The issues affecting you. Revealed. Explained. Discussed. Now on WGAL eight InFocus. Hello, I'm Susan Shapiro. March is brain injury awareness month. According to the Brain Injury Association of America, at least 64 million adults say they had at least one traumatic brain injury in their lifetime. The association also says prior brain injury and head trauma have been linked to development and neurodegenerative diseases and other conditions, including Parkinson's, Alzheimer's and depression. Tonight, we'll meet a five year old boy who had four intracranial brain hemorrhages due to a birth injury. We'll learn about his treatment and speak with his doctor. We're putting brain injuries in focus. Joining us now are Tara and Colton Kis of Millersville, Lancaster County. Thanks so much for being here. Thank you for having us. Colton was born in March of 2020. That was certainly some time. We all remember the height of the pandemic. What was that like? he was actually born that Monday. Everything shut down. So he was born right when everything got crazy. Yeah, that must've been a little crazy, that's for sure. And nothing has stopped being crazy. Now, Colton was delivered with something known as vacuum extraction. Why did that have to be used? So the vacuum extraction is one way that they use. It's a birth tool. Like they also have forceps. the vacuum extraction was used because Colton's heart rate kept dropping to critical levels, and that there was no more time to wait to get him out, and it was too late to do a C-section. Did you know anything about that? And the fact that you had told me earlier, you actually, as many people do, you sign a paper and you agreed if that was necessary to do. Yeah. So around 18 to 20 weeks at your prenatal visits, they actually give you a paper and a sign, at least with my OB. And it asked you if you consent to the use of forceps in the event that they would need it. And I signed the paper, but I didn't know what all that entails. Like, I've heard of the vacuum extraction and I've heard of the forceps being used, but I never heard of anybody having any problems with that. Like, I don't know of any problems that could have happened until after it happened. You didn't know about the possible risks. What did happen? What caused the brain injury? So what happened with Colton is once they used the vacuum to extract him out, it actually calls for intracranial hemorrhage in his brain. And what happened with that is the suction of the vacuum or in the back of his head. When babies are born, their skulls aren't closed yet. And what happened with him is the section of the vacuum actually bursted. His blood vessels in his brain. Wow. Oh my gosh. And that must have been frightening for you to hear about that. It was. But at the time we didn't know what had happened until about 12 hours later when he was in the nursery, I was woken up by one of the nurses. The first thought that he had sepsis, which is a blood infection, and they told me that they're going to start him on antibiotics and just see how it goes, because he was having seizures. And I think it was maybe four hours later, they came and told me that they did a scan, and they found what they thought at the time was brain cancer, a brain tumor on his brain, and that he had to be transported to chop. we got to chop. And when they did the MRI, they actually found out it wasn't a brain tumor. It was a pretty big blood clot on the base of his cerebellum. And it was so big, it was blocking flow of his fourth ventricle in his brain. In addition to the four brain hemorrhages, he had two in the front and two in the back. Wow. Oh my gosh. That's a lot to take in for your first baby. Yes. Thank goodness. he seems like he's doing very well now. you know, how has that affected him long term? he is doing better now. So the cerebellum controls movement, balance and speech. So where his damages, it is mostly affecting his right side. So he does have problems with his balance. which he is in RTE for. So we're working now on being able to do stairs without holding on. And he is starting kindergarten. So we're practicing carrying things on trays for when he has to like carry his lunch tray and stuff like that. We want him to be able to walk without falling. it's mostly when he's tired now, which is mostly to the end of the day. He'll get pretty clumsy and fall a lot. he does sometimes still have tremors with his hands when he is either trying to focus or, like I said, when he gets pretty tired. But other than that, looking at him, he's doing so well you wouldn't know anything is wrong. How are you doing, Colton? How are you? Good. What do you like in school? Buddy, what do you like in school? Do you like your friends? Do you like playing? What else do you like to do? You like to go on the playground? Yeah, yeah. Who doesn't like that? Well, you two stay right here. We're going to talk more