Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Dr. Joe Lillegard, Director of Research, Head of Open Fetal Surgery, Midwest Fetal Care Center

Transcript

Dr. Joe Lillegard, Director of Research, Head of Open Fetal Surgery, Midwest Fetal Care Center · Becker’s Healthcare -- Pediatric Leadership Podcast

0:00
This is Crystal Olson with the Becker Healthcare
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care podcast.
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Thrilled to be joined by Doctor Joel Lil,
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Pediatric and fetal surgeon at Midwest fetal Care
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center,
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collaboration between Children's, Minnesota and Align of health.
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He is head of open fetal surgery at
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Children's, Minnesota and at the center.
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He's with us today to discuss topics that
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include the fetal care center success in treating
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My Men or M.
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Talk to. Thank you for joining us.
0:24
Thanks for having me.
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Yes. Wonderful. Joe, what... If you don't mind,
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could you please introduce yourself and tell a
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bit about your background?
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Yeah. So, so I'm Joel Lil.
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1 of the pediatric and fetal surgeons at
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the Mid midwest fetal care center in Children's
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Minnesota and Line of health.
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1 of the
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privileges that I have is not only taking
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care of
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kids and operating on kids with surgical needs
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after they're born, I get a chance to
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meet with moms and families
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to address a lot of,
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important clinical issues, prior being born, making diagnoses,
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care plans and even,
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creating interventions,
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product kids being born in that sometimes involve
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surgeries.
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So,
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for me, this is what I spend the
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bulk of my professional life doing and probably
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the thing I'm most excited about.
1:18
Thanks for that, Joe. Just to take the
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wider view for a second here,
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clearly really, someone in your position has a
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lot of things on their mind. Some of
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which you just laid out. But what would
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you say are the biggest issues that you're
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following in health for health care rather right
1:31
at this moment.
1:34
Yeah. So
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taking a step back. I mean, the answer
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to that question is kind of scale. Right?
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So
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like, nationally, it's pretty important and obvious to
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a lot of people that women's health and
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reproductive rights, especially how it affects
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our fetal care center
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are or are are big and on the
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the forefront
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for us.
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We also think about health care access and
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dollars used to subsidize
2:00
health insurance plans and their,
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continued protection nationally.
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And then we also think about payers in
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their relationship with hospitals and providers, that dynamic
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is changing.
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It seems to change
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pretty rapidly even in my career. I've seen
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substantial changes in that.
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Improved access, but it comes with other changes.
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And you can think about things that you
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really affect our region in our state.
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Healthcare care organizations and their collaborations and ability
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to recruit talent
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to,
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sort of build in, a staff
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that,
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allows them to kind of meet care plans
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and patient needs. I think that is becoming
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an increasingly
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challenging problem in the current economic climate.
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And then you know, for our state, we
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both have a huge, like,
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metropolitan urban population, but we also serve a
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substantially,
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large,
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role
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populations. So
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we focus on and think about how our
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region will address significant budget constraints and how
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these
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programs that can be built to help our
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patients here immediately,
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will be able to not only reach the,
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sort of the greater metro area, but also,
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the rural communities.
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You know, in doing so, we have to
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build sustainable and meaningful programs that are beneficial
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the parents.
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And patients and have them be cost effective
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and sustainable.
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And the other thing that we think about
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a lot here, we have a pretty diverse
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patient population
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And we always... We think about
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equity within our health care system. And I
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think that that's 1 of the things that,
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our region is trying to overcome
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the psycho social logistical and financial obstacles of
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achieving
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excellent health care
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that is sustainable
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and and highly effective for our patients.
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And then I think about, like, things, and
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I know that our center talks about this
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and many of our providers think about this.
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Our role in our center in our hospital,
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realizing that
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we have a pretty substantial role within the
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the region and to be an effective tertiary
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quan center that provides
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partnerships to
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not only our local community, but our region
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so that we can, once again, build high
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value programs that can only be found at
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these centers that can bring a lot of
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patients and resources
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together to build,
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these complex care programs. And so I think,
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we're always trying to find creative ways to
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build solutions in this space. And I think
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that that's probably 1 of our biggest local
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challenges you know, to to strategize around those
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those
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those topics
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and move and move our programs forward in
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the fetal care center is very much
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sort of a an ama of of those
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issues.
