Future's so bright, he's gotta wear shades (cue the 80's music)

In Short:

Results: Newt count: 1,250  (I know, that feels low after being in the 2,000's but it's okay)

Platelets: 400 and "something" (didn't even bother writing it down - it was so perfectly normal)

Weight: 14 lbs 

Age:  3 months 2 weeks

Photo shoot while waiting (we actually were able to leave but had misunderstood what the doctor said...we were so used to waiting and waiting that it seemed normal. Whoops! But it was a good mistake, we had time to get a picture!)

Okay...so we didn't go out on a bang...but it's still a acceptable range for his age - which is anything over 1,000. I will admit - I would have preferred a number in the 2,000 range. I am fighting the voices in my head trying to bring me down - telling me, what if this is a new trend and he's dropping? What if THIS is the IVIG wearing off... what it if just took this long, I mean, they really don't know squat about IVIG and infants...

But I'm going to try to let that go... It's above 1,000 and the doctor wasn't the least bit concerned. 

IN other good news, this was the easiest visit ever. They only needed to do a finger stick (they tried the toe too, but gave up on that). He didn't cry at all - little trooper! And, I so have this whole "clinic thing" down now. I know exactly what time to leave, best parking garage, how to pack for the day... I was smart enough to have them change my appointments to 11:30 so I'm home by 2:00.

I'm a "clinic mom" now - and, the best part about today --- is that I don't have to be one anymore!!!

Our last view of UVA -for forever we hope! 

Yep. We are done. We are not totally out of the woods yet... that will be when he turns 6 months old and reaches that age with no issues. Until then, if he were to get a fever we would do a CBC and watch him closely. But otherwise he has convinced the doctors that it was indeed an maternally-given antibody issue that is resolved now.  He does not need to have regular CBC's anymore!

And just to be clear, these were "IgG antibodies" which are a type that only cross the placenta. They not passed over to the baby via mom's milk (I know some people have, very legitimately, wondered this - since it is well known that breast milk is full of useful, non-destructive antibodies... but, no, he only received the "newt-destroying" antibodies before birth via the placenta. After birth, once the antibodies "die off" that's the end of them in his system).

Praying just before we got in the elevator...

I have the highest respect for the doctor who saw us at clinic every monday and for the doctors that cared for us at UVA when we were living there. We were in good hands - I'm so grateful for that. Now the plan is to never see them again... I hope we can stick to that!

(His band-aid fell off and it was almost enough motivation for him to reach a new milestone of rolling over. You never know what your kids will find interesting, but you can bet it often won't be the toy you bought them!)

  

Arthur continues to be a joy in our household - he is so full of happiness and such a talker in his own crazy way (it's more like loud squawking and squealing than cute litte-baby babble)! He is growing quite well as you can see, weighing in at 14lbs. He is doing the opposite of his big sister. Lillian is in (possibly below) the bottom 15th percentile and he is in the upper 15th on the growth chart. It's great and all, but wow, he is a work-out for me considering (girth-after-third-child not withstanding) I'm more like Lil...not sure I make it on the chart.

That's it for today...going to work on a post I've been wanting to write about his name...and another one that will be a quizz - can you tell Arthur and baby Lillian apart?

Oh...how I need to get to both big-sisters' blogs - so much to share there... but for now, this little brother has been stealing the show.  (BTW, LOVE my shirt Heather and Ian - thank you!)

For every show of support, all the care extended, the prayers, and all the baby-gifts (thank you cards are coming, I'm just slow...) - thank you!!!!



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Notes for myself (further reading if you are interested...):

About Neutropenia:  http://www.neutropenia.ca/about/what-is-neutropenia

Isoimmune neonatal Neutropenia

Analogous to Rh hemolytic disease of the newborn, isoimmune neonatal Neutropenia results following maternal sensitization to fetal neutrophil antiogens during gestation. Antibodies freely cross the placenta, destroy infant neutrophils, and predispose these affected children to serious infection. Commonly cutaneous infections are seen but, occasionally, respiratory tract or urinary tract infections occur. Bone marrow evaluation usually shows a relative myeloid hyperplasia, with an unusually decreased number of mature neutrophils. Often, a specific maternal neutrophil antibody is identified that reacts with the father's neutrophils. Most commonly, antibody is directed against paternal NA1 or NA2 which is inherited by the fetus. Since the half-life of circulating maternal IgG is approximately 7 weeks, the child's Neutropenia usually resolves by about 2 months of age. Antibiotics serve as the foundation of treatment of this disorder. In seriously ill neonates, transfusion of maternal granulocytes might be considered.

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http://www.blutspendedienst-west.de/ueber_uns/zentren_einrichtungen/leukozytenimmunologie_eng/nin.php

Neonatal immune neutropenia (NIN) (1) is due to maternal neutrophil antibodies binding to paternally inherited antigens on fetal neutrophils. ...

Clinical findings. NIN can occur in the first pregnancy which might be the result of a transplacental passage of the mobile neutrophils into the maternal circulation. Allo- and isoimmunization to neutrophil antigens occur in about 0.4 %, but the incidence of NIN is below 0.1%. In utero the fetus is protected against bacterial infections. After birth, NIN has a diverse clinical presentation, ranging from no infections to reported fatalities of up to 5% associated with overwhelming septicaemia. However, infections of the navel (omphalitis) and the skin predominate. 

Typically, affected neonates present absolute neutrophil counts of less than 500 per µl, and neutropenia resolves within 11 weeks, but can persist as long as 28 weeks...

Since NIN is a self-limited disorder, symptomatic and prophylactic treatment with antibiotics is usually sufficient. In severe cases, the granulocyte colony-stimulating factor (G-CSF) has been successfully used to increase the neutrophil counts although resistance to G-CSF has occurred due to anti-HNA-2 isoantibodies (2). On the one hand G-CSF resistance can be the result of reduced neutrophil production in the bone marrow as HNA-2 expression begins very early in myelopoiesis, on the other hand, G-CSF causes increased HNA-2 expression on the neutrophil surface promoting antibody binding and phagocytosis by macrophages. In these cases high doses of intravenous immunoglobulin (IVIG) might be an alternative although ineffective IVIG treatment of NIN has been repeatedly reported.

Neutrophils (aka polymorphonuclear cells, PMNs, granulocytes, segmented neutrophils,  or segs) fight against infection and represent a subset of the white blood count. Neutropenia by definition is an ANC below 1800/mm3 (some sources use a lower value).  http://www.globalrph.com/anc.htm

Normally the ANC is above 1,500 (1,000

in children less than 2 years of age)

http://www.bcm.edu/pediatrics/documents/4120.pdf


http://www.blutspendedienst-west.de/ueber_uns/zentren_einrichtungen/leukozytenimmunologie_eng/nin.php


http://docsadviceformothers.blogspot.com/2012/10/omphalitis.html
Some babies are born with low white blood cell count because maternal antibodies are attacking their white blood cells. This condition is known as NEONATAL ALLOIMMUNE NEUTROPENIA. Because white blood cells fight bacteria, their decreased white blood cells in the blood render these newborn easily susceptible to infection such as OMPHALITIS.