Montefiore Insider - Issue 3 - January 2017

Separate but together: formerly conjoined twins Jadon and Anias Mcdonald move on to the next chapter

The twins will spend months receiving specialized rehabilitation care but will continue to see Montefiore doctors who separated them.

Nine weeks after undergoing more than 20 hours of surgery, formerly conjoined twins Jadon and Anias McDonald began the next chapter of their remarkable story: they were discharged from the Children’s Hospital at Montefiore (CHAM) to receive specialized rehabilitation care at Blythedale Children's Hospital, in Westchester, NY.

On October 14, James T. Goodrich, M.D., Ph.D., D.Sci. (Hon.), director, Pediatric Neurosurgery, CHAM and professor, Clinical Neurological Surgery, Pediatrics and Plastic and Reconstructive Surgery, Albert Einstein College of Medicine and Oren Tepper, M.D., director, Craniofacial and Aesthetic Surgery, Montefiore and assistant professor of Surgery, Einstein, led the successful separation of Jadon and Anias, who had been conjoined at the brain and skull. Although the boys experienced obstacles in the weeks post-surgery, with the support of the multidisciplinary team on the Pediatric Critical Care Unit at CHAM, they are now well enough to move on to the next stage of their recovery.

“We like to attribute the astonishing progress of these boys to two factors,” said George Ofori-Amanfo, MBChB, FACC, chief, Division of Critical Care Medicine, CHAM and associate professor of Pediatrics, Einstein. “First of all, the McDonald family and these children have shown strength and determination that is really quite extraordinary. And second, they received 24/7 nursing attention in our Critical Care Unit, and were cared for by a multitude of dedicated therapists, critical care physicians and Child Life Specialists. This is a testament to the skill and compassion of all the providers on the unit.”

The McDonald twins have spent several months in and out of the Pediatric Critical Care Unit since arriving to CHAM in February. During their inpatient stays they have required close monitoring, with focus on pain management, wound care and respiratory support. The boys experienced challenges after the final separation, including infections. Anias also developed seizures, not uncommon after surgery separating conjoined brains, which are now well controlled on medication.

Despite these challenges, both boys are breathing on their own, eating and interacting with their family. Most exciting of all to their parents and the teams involved, the boys are often smiling and are able to look at each other, play together and hug one another.

“Jadon and Anias continue to surprise us every day,” said Dr. Goodrich. “As one of my most difficult cases, we knew recovery would take time, but we are all amazed by how well the boys are bouncing back and are confident they will continue to achieve new milestones at Blythedale.”

The McDonalds are the seventh set of craniopagus conjoined twins Dr. Goodrich and the CHAM team have successfully separated with various surgical teams from around the world. Dr. Goodrich and his team at CHAM have now consulted on a total of 21 sets of craniopagus conjoined twins. Each set of separations has resulted in good outcomes with no deaths or severe morbidities. One in two and a half million live births are craniopagus and without separation craniopagus conjoined twins typically do not live past their second birthday. Since February 2016, Dr. Goodrich, Dr. Tepper and a team of expert surgical and medical providers at CHAM, have supported the complex needs of the boys and spent countless hours preparing for each of the four stages of the separation, using virtual planning and 3D printing technologies to map the boys’ conjoined anatomy and carefully plan each stage in advance.

“This is a bittersweet day for us,” said mom Nicole McDonald, “We are so proud of the strength our boys show us every day as they progress in their recovery, and we are looking forward to seeing them thrive in rehab, but the people at Montefiore have become our extended family. They have supported us every step of the way and we will miss them and this community so much.”

Now 15 months old, the boys will return to CHAM regularly for follow-up care with Dr. Tepper and Dr. Goodrich will also continue to closely monitor the boys’ progress.