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Thank you for laying out those balances as
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for us bill. No doubt a lot of
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your peers time relate to those and how
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you go about
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addressing them, but zooming me a little bit,
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the main reason we have you on the
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podcast today. Is to discuss the midwestern care
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center and all the success we've have in
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in M and addressing that. So you understand
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you have
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the 100
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Procedure in March?
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If you don't mind, could you please trial
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procedure and how it can improve the fe
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development?
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So many years ago,
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researchers at the University of
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of, San Francisco
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began to ask the question
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how can we improve
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the life of babies with significant fetal anomalies
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diagnosed to that we could make in euro,
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and which anomalies would benefit from an
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intervention and which would still be benefited by
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early,
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post care. The idea was is that Sp
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is a disease that
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became
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kind of an important target because it was
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a non lethal disorder that affected 1 in
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3000 patients, so a pretty significant number of
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patients
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worldwide in particular in North America,
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and,
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these patients in general are all going to
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be born but formed with substantial deficits
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when you think about the procedure, you sort
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of have to figure
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and and and why we do a fetal
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intervention, you have to figure... You have to
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understand the disease a little bit. The disease
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itself affects the brain by creating swelling and
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blockages in the brain
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because of loss of cerebral spinal fluid out
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the back.
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Where the defect is seen. It causes hernia
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of,
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important contents of the brain that can compress
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on critical centers of the brain.
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The defect itself in spin of if is
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a lack of,
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proper covering of the neural elements, the spinal
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cord to the nerves of the back.
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And
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that creates also nerve injury to all the
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levels of the nerves affected at the level,
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the defect and below. So if you have
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at a defect in the, lower back, which
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is the most common to see this, you
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can have substantial deficits
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and dysfunction with bowel bladder function
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and lower extremity, motor and sensory function where
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many of these kids, the majority of these
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kits are
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wheelchair bound in their,
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pre teen and in teen years,
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we requiring
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substantial medical intervention for bound bladder programs,
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and needing multiple neurosurgery and orthopedic surgeries
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to help
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maintain
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the best quality of life for these patients.
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So what we found is in,
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the early research that if we could
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close the back of these babies, much like
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we do after they're born,
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we can,
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improve the disease project... Trajectory or the disease
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path for these patients.
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And the reason being is that not only
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do you
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stop that leakage of cerebral spinal fluid as
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it leaks out the back, but You also
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protect the neural elements from,
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being,
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injured by the am antibiotic fluid that does
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pretty toxic to
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developing nerves.
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So if we
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create a,
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a closure technique, a water closure technique to
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those neuro elements,
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between 23 and 26 weeks, what we see
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is a significant improvement
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in the disease
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progression of these kids. It doesn't cure the
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disease, but it greatly am the disease.
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So the surgery is done
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now a couple different ways.
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Initially, it was done through,
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like, a lower abdominal typical c section incision
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where we would open up the abdomen a
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bomb
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and expose the uterus and find a place
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on the uterus a safe distance away from
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the placenta
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and create about a 6 to 8 centimeter
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opening in the uterus to expose the back
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of the baby and then in multiple layers,
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close the back of the baby, then close
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the uterus, close moms
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abdominal wall and let the baby
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continue ge dating for another
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10 to 13 weeks.
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We've since advanced our approach
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and
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begun doing things through a minimally invasive approach
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or ph approach where we can do all
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the same exact closure techniques, but through small
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little 5 millimeter incision, 3 of them, through
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the uterus.
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That ema a lot of the morbidity and
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potential morbidity for mom
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in future pregnancies
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and allows for moms to continue on their
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pregnancy and have at vaginal delivery whereas the
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open
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incision on the uterus means that mom needs
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to have a a future C section,
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and all future pregnancies need a c section.
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And when we do this, we know is
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a population of patients,
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we take and we improve their shu rates
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the need for draining that fluid from the
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brain,
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we reduce it substantially.
