DiversityNursing Blog

Written by Honor Whiteman

www.medicalnewstoday.com

Researchers have identified a signal in the amygdala brain region of young children that stimulates aversion to the opposite sex and induces interest in the opposite sex as children enter puberty.

Published in the Journal of Cognitive Neuroscience, the study challenges previous beliefs about the role of the amygdala, according to the researchers.

Lead investigator Eva Telzer, of the University of Illinois at Urbana-Champaign, says the amygdala was once believed to be a threat detector. "But increasing evidence indicates that it is activated whenever someone detects something meaningful in the environment," she notes. "It is a significance detector."

To reach their findings, Telzer and her team enrolled 93 youths aged 7-17 years to the study and assessed their attitudes toward children of the same sex and of the opposite sex. 

In addition, the researchers used functional magnetic resonance imaging (fMRI) to assess the brain activity of 52 youths aged 4-18 as they viewed same- and opposite-sex faces.

Amygdala activity wanes between the ages of 10 and 12

The team found that young children aged 4-7 years had more negative attitudes toward the opposite sex - a finding they say supports the "cooties" phenomenon, in which young children steer clear of the opposite sex with the belief that they may "contaminate" them if they get too close.

"Only the youngest children in our sample demonstrated a behavioral sex bias such that they rated same-sex peers as having more positive (and less negative) attributes than opposite-sex peers," say the researchers.

Interestingly, children of this age showed increased brain activity in the amygdala region of the brain as they viewed faces of the opposite sex. "And so we think the amygdala is signaling the significance of cooties at this developmental period," says Telzer.

The researchers found that among children between ages of 10 and 12, there was no difference in the amygdala's response to same- and opposite-sex faces.

However, they saw a significant increase in amygdala response to the opposite sex from 12 years onwards - just as children begin to enter puberty. The researchers say this may correspond with the "crush" phenomenon, in which pubescent youths become captivated with the opposite sex.

"When puberty hits, gender becomes more significant again, whether it's because your body is changing, or because of sexual attraction or you are becoming aware of more rigid sexual boundaries as you become more sexually mature," says Telzer. "The brain is responding very appropriately, in terms of what's changing developmentally."

In May 2014, Medical News Today reported on a study published in the Proceedings of the National Academy of Sciences, in which researchers found changes in cerebral blood flow levels differ between girls and boys during puberty, with such levels rising in girls and reducing in boys.

The researchers of that study - led by Dr. Theodore Satterthwaite of Perelman School of Medicine at the University of Pennsylvania - say the findings were linked to higher risk of anxiety in females and increased risk of schizophrenia in males.

"These findings help us understand normal neurodevelopment and could be a step toward creating normal 'growth charts' for brain development in kids," says Dr. Satterthwaite. "These results also show what every parent knows: boys and girls grow differently. This applies to the brain as well."

By Elizabeth Cohen and John Bonifield

www.cnn.com

Today, because of a CNN story and the generosity of donors from around the world, Kekula wears scrubs bearing the emblem of the Emory University Nell Hodgson Woodruff School of Nursing in Atlanta, where she's learning skills she can take back home to care for her fellow Liberians. 

"It's a surprise -- a young child like me who came from a very poor background coming to the U.S.," she said. "I'm thankful to CNN and I appreciate the people who made donations, and I'm thankful to Emory for accepting me to study."

At Emory, Kekula has asked for special training on certain skills, such as caring for burns, a common type of injury because children in Liberia sometimes fall into the open fires used for cooking. 

One of her instructors, Kelly Fullwood, said Kekula's an excellent student who has taught her teachers a thing or two about how to do procedures without costly equipment, as she's been forced to do in Liberia. 

"She fascinates me every day," Fullwood said. "She gets nursing. She gets what it's about."

Kekula, 23, was just a year away from finishing up her nursing degree in Liberia when Ebola struck and her mother, father, sister and cousin came down with the disease. Hospitals were full and no doctors would visit her home, so with just advice from a physician on the phone, Kekula took care of all four of her relatives at the same time. 

All but her cousin survived -- a high success rate considering that at the time, about 70% of Ebola patients were dying in Liberia.