about his therapy and also a fundraiser that you started that. Stick with us, Colton. This is InFocus coverage. You can count on. We continue our conversation with Tara and Colton Kis of Millersville, Lancaster County. Colton experienced brain damage during the birth process. Tara, that must be so hard to deal with. How do you deal with it? We just try to raise as much awareness as we can, and I just want everyone to know, like, you have options, you're in charge and never, ever assume that the doctors and nurses know what's best for you. you are allowed to request to be checked, and you can tell them what you want and what you do not want. Had I told them to check me, he would have been fine. We could have explored other options. We could have potentially done a C-section if it was too. If it was not too late, we could have done one before it got too late. I don't know what else we could have done, but had I known he was in trouble, which we knew he was in trouble. But nobody did anything to, like, try to prevent it. Why do you think that happened? That they didn't check me? Yeah. My assumption is because he was my first baby. And everybody assumes that because it's your first baby, that it doesn't progress as fast as it could progress. But it didn't. I was stuck at one centimeter for over six hours before they started the pitocin. So me, I'm just assuming once they started the pitocin, I just dilated and progressed sooner than anybody expected to. they actually told my mom to go home because it probably wouldn't be until the next morning delivery. And it happened an hour and a half later. So I think they just didn't know it was happening, but they should have known it was happening. So this will be a long term, lifelong impact on Colton. he seems like, as we said, he's doing pretty well. what does he have to do on a daily basis in terms of therapy and physical therapy itself to patients? Therapy, where actually we graduated from speech. He does do, speech through IU 13 just to keep him up to date with educational stuff like that. But as far as like medically with speech, he's just graduated from that. He does do physical therapy once a week, and he does occupational therapy once a week just to, help him with his strength. So where the damage on is on his brain, we're hoping that his body will strengthen enough to compensate for where the damages. And with the occupational therapy, we're hoping to strengthen his motor skills so he can tie his own shoes. And we're working on doing zippers and buttons and dressing himself. He is able to dress himself. we're still working on undressing himself, but. Well. Speech. Colton, how's your speech? I want to hear you talk. You. But I know you're going to go maybe get a toy after we finish this. What are you looking forward to getting? What's your favorite toy? Oh, I think that one. An ice cream truck and ice cream truck. Wow. What's your favorite flavor? chocolate. Orange. Ice orange. Okay, now, Tara, you you know, now we're doing a fundraiser for chop. Why is that so cool? He's turning five this year, and I thought that's a milestone birthday. the brain actually develops the most between ages three and five. So brain injury awareness month being in March and him turning five, I thought there's really no question like, we should get back to the neurology department. Doctor Agarwal is the one who saved him. So my hope is to raise as much money as we can for Chop neurology, and then we're going to take a trip down to Philly and let Colton give all the proceeds to his neurologist as a thank you. Oh, that's just so we can help other kids like Colton who need it. I'm. What's your hope for him? you know, for the future. I just want him to be happy and strong. Right? Are you brave? Yes you are. I want him to know that just because something that happened to him doesn't mean he's limited to anything. I want him to know that he can do whatever he wants to do. And if you weren't, if you didn't know or you don't know him, just looking at him, you wouldn't know that anything's wrong. So I feel like we're doing pretty well, but I just want him to know that he is a normal kid and he's been through most anybody read through a lot? Yeah. Oh, yeah. He's a great kid. Yeah. Are you brave? Yep. What do you want to say? You want to say thanks? Thanks. Well, thanks for being here, Paisley. Thank you for having us. Coming up on WGAL eight InFocus, we'll talk with an OBGYN about the risks of vacuum extraction. This is WGAL eight InFocus coverage. You can count on. Tara spoke about her experience with vacuum extraction during childbirth, and we wanted to learn more about that. Joining us now is Doctor Ellen Hancox. She's an OBGYN in Erie County. She's also a Pennsylvania medical Society Board of Trustees member. Thank you for joining us. I'm so happy to be here. Thank you for inviting me. Doctor Hancox, what would necessitate