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And sometimes as much as 4 fold reduction
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in shu rates. We can
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improve dramatically the high brain hernia rate. We
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improve neuro scores or Iq scores and functioning
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we have substantial improvements in bladder program,
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or bladder function.
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And then we have... We doubled the number
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of una
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una
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in this patient population. So we were taking
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kids that would otherwise be severely affected needing
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assisted in their ambition, whether it's crutches or
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thought braces, where been wheelchairs, and we're doubling
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the number of kids
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who don't require any assistance in.
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So we're improving their life significantly.
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So that's that's the reason why we do
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it, that's kinda how we do it.
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And we're always looking as a as a
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as a field to improve
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not only the procedure decreasing the the risk
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to mom and baby, but to also improve
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our outcomes.
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Wow, doctor. This is just incredible that this
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procedure even exists really that you're able to
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improve children's lives in such a way before
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they born.
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Right looking ahead,
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now that you've seen that this procedure is
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successful
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what do you think might be the next
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evolution of treatment in this area?
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Well, for Spine, in particular,
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I think that
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understanding the path physiology or how spin
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develops,
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being able to prevent it or treated even
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earlier so that we can have improved outcomes.
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And treatment earlier, I think may involve non
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surgical means for treatment or even more minimally
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invasive means for treatment.
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And I think this is a hugely interesting
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topic thinking about providing coverage to those neural
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elements through
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cell based therapy approach that could be delivered
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with just a simple needle,
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instead of needing a more complex surgery, or
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thinking about how to,
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prevent
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the molecular mechanisms that lead to
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the
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the spin of bi defect itself. So I
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think that's the future for this. But I
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think in general,
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being able to do fetal surgery for by
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open the door
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to fetal surgery in general, being able to
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teach us how to not only perform the
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surgery as a field
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but also expand the number of
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potential diseases and targets that would benefit from
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fetal surgery.
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So now we do fetal surgery
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for other indications, sometimes,
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very large and impactful tumors that would be
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otherwise fatal for the fe us.
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We do fetal interventions for, a number of
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other
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indications such as twin pregnancies that,
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have un unbalanced sharing of blood,
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So there's a number of other indications that
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have really grown out of this, early fetal
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surgical experience. And I hope to in the
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future that we're able to target more fetal
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anomalies
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so that we can improve outcomes for patients
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and families, but also reduce the burden of
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health care costs within the system.
13:03
Here's hoping a lot of those treatments that
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you mentioned, Doctor are going to arrive sooner
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rather of than later although See there's a
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lot of research and work to be done
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before that happens. Lastly, I simply wanna ask
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you as someone who is a leader in
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health
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What do you think leaders needs to be
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successful in the field in the next 2
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to 3 years?
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Yeah. I so, you know, I think about
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how even
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25 years ago, when when I thought about
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science and medicine,
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a lot of work was happening
13:33
still in silos and
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people competed with programs,
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and they looked at how they could advance
13:41
a particular area
13:43
or a particular field, but in a very
13:45
limited way.
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I think we're at a point now we've
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seen so much advancement in technology and our
13:51
knowledge that
13:53
healthcare leaders need to... From a science standpoint,
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be able to integrate the knowledge that we're
13:58
developing between different fields, get out of our
14:00
silos and be able to integrate
14:02
usable solutions for patients. So basically translate our
14:05
research to usable results to our patients. And
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I think you you all take that same
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theme from science and you apply it to
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the strategy of the business of running a
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hospital in a healthcare care system,
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patients need integrated care plans. And
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this also solves a second problem, which is
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to do things in a sustainable way. We
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need to have high value, high quality
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care plans and care programs for patients that
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can address
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a number of different patient populations
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And I think that if we do that,
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we'll be able to be able to to
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deliver
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these really complex care solutions and plans in
14:44
a sustainable way rather than in a competitive
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or 1 off way that isn't very sustainable
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or really in the interest of program billing
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in collaboration, which is what our parent patients
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demand of us.
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Doctor Thank Being so generous through time and
14:59
insights today. We absolutely cannot wait to share
15:01
them with our audience, and we look forward
15:03
to connecting with you again soon.
15:05
Alright. Thank you so much. Appreciate it.