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Sydney, 15 months

Richmond | Services: Pediatric Intensive Care Unit (PICU), Neurology, Nephrology, and Emergency Medicine

When Dreams Become Reality

It’s every mother’s nightmare to find their child unresponsive in the middle of the night,” said Melissa Kalman. For Melissa and her husband, Noah, that nightmare became a reality last March when they found their 3-month-old daughter, Sydney, in her crib after being awakened at 3:30 a.m. by cries from Sydney’s twin sister, Zoe.

“Sydney was blank,” Melissa recalled of her daughter’s distant stare, grayish coloring, unusual breathing and unresponsiveness. “We didn’t know what was going on.”

Noah, a radiation oncology resident at VCU ealth, knew Children’s Hospital of Richmond at VCU (CHoR) would have the specialists Sydney needed. While he stayed home with Zoe and their older daughter, Harlow, Melissa and a friend rushed Sydney to CHoR’s emergency room.

Although Melissa admits her memory of the night is “foggy,” she said she felt like she “was in the ER for hours” and remembers being “really scared when Sydney wasn’t even crying” while getting an IV.

After undergoing multiple blood tests and a nebulizer treatment to help her breathing, Sydney’s lab results came back showing elevated white blood counts and reduced liver and kidney function. She was admitted to CHoR’s Pediatric Intensive Care Unit (PICU) with acute kidney and liver failure.

Searching for a Cause

Despite spending a few days in a neonatal intensive care unit (NICU) to gain weight after her November 2014 birth, the first three months of Sydney’s life were relatively uneventful. Diagnosed with an ear infection and nasal congestion in mid-February, she was taking medications and had eaten less than four hours before Melissa and Noah found her on March 1.

After being admitted to the PICU and over the next 12 days, Sydney saw specialists from nephrology (kidney care), neurology, cardiology, gastroenterology, infectious diseases and genetics, continued to undergo tests including a CT scan, EEG and MRI, and received two central lines, one that required her to undergo anesthesia, that were used to administer medications. Because of her kidney failure, she needed one round of dialysis, and as a result of her liver failure, she experienced a brain bleed that caused seizures. She also received blood and clotting factor transfusions.

Throughout Sydney’s inpatient stay, Melissa or Noah never left her side, taking turns staying at the hospital and at home with their other daughters. Melissa said she held Sydney as often as she could (“which was always difficult because of all the cords and wires coming from different places”), played music, sang and decorated Sydney’s hospital crib with pictures of Zoe and Harlow.

“For the first few days, Sydney would glare off and wasn't really ‘present,’” Melissa recalled of her usually bright-eyed, smiling little girl. “It was sad and terrifying. And without any answers in terms of why this was happening and when it would get better, it would just eat away at my insides. As a mother, all I wanted to do was make it better.”

As she waited for answers, Melissa said she appreciated the accessibility of nurses and doctors who took time to explain what was happening and what the next steps were in Sydney’s care. But even with the thoroughness of CHoR’s specialists, Melissa said doctors told her “there was a possibility we may never know the cause.”

Making Progress

After leaving the PICU, Sydney was transferred to CHoR’s Acute Care Unit, where she was re-evaluated by neurology specialists for “alterations in her level of consciousness,” said Lawrence D. Morton, MD, Chair, Division of Neurology, and Chief, Clinical Neurophysiology. “When the kidneys aren’t working well, it can interfere with mental status.”

Melissa and Noah Kalman are happy to have their hands full with 3-year-old Harlow and 15-month-old twins, Sydney and Zoe.

Dr. Morton determined Sydney’s symptoms were caused by seizures from her brain bleed, and he prescribed anti-seizure medication. He also coordinated her treatment with other CHoR specialists and communicated with her community pediatrician about her care.

“The number of specialists on-site at Children’s Hospital of Richmond at VCU helped stabilize Sydney in her first 48 hours,” Dr. Morton said. “The outcome may not have been the same if she hadn’t been here and if the specialists, particularly nephrology and the PICU, hadn’t been so attentive when Sydney developed new neurological complications.”

Sydney spent 12 days at CHoR and has been followed by Dr. Morton since discharge. In December, after showing no signs of additional seizures, she stopped taking the anti-seizure medication but will continue to see Dr. Morton on a less frequent basis.

Because Sydney’s brain hemorrhage damaged part of the right front portion of her brain, the part responsible for organizational skills and inhibition, she may have challenges with attention span when she’s older. However, because of her young age and the ability of the left side of her brain to compensate, Dr. Morton said he expects Sydney to continue to meet her developmental milestones.

A Bright Future

Sydney’s big brown eyes light up when her parents or sisters enter the room. She loves being read to as much as she enjoys pushing a toy while preparing to take her first unaided steps. And although doctors never determined a definite cause for her kidney and liver failure, Melissa and Noah were so pleased with Sydney’s care that they asked family and friends to make donations to CHoR’s PICU in honor of all three girls’ birthdays last fall.

“Every day I’m so thankful and grateful she’s here,” said Melissa, who is thrilled to have her smiling, active daughter back. “It’s hard to think about what could have happened if we hadn’t found her and if we hadn’t had such a strong team. The first 48 hours of her care were critical, and the PICU staff from Dr. Bain to Drs. Lo, Xiao and Bunchman from nephrology saved Sydney’s life.”

“I couldn’t have been happier with the care we received,” Noah said. “All the resources, specialties and expertise at Children’s Hospital made a big difference in her recovery.”

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