Kekula couldn't continue her nursing education in Liberia, because the schools had closed. 

A CNN story about Kekula in September prompted donations from around the world to IAM, an organization that raises money to help African natives pay for education. 

David Smith, an associate dean at Emory's nursing school, said they accepted Kekula because they were struck by how both she and Emory each treated four Ebola patients at around the same time last year -- and Emory had dozens of doctors and nurses and millions of dollars in technology while Kekula had nobody and nearly no supplies.

"It was obvious to us that this woman was intelligent and strong and fearless," he said. 

Kekula is scheduled to return to Liberia in August. 

"These things that I have learned here I am going to take back to my fellow nurses," she said. "I love to care for people. I love to save lives."

www.sunnyskyz.com 

Matt and Danielle Davis had been married only seven months when a devastating motorcycle accident left Matt on life support and in a coma.

Given only a 10% chance of waking up, Davis told WTOC that doctors advised her to pull the plug on her husband. She recalled hearing them say, "That's what they'd want their family to do."

Danielle refused to give up on him. "We didn't really have a chance to start our life together, I wasn't going to give up."

Matt spent three months in the coma, and moved from the hospital to their home where Danielle cared for him 24/7.

Then one day, against all odds, Matt said, "I'm trying."

He eventually came out of his coma, but he didn't remember anything that had happened in the last three years. He retained no memory of his father's death, or even meeting and marrying his wife.

But in the time that has passed since the accident, Matt has made amazing progress. Physical therapy has helped him learn to walk again.

They play scrabble and enjoy going to yoga classes together, and he's recently started driving a stick shift car for fun because he loves cars.

"One conversation with Matt will change your life," Danielle shared. "He has a servant's heart and a love for people. He never complains or feels anger about his circumstance. He just wants to make a difference and give hope."

The couple is currently trying to raise funds for Matt to continue his therapy.

JOE PALCA

www.npr.org 

A promising technique for making brain tumors glow so they'll be easier for surgeons to remove is now being tested in cancer patients.

Eighteen months ago, Shots first told readers about tumor paint, an experimental substance derived from scorpion venom. Inject tumor paint into a patient's vein, and it will actually cross the blood-brain barrier and find its way to a brain tumor. Shine near-infrared light on a tumor coated with tumor paint, and the tumor will glow.

The main architect of the tumor paint idea is a pediatric oncologist named Dr. Jim Olson. As a physician who treats kids with brain cancer, Olson knows that removing a tumor is tricky.

"The surgeons right now use their eyes and their fingers and their thumbs to distinguish cancer from normal brain," says Olson. But poking around in someone's brain with only those tools, it's inevitable surgeons will sometimes miss bits of tumor or, just as bad, damage healthy brain cells.

So Olson and his colleagues at the Fred Hutchinson Cancer Center in Seattle came up with tumor paint. They handed off commercial development of the compound to Blaze Bioscience.

After initial studies in dogs showed promise, the company won approval to try tumor paint on human subjects. Those trials are taking place at the Cedars Sinai Medical Center in Los Angeles.

Dr. Chirag Patil is one of those surgeons. He says it's remarkable that you can inject tumor paint into a vein in a patient's arm, have it go to the brain and attach to a tumor, and only a tumor. "That's a concept that neurosurgeons have probably been dreaming about for 50 years," he says.

Patil says they've now used tumor paint on a about a half dozen patients with brain tumors. They use a special camera to see if the tumor is glowing.

"The first case we did was a deep tumor," says Patil. "So with the camera, we couldn't really shine it into this deep small cavity. But when we took that first piece out and we put it on the table. And the question was, 'Does it glow?' And when we saw that it glows, it was just one of those moments ...'Wow, this works.' "

In this first study of tumor paint in humans, the goal is just to prove that it's reaching the tumor. Future studies will see if it actually helps surgeons remove tumors and, even more importantly, if it results in a better outcome for the patient.

That won't be quick or easy. Just getting to this point has been a long slog, and there are bound to be hurdles ahead.

And even if tumor paint does exactly what it's designed to do, Dr. Keith Black, who directs neurosurgery at Cedars-Sinai, says it probably isn't the long-term solution to brain cancer. "Because surgery is still a very crude technique," he says.