the use of vacuum extraction? So Acog, my college, the American College of Obstetricians and Gynecologists puts out guidelines and the three indications for either a vacuum extraction or a forceps delivery are either prolonged second stage of labor. So basically, mom has been pushing for a very long time. suspicion of fetal compromise, either immediate or in the near future. Like, basically, this baby needs to be delivered as soon as possible. Or the maternal resource. So mom is just completely exhausted and can no longer push out this baby. What are the risks of vacuum extraction? So a major risks are lack of success. So when you plan for a, vacuum extraction, you need to be able to immediately do a C-section afterwards. And that c section could be a little bit more difficult. after, an attempt at a vaginal, extraction, the baby could develop a hematoma, which is, blood collection, in certain parts of the head or in the brain, a hemorrhage or, increased levels of bilirubin, afterwards. And is it possible that that could cause brain damage? Absolutely. Everything that we do does have risks. And we always have to weigh one intervention versus another intervention with the risks. And the thing is, not delivering the baby at that moment could absolutely also cause brain damage. And often the scenario that got you to the point of needing to do a vacuum extraction may have been the reason for the baby to have certain deficits afterwards. It's really hard to narrow down what actually caused it, because you were in a situation where that kiddo had to be delivered right away. How experienced does the delivery the Gyn have to be with vacuum extraction? How much experience do you get with that? That's a great question. I probably did 50 to 60 of them as a resident, and Lord knows I've done lots more as an attending. there is certainly a learning curve to doing them, but once you've done them for a certain number of years, there doesn't seem to be a huge difference. And I'm in experience once you've done enough. In what case, though, would it cause brain damage? Is it done improperly, or is it just the risk of using this particular procedure? Everything that we do has risks, and essentially a vacuum extraction is a soft little cup of what most people do. And we put it on the head in a very specific location. So you need to know the babies, you know, where the kiddo is and how that baby is positioned. And then we apply some suction and then we pull. And that helps the baby come out as mom pushes. And I'm sure you can imagine, like, the suction on the baby's head and it increases pressure, on the baby being pushed into the pelvis. But of course, so does pushing a baby out with the abdominal muscles. What's the difference between using that and forceps? So they have very similar outcomes. forceps. I, I'm sure everyone understands. They're like kind of big spoons that go around the baby's head. And then the kiddos pulled out manually rather than with suction. forceps are not as commonly used anymore. I mean, they are used often to great effect, and they actually have a slightly higher risk of successful vaginal, I mean, slightly higher chance of successful vaginal delivery than a vacuum extraction. but forceps are associated with worse terrors for mom. So what we call, you know, third or fourth degree lacerations, which are tears that go into the bone, which has a much harder recovery for everyone. which is why the OBGYN community, to some degree, has moved more toward vacuums rather than forceps. You mentioned C-section. Is there a point where you wouldn't do a C-section that it's gone beyond that? So it's always a judgment call, unfortunately. And at a certain point, the baby is so low in the pelvis and so close to that opening that it's easier to come out from below than above, if that makes sense. also, you can't do a C-section instantly. I mean, you can you should be able to get into an operating room and have that C-section started within 30 minutes. That's the national standard, but that's 30 minutes. And if you can put a vacuum, a little cup on the baby's head that should be completed within size are the general guidelines. Are they really pretty successful? Yes, they're very often successful. And overall complication rates are very low. if you look, there've been a few studies out there. If you look at deaths from an intracranial hemorrhage, it's we're talking 3 to 4 from 10,000, which are actually similar to rates for cesarean deliveries. And if you look just at, hematomas or at other complications like that, the rates are more around four per thousand. But again, that's also close to the overall rate for cesarean deliveries. Doctor, thank you very much. My pleasure. And coming up on WGAL eight InFocus, we'll speak with Colton's doctor. This is WGAL eight InFocus coverage. You can count on. Joining us now is Doctor Sonika Agarwal, who's a neurologist