Calvin Sawyer of the iowa city lundbergs

4498 grams

54cm

blood ph 6.97

Liz and I have a son, and Prudence has a little brother. His name is Calvin Sawyer. He was born in the wee hours of July 27, at UIHC, by his heroic mother, his father, their doula, and a dozen other people we never imagined we would ever meet.

At birth, Calvin required resuscitation and had low oxygen levels. Liz had complications after delivery as well. We expected some possible complications with Liz, but were not prepared for the interventions Calvin would require to take a breath of air, and then protect his brain. There was evidence that Calvin had sustained a type of injury called HIE, and the possible outcomes range from nothing at all to serious disabilities or death.

Hypothermia Treatment at NICU

In cases of likely brain injury, scientists have found that inducing hypothermia within six hours of birth improves outcomes. When deprived of oxygen, the body begins looking for energy wherever it is available. It will detonate those cells and release that energy to be used elsewhere.

The cells then degrade and release harmful cellular instructions to the surrounding cells as they die, and this process can be halted and altered by lowering the body temperature. The goal is to allow the brain to reboot and restore before the secondary degradation of cells is fully underway. It's why you read about sledding or ice-fishing accidents where people are getting pulled out of the river after being trapped under ice, and miraculously recovering.

"Clinical and experimental studies have demonstrated that neuronal death occurs in two phases following a reversible hypoxic-ischaemic global insult."
"Therefore, a therapeutic ’window of opportunity’ exists in the interval following resuscitation of the asphyxiated newborn before the secondary phase of impaired energy metabolism and injury (Gluckman 1992;Lorek 1994;Penrice 1996)."
Liz out of OR, Calvin just chillin'

Blood gas levels and Ph determine the probability of damage to the brain, and Calvin was also put on an EEG to monitor for seizures. His physical and physiological condition improved quickly; muscle, motor, and his pupils responding to light and movement. His hearing appears normal as well. There may have been a brief seizure recorded of 10 seconds, but similar recordings occurred during later hiccuping so it's hard to know. Regardless, medical staff are more concerned by longer durations lasting several minutes.

Still on cooling mat.

The hypothermia protocol is 72 hours, and then warming begins. This is where many infants begin having more seizure activity as their brain "starts up" again.

Here comes the sun

One the morning he started the warming procedure, it was a warm sunny morning after a few days of thunderstorms and menacing clouds. I interpreted this as a Good Omen, much like the butterfly slowly working it's wings on the mirror of my mother's car.

Mundane things suddenly taking on prophetic qualities
Mrmph?

Liz and I sang "Here Comes the Sun," softly to Calvin to commemorate the start of the process.

Warming went well, no seizures, which wasn't expected by the Neurologists. It's very common to have seizures and they were expecting them to occur. They had suggested the possibility of using seizure medication prior to warming to control them but it seemed better to wait and see if he actually had them first rather than give him medicine that may not be needed. The neuro team wasn't winning me over, which is doubly frustrating considering they have a crucial role yet to come. Most of them have the bedside manner of a diesel mechanic that just realized they will be getting that new boat after all.

After Calvin bravely assumed normal body temperatures that evening, and the neurology team accepted that he wasn't having seizures, they had the EEG leads removed. We got to hold him.

Hellooooooo Calvin!

He has been sedated off and on and dozes quite a bit. He has talkative jibber jabber with the night nurses quite a bit so I guess that means he's a bit of a night owl right now. His food intake is steadily growing and all organ function seems to be normal neonate behavior.

We are decidedly adorable guys

So, what next?

Here's arguably the most infuriating part: By all accounts he is doing great. He appears great. He is doing all the baby things. He has given no curve-balls or had severe issues once he began hypo, the only remaining question is: how is his brain?

The best way to determine the current state of his brain is to do an MRI, and there are a few developmental windows that they avoid doing tests like this because they conceal issues, or essentially give a false negative. So we wait, and hope he can have some Imaging done this week and we are also being told that this isn't conclusive or perfectly illustrative. Our expectations are being heavily managed at every opportunity and part of that is the medical staff and doctors really don't have the experience with outcomes for this type of case beyond knowing that the hypothermia treatment will improve things for him considerably.

Keep sending Calvin and our family positive feels, we were really looking forward to nesting and bonding and we haven't been able to really do that yet. Everything feels up in the air and uncertain in dozens of horrible ways, but we try to maintain positive goals on the horizon as our focus.

Napping Saturday morning, Day Six

If you would like to do something nice for us, if you or someone you know has been through this process with a positive outcome, I would love to hear from them. Consider this my volunteering to be that person for you should you ever need it. It is a very rough stretch of road.

Probably gas. Or a funny dream. ;)

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