[July 06, 2008]

Twins small but 'doing great': Laser surgery before boys' birth remedied harmful blood condition

(Houston Chronicle (KRT) Via Acquire Media NewsEdge) Jul. 6--Kim and Nate Stroh stood surrounded by relatives outside Texas Children's Neonatal Intensive Care Unit on Saturday afternoon. All were beaming.

Just through the doors were the newest members of the Stroh family -- Blake Daniel and Owen Nathaniel.

"They're our miracles," said Kim Stroh, 27.

Though born a bit small, the identical twin, 2-day-old boys require minor amounts of oxygen and are "doing great," Nate Stroh said.

Just weeks ago, it was questionable if the twins -- the couple's first children -- would even be born.

The Strohs, who live in Humble, learned at 22 weeks' gestation that their fetuses were suffering a rare condition known as twin-to-twin transfusion syndrome.

The condition, which causes one identical twin to receive too much blood and the other to get an insufficient supply, is rare and affects 6 percent of identical twin pregnancies, or 1 in 4,000 of all pregnancies, according to Texas Children's Hospital.

Exactly 10 weeks prior to the boys' birth, Kim Stroh underwent laser surgery to separate the blood vessels that connected the twins.

Without the procedure, doctors had warned, both fetuses would likely die. With it, there was only a 60 percent chance that the couple would take home two healthy babies.

"No question, this is a win for us," said Dr. Kenneth Moise Jr., the Texas Children's Hospital fetal interventionist who performed the operation.

Owen, whose name means "young warrior," was known as the recipient twin, because he was receiving blood from his brother. Prior to the surgery that welded 14 blood vessels, he was taking in too much blood and producing too much urine, overworking his heart.

"Less than 24 hours after surgery, his signs of congestive heart failure were almost gone," Nate Stroh said.

At birth, Owen weighed 4 pounds, 6 ounces.

"All along, he's been the laid-back one, the 'chill' baby," Kim Stroh said.

Blake is "the feisty one," she said of the smaller twin who was born weighing 2 pounds 6 ounces.

"He's a wild man," agreed nurse Liz Fennell, laughing.

As the "donor baby," he wasn't receiving enough blood or making enough urine to fill his amniotic sac and was "shrink-wrapped" into a corner of the uterus prior to the surgery.

Doctors decided to deliver the boys Thursday, at the important 32-week gestation mark.

The couple learned Kim was pregnant on New Year's Day. Three days later, they discovered they were expecting twins.

Then came the April 21 diagnosis of twin-to-twin transfusion syndrome, which affects identical twins who share a placenta.

Fraternal twins each have their own placenta, as do about one-third of identical twins.

"It was scary, definitely. This has been a wild ride," said Nate Stroh, who will turn 29 Wednesday.

"It's a disease you never hear about until you've got it," said Moise, who said there are more deaths from twin-to-twin transfusion syndrome than from Sudden Infant Death Syndrome.

Ten years ago, there was no treatment for twin-to-twin transfusion syndrome, only treatment for the symptoms. "We would drain amniotic fluid, but that was pretty much it," Moise said.

He has been performing the procedure since 2003 and said the rate of success -- measured in healthy babies -- is increasing.

As the only surgeons offering the procedure in the central United States, Moise and his partner, Dr. Anthony Johnson, have performed more than 110 of the surgeries. About 70 percent of their patients are from outside the Houston area.

Moise, a faculty member at Baylor College of Medicine, is passionate about educating both the public and the next generation of doctors about the syndrome. "This is something that an average physician may only see four or five times in a career," he said.

Kim and Nate Stroh are thankful that doctors were able to diagnose and treat the disease in time to save their sons.

"We started saying earlier this year that things were 'great in '08.' And it's been a great year so far," Nate Stroh said.

"And it's going to get even better."

jennifer.leahy@chron.com

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