Critical Difference Stories: Birth
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The Tayton Richardson Story

Hello - Goodbye
When you become a parent for the first time, your world becomes a series of “firsts;” the first diaper change, the first 2 a.m. feeding and the first smile. But Angela and Tyler Richardson never envisioned the birth of their first child would also include a medical first.

Angela had a normal, healthy, pregnancy and delivery at Mercy Medical Center, but the situation changed within minutes after Tayton’s birth. Instead of greeting the world with a characteristic cry, the newborn boy arrived with silence. While he appeared healthy at first, it quickly became apparent he was struggling to breathe.

Tayton was laid on Angela’s tummy for a brief introduction, and then rushed to the nursery to receive oxygen. Tayton was still receiving oxygen when his collapsed lung was discovered. The baby’s chest was filling with air from the malfunctioning lung, and a needle was used to draw-out the air from the infant’s chest cavity. After the needle-drain was required again, the Saint Alphonsus neonatal transport team arrived and inserted a small tube into Tayton’s chest, beneath his ribs and near his lungs, to release the unused air, allowing his lung to inflate.

It was clear that the newborn required more specialized care than Mercy Medical Center could provide. But only a few days earlier their staff had learned about a new neonatal treatment for situations such as this available at Saint Alphonsus Regional Medical Center – that’s where he needed to go. Tayton was returned to his mother for his second brief visit, all the while fighting for each breath. He had been sedated for his trip, and he lay motionless next to Angela - the exhaust tube protruding from his chest and the breathing tube sustaining him. The young mother kissed her baby goodbye and Tayton was off to Saint Alphonsus.

A Cool Plan
After his 20-minute ride to Boise, the newborn arrived in critical condition at the Saint Alphonsus Level III Neonatal Intensive Care Unit (NICU). Neonatologist Jennifer Merchant, MD, was called in to care for baby Tayton, and after her examination of the boy, she went to speak with Tyler, waiting anxiously nearby.

Tayton's lung was improving, but there were other, more serious risks that needed to be addressed. Tayton’s lack of breathing following delivery limited the amount of oxygen absorbed by his blood, which in turn, reduced the oxygen supply to his brain, a condition that occurs in approximately 1 in 1000 births in the United States. Depravation of oxygen in a newborn during or after delivery increases the risk of permanent brain damage, including cerebral palsy, mental retardation and epilepsy. Until recently there was little that could be done to reverse or reduce brain injury which evolves after the condition is diagnosed. But neonatal medicine, borrowing a page from cardiac medicine, has introduced the use of induced hypothermia - intentionally cooling the body.

The protocol involves quickly reducing the infant’s body temperature to approximately 92.3 degrees Fahrenheit for 72 hours, and then gradually increasing the infant’s temperature to normal. Cooling temporarily reduces brain metabolism, during which time the brain’s need for oxygen is also reduced and other secondary deleterious effects of hypoxia can be reversed. The result is an improved chance for normal neurologic development. Candidates for this treatment must meet strict criteria, and the cooling must be initiated as soon as possible. Neurological examinations are performed before the procedure, and the baby’s brain activity is closely monitored during the cooling period. Brain imaging is performed after the cooling procedure to aid in long-term prognosis.

A New Baby Blanket
After Dr. Merchant described the procedure to Tyler, he responded without hesitation. "I want you to do whatever you have to for my baby," Tyler said. Having received the father’s approval, Dr. Merchant was about to break new-ground in neonatal care in Idaho. The full-body cooling protocol on infants had been performed in only a handful of hospitals across the country, and never before in Idaho.

Dr. Merchant used a special infant-sized cooling blanket to quickly reduce the newborn's temperature. Tayton had already started to cool when Angela arrived at Saint Alphonsus. Fighting a mother's urge to pick-up her newborn, Angela looked in awe at the web of wires and tubes connecting Tayton to the collection of devices surrounding his tiny bed. "He was still, but he looked peaceful," Angela recalled.

The Right Time
The revolutionary procedure had accomplished its objective and Tayton was ready to begin the slow warming process. When breathing assistance was finally removed from Tayton, he was able to breathe without assistance for the first time.

It had been four days since Tayton's birth, and his parents were about to hold their baby for the first time. Having survived his first crisis, which occurred during the first week of his life, and after becoming the first newborn to undergo an important new medical procedure, Tayton went home…for the first time.