Tiny patient… Big results

A 24-week micropreemie recently became the smallest patient to have neurosurgery at Memorial Hospital in more than a decade. Daniel Fulkerson, MD, one of four board-certified pediatric neurosurgeons in Indiana, is helping Beacon’s pediatric patients and families stay close to home for care.

Bud Smith was born by emergency C-section on June 3 at St. Anthony’s Hospital in Michigan City. With bleeding in his head, a risk when babies are born so early, Bud was transported after just a few days to Beacon Children’s Hospital. Beacon’s NICU team determined the baby would require surgical intervention to address his developing hydrocephalus, or accumulation of spinal fluid on his brain. In the past, patients like Bud and their families typically transferred to Indianapolis, Chicago or Grand Rapids for such procedures.

Laura Smith, Bud’s mom, was thankful Dr. Fulkerson could perform the surgery at Beacon, where she had become close with the staff. Laura stayed at the Ronald McDonald House so she could be with Bud every day, as opposed to driving back and forth from Michigan City. “The nurses became my family after awhile, and they took such great care of Bud,” she said.

Before adding his first surgery at Beacon to the schedule, Dr. Fulkerson held meetings with clinicians to discuss special considerations for the operation. Bud was brittle at 29 weeks gestation and he weighed less than two pounds. It would require special surgical instruments, namely the little catheter, and other adjustments and changes. The NICU team worked very closely with the ICU team. “We’re dealing with really small IVs, and ventilators might provide breaths at a rate of 10 to 12 breaths a minute for an adult, but a child needs more like 60 breaths a minute,” said Fulkerson, who practices at Beacon Medical Group North Central Neurosurgery.

On the day of the surgery, Dr. Fulkerson inserted the small catheter in Bud’s fragile head to drain the spinal fluid present. Two months later, when Bud reached 36-weeks gestation, Dr. Fulkerson replaced the catheter with a permanent shunt to siphon off extra spinal fluid. “He’s done great since,” said Dr. Fulkerson, who is one of only about 140 pediatric neurosurgeons in the country. His mission is to keep as many kids at Beacon as possible, as opposed to having them transferred to other hospitals. “We want these kids to stay locally whenever possible, because transferring can mean a hardship on the family.”

“Time often matters in these cases,” he said, “so handling a case four hours sooner than a helicopter ride is a big deal.”