Mary said) as well as a gastronomy tube for feeding. His only visits to Children’s now would be for quarterly checkups. However, things quickly changed during his three-month visit when doctors told the Graues that the “soft spots” on Austin’s head were closing too quickly and he would need surgery, again.

A new diagnosis: Austin had Pfeiffer syndrome.

“Austin had experienced challenges since birth and now we finally had the answer why,” Mary said. “It was such a relief to finally have an answer.”

Hope for Austin’s future was growing.

Pfeiffer syndrome is a rare genetic disorder which only affects about 1 in every 100,000 people. Because of his condition, the bones of Austin’s skull had prematurely fused together, putting increased pressure on his brain. If left untreated, Austin’s brain would not be able to fully develop, causing a host of developmental problems. Physically, Austin would begin to develop bulging and wide-set eyes, a high forehead and an underdeveloped jaw.

At just 1 year old, Austin and his family met Robert Tibesar, MD, one of the craniofacial surgeons at Children’s ENT and Facial Plastic Surgery, the first and only ENT and facial plastic surgery practice in Minnesota that cares exclusively for kids.

“Austin had fusion of many of his sutures – or joints – in his skull,” Tibesar said. “That meant that his mid-face, forehead and the back of his head were not growing properly. The fused sutures had constricted growth and were causing Austin to have an abnormally shaped head, as well as put him at an elevated risk of pressure inside his skull.”

First, Tibesar, along with Joseph Petronio, MD, Children’s neurosurgery medical director, performed surgery to advance the front part of Austin’s head and eyebrows, allowing him to better close his eyes and improve the contour of his forehead.

Pfeiffer syndrome is a rare genetic disorder which only affects about 1 in every 100,000 people.

“As expected in children with Pfeiffer syndrome, the problems with Austin’s skull could not be solved with just one operation,” Tibesar said. “The fused sutures in the back of his head continued to constrict the growth of his skull.”

“The back of Austin’s head was flat,” Tibesar continued, “and that was preventing his brain from fully developing. The back part of the brain serves important functions for vision and balance, and we needed that to be decompressed to allow his brain to grow normally.”

Tibesar would use his knowledge of the jaw distraction procedure – a procedure pioneered at Children’s – to perform a “cranial vault expansion” on Austin, which would be coupled, for the first time, with image-guidance technology.

“In looking at the literature, there are no other case reports of this exact procedure for this exact problem,” Tibesar said.

As Austin’s dad, Phil, described it, Tibesar and his team were going to “move an island of bone” on Austin’s head.

Tibesar likened image guidance to using a GPS in favor of a paper map. “When you’re trying to get somewhere using a map, you may not know exactly where you are; sometimes you have to make your best guess. With GPS, you know exactly where you are at all times. The same is true with image guidance. During surgery, we know exactly where we need to make each bone cut.

“For Austin, and for many other kids to come, this represents a significant advance in terms of precision, and, therefore, safety for these types of surgeries.”

Austin would become a pioneer.

In the operating room, Tibesar and his colleagues opened Austin’s skull and attached four “distractors” over his head from ear to ear – these distractors would allow Austin’s skull to expand and grow. At the completion of the surgery, four small key holes protruded from Austin’s head, and his parents were entrusted to turn a special key twice a day to slowly expand his skull, causing little to no pain for Austin.

Doctors opened Austin’s skull and attached four “distractors” over his head to allow his skull to expand and grow.

“It was really hard at first,” Phil said. “You are literally moving his skull… I couldn’t believe I was doing it.”

After 30 days back home, Austin’s skull had expanded nearly 3 centimeters and was starting to grow properly on its own.

In February 2013, Tibesar and his colleagues removed the distractors in order to allow the bones of Austin’s skull to fill in more completely. Since the surgery, Austin has experienced few complications and has only been back to Children’s for routine check-ups.

Before (right) and after (left) X-rays of Austin's skull

According to Tibesar, the next-closest place that offers surgery for kids with Pfeiffer syndrome is in Chicago. Thankfully for Austin and his family, he would be able to be treated less than an hour from home.

“Things have been normal,” Mary said. “We have our daily worries, but otherwise Austin is going to school, talking more and making friends. As time goes on, we are getting more normal around here.”

Austin Graue with his mother, Mary

For other parents that will face a similar journey, Mary encourages them to “take things one day at a time.”

Austin will have to undergo another surgery in a few years to ensure that the bones of his face grow along with the rest of his skull, but he’s well on his way to a much more typical life.

“We need parents who put their trust in us,” Tibesar said. “It’s a big honor to have that trust, but really, [the children] become the pioneers and we are able to apply this technology to the benefit of others.”

More about Austin Graue’s story is available here.

Surgery before birth saves lives of preemie twins

Amina (left) and Rania Abdi were born Feb. 11, 2014, at 25 weeks. The twin sisters were diagnosed with twin-to-twin transfusion syndrome while in the womb. (Jimmy Bellamy / Children's Hospitals and Clinics of Minnesota)

We continue our focus on fetal care this month by honoring Siman Abdi and her twin daughters, Amina and Rania, who were born Feb. 11 at 25 weeks.

Earlier in Siman’s pregnancy, the sisters were diagnosed with twin-to-twin transfusion syndrome (TTTS), which is a rare condition that occurs when one twin donates blood to the other while in the womb and, if left untreated, potentially can be fatal for both babies.

Thanks to the work of the Midwest Fetal Care Center, a collaboration between Abbott Northwestern Hospital and Children’s, Siman’s daughters are recovering at Children’s and continue to grow stronger each day.

Learn more about twin-to-twin transfusion syndrome:

Twin-to-Twin Transfusion Syndrome from The Mother Baby Center on Vimeo.