Tackling unanswered questions in the care of newborn babies

Aaron Hamvas, M.D., finds challenge and satisfaction in helping infants survive and thrive outside the womb

For more than 10 years, Aaron Hamvas, M.D., associate professor of pediatrics, has been treating newborn babies -- helping them survive and thrive in a world outside the womb. Many of these newborns are born with an array of problems, from life-threatening infections to debilitating physical defects to immature organs that cannot function without technology. And although one might think Hamvas has encountered most problems and can foresee how babies will do, his experience has been the opposite.

"The longer I do this, the more I've become humbled in terms of the ability to predict outcomes," said Hamvas, also medical director at St. Louis Children's Hospital neonatal intensive care unit. "I keep reminding myself of this every time I'm dealing with a difficult case that looks hopeless. I'm now following many children several years old who seemed hopeless at one point and now are doing just fine."

In the field of newborn medicine, or neonatology, hosts of questions about development, diseases and technology remain unanswered. Although frustrating at times, this aspect is the one Hamvas enjoys most. "I like having the ability to identify a problem, ask a question and use the resources of this environment to come up with an answer that will benefit the patient," he said. "I like the intellectual challenge."

Hamvas' problem-solving skills make him a great clinician, said F. Sessions Cole, M.D., professor of pediatrics and director of the School of Medicine's Division of Newborn Medicine. "Not only are his opinions sought by many health care providers at the Medical Center, they're sought by clinicians around the world," Cole said.

Hamvas is respected for his perseverance as well. "He never gives up when working on a problem or an idea," said Vijay Nama, M.D., assistant professor of pediatrics at Saint Louis University, who was a fellow in Hamvas' lab for two years. "If he wants to do something, he'll do it."

Newborn lung diseases

In 1991, Hamvas, working with former colleagues Harvey Colten, M.D., and Lawrence Nogee, M.D, helped identify pulmonary SP-B deficiency. After a full-term baby at St. Louis Children's Hospital died of respiratory distress, a medical history showed that the mother had given birth to a child who had died from the same problem 18 years earlier.

Colten and Nogee identified the specific genetic deficiency so that physicians now can diagnose this disorder definitively using amniocentesis or by taking a blood sample after the baby is born. Early identification of the disorder allows for the necessary arrangements for treatment at birth with a lung transplant.

Hamvas has been at the center of the clinical care of SP-B deficient infants facilitating the diagnosis, developing strategies to stabilize the infants for lung transplantation and understanding the long-term outcome of these infants following transplantation.

Hamvas and Nogee, now associate professor of pediatrics at Johns Hopkins University School of Medicine, still collaborate on pulmonary SP-B deficiency studies. Nogee said Hamvas has an excellent understanding of clinical medicine and clinical issues as well as of science. "He has an ability to see the big picture and to get the questions answered," said Nogee, who described Hamvas as quietly effective. "He's also very unselfish in terms of putting patients first instead of his own agenda. He doesn't make a big deal or fuss -- he gets things done without a great deal of fanfare."

Aaron Hamvas, M.D., and his patient Daniel Johnson, 17 months, who was born prematurely.

Hamvas relishes the many facets of his job -- clinical, educational, research and administrative. But during his medical training, he didn't know he wanted to go into academic medicine. And as a young child, he dreamed of becoming a professional violinist.

Hamvas spent his childhood in Yankton, S.D., a small college town in the southeastern corner of the state. His father made his living as a music and piano professor; his mother was a nurse. Hamvas, the oldest child, discovered the violin as a 5-year-old and now plays in a folk music group at his synagogue.

He became interested in medicine in junior high, when he had surgery on his hip. His orthopedist had a great bedside manner and explained everything in great detail. So he chose medicine over music before college, setting his sights on orthopedic surgery.

"Although I loved the violin, I thought the career options as a violinist would be fairly limited," he said. "Plus I believed I'd have more daily challenges with medicine." He'd always liked science, he added.

After receiving a bachelor's degree from Rensselaer Polytechnic Institute in Troy, N.Y., Hamvas entered Washington University School of Medicine. During an orthopedics rotation he decided the specialty wasn't right for him.

He became fascinated by a different specialty that commanded a broad field of knowledge. "Pneumonia in a 5-year-old is different than in a 6-month-old which is different than a newborn. I was intrigued by the many aspects of development, of disease and of the developing child's response to the disease," Hamvas said.

First encountering neonatology as a resident, he also was struck by the unique challenges of the field: the physiology, how organs in a premature baby function outside the womb before they are meant to; the technology, how physicians can apply physiologic principles and get immediate responses in an effort to help the patient; and the ethical issues involved in care.

"I thought it was the field where you're able to use all the resources you've accumulated over time and apply them in a real-life setting," Hamvas said.

Special resources

Being a parent himself helps Hamvas relate to his patients' families. He and his wife, Paula, a social worker for an employee assistance program, have three daughters. Ann Lesley is a freshman at Lake Forest College near Chicago, and Corrine is a senior and Lauren a sophomore at Ladue High School. The family enjoys hiking, biking, tennis and float trips together. And for the past three summers, Hamvas has been a volunteer doctor at Camp Ramah in Wisconsin, where his children have been campers.

Hamvas said he enjoys the variety in his life as well as in his job. "I want to come to work every day because I don't know what's going to happen," he said. "I like knowing there will be some sort of intellectual challenge to be dealt with during the course of the day."