in the division of neurology at Children's Hospital of Philadelphia, or Chop, and she is also Colton's doctor. Thank you so much for joining us. Thank you for having me. Can you describe how Colton came to have this type of brain injury? yes. So, Colton, presented to us right in the first, day or second day of life, with the condition that we call, neonatal encephalopathy, where babies are not as not awake, not very responsive. they may be having some abnormal movements, which can be seizures. And, so really you have to, look at a very broad, range of conditions, but specifically focusing on the brain. when we did a brain scan for him, he, he had had some difficulties, you know, transitioning from in utero to outside and, he did show a big bleed in the back of his brain, which we call, a hemorrhage in the cerebellum or Vermes, which is a structure in the back of the brain that controls, our, movement, coordination, posture and tone. I, it's also, causes impact on speech and language and social and behavioral. So it's one of the very common, conditions we see that impacts babies really early on, soon after delivery. And we have a specialized team, in the neonatal ICU. What we call the Nic, with the neonatology team. And we have a specialized, brain focused neonatal neurology team that, get involved in the care right away. How do you treat that initial hemorrhage? So, majority of these hemorrhages are, treated by what we call a conservative approach. so our approach mainly is when, one is figuring out what caused the hemorrhage. like, is there abnormal blood vessel in the back of the brain that caused the bleed, or was there, another like, infection or exposure or a genetic cause or a cause where the blood doesn't correlate as well and that predisposes a baby to deliver, with, and have hemorrhages around this time. Or it could be a combination of factors. So after our our immediate focus is on stabilizing the baby. So making sure their brain is getting, enough flow oxygenation on supporting their airway, supporting their breathing, and, checking some labs, to make sure that they don't have any issues related to blood population where the blood doesn't, thicken and leads to such leads. And then the second part is, doing a really good brain scan where we focus on the pictures of the brain to look at the area of injury, because once you identify the area of the injury, that really tells us what function can be affected in the short term and in the long term, and what kind of rehabilitation a baby needs. we also had some specific, MRI images, magnetic resonance imaging pictures, which are really sophisticated, looking at the blood vessels that flow around the brain and inside the brain, because sometimes you can pick up some abnormalities that could have predispose the baby to this kind of a bleed. He seems like he's doing very well. What's his long term prognosis? Yes. So he's doing really fantastic. So after the initial care, you know, it's the long term partnership with the parents and with the early intervention teams and the clinicians who are following them. So early intervention, is a team which is, working with these, children, providing them physical therapy, occupational therapy, speech and language as they grow. the first year is more of the motor milestones where they learn to roll and sit and stand. so as far as I remember, we told them, you know, in the first year when he was really getting to those skills of standing and walking balance was a big problem. He really had some problems with the movement of the head, his vision and alignment of the eyes, which again is affected by this back of the brain, really controls those functions. And when he would walk, he would stumble, he would fall. even now he can run and climb and he's so strong. But looking back, he's like a totally different child now. So, his, his mom and, the therapy teams and all the clinicians have really focused on his strengthening and tone and movement. And really, it's also, I tell families and parents, the therapy teams will be seeing you once or twice a week, but it's the parents who are their child's biggest therapy therapist, because you really have to be very consistent in promoting these developmental skills on a daily basis. And then, siblings, you know, role of sibling siblings, being around, being in a language rich environment, exposing them to really rich, language in terms of reading and music can be all these can really change the developmental outcome in the long run. Oh, well, that's great. Thank you for joining us for WGAL eight WGAL for all of us at WGAL, I'm Susan Shapiro. And join us again next Saturday night at 7:00 for WGAL eight WGAL right after NBC Nightly News. And you can watch each episode of InFocus plus Google's latest newscast, original programing, and more. Just download the very local app and stream for free on Roku and Amazon Fire TV.