Even in the best of circumstances, Black says, surgery is traumatic for the patients, and tracking down every last cell of a tumor is probably impossible. Plus, it's inevitable that some healthy brain tissue will be damaged in removing the tumor.

"Ultimately, we want to eliminate the need to do surgery," says Black. A start in that direction will be to use a compound like tumor paint to deliver not just a dye, but an anti-cancer drug directly to a tumor. That's a goal several research groups, including Jim Olson's, are working on.

By Laura Geggel

www.foxnews.com

A boy in Canada mysteriously became allergic to fish and nuts after he received a blood transfusion, according to a new case report.

The 8-year-old boy had no history of being allergic to any foods, and was undergoing treatment for medulloblastoma, a type of brain cancer. A few weeks after receiving a blood transfusion, he experienced a severe allergic reaction called anaphylaxis within 10 minutes of eating salmon, according to the report, published online April 7 in the Canadian Medical Association Journal.

His doctors suspected that the blood transfusion had triggered the reaction, they wrote in the report. After treating the patient with a drug containing antihistamines, the doctors advised him to avoid fish and to carry an epinephrine injector in case he had another reaction. [9 Weirdest Allergies]

But four days later, the boy was back in the emergency department after eating a chocolate peanut butter cup. Blood tests and a skin prick test suggested that he was allergic — at least temporarily — to peanuts and salmon, so his doctors advised him to avoid nuts and fish.

"It's very rare to have an allergic reaction to a previously tolerated food," said the report's senior author, Dr. Julia Upton, a specialist in clinical immunology and allergy at the Hospital for Sick Children in Toronto. "The overall idea is that he wasn't allergic to these foods," but in the blood transfusion, he received the protein that triggers an allergic reaction to them, she said.

That protein, called immunoglobulin E, is an antibody associated with food allergies, Upton said. When it encounters a specific allergen, it causes immune cells to release chemicals such as histamine that lead to an allergic reaction. 

However, because the boy's body itself did not make such antibodies against fish and nuts, his doctors said they suspected his allergies would go away within a few months.

Acquiring allergies from a blood donor is rare, but not without precedent. The researchers found two other case reports, both in adults, in which patients acquired temporary allergies from blood plasma. In a 2007 case, an 80-year-old woman had an anaphylactic reaction to peanuts. An investigation showed that her 19-year-old plasma donor had a peanut allergy, according to the report in the journal Archives of Internal Medicine.

In the new case, the 8-year-old also received plasma, the liquid part of blood that contains antibodies. The researchers inquired about the donor to Canadian Blood Services, and found that the donor did have an allergy to nuts, fish and shellfish. The service did not have any more blood from the donor, and subsequently excluded the individual from making future donations, the researchers said. 

About five months later, blood tests showed that the boy's immunoglobulin E levels to salmon and peanut were undetectable. By six months, his parents had gradually and successfully reintroduced nuts and fish back into their son's diet.

However, Upton said, "In general, we would recommend that this be done under medical supervision," just in case there is a medical emergency.

It's unclear how doctors could prevent future cases, she said. Neither Canadian nor American blood service organizations bar people with allergies from donating blood. And testing donated blood for levels of immunoglobulin E doesn't always predict allergies. Some people with high levels of immunoglobulin E don't have allergies, and others with low levels of the protein do, she said.

"Clearly, the safety of the [blood] supply is of everyone's utmost concern," but more research is needed to determine how best to avoid the transfer of allergies, and how frequently this happens, Upton said.

"I think it's hard to make sweeping recommendations based on one case report," Upton said.

In the United States, "If a donor is feeling well and healthy on the day of donation, they are typically eligible to donate," said Dr. Courtney Hopkins, the acting chief medical officer for the east division of the American Red Cross. "We will defer donors on the day of donation if they are not feeling well and healthy, if they have a fever, or if we notice they have problems breathing through their mouth."

Donors can learn more about blood-donation eligibility here. Individuals with allergies shouldn't be dissuaded from donating, Hopkins added.

"We always need blood. We always need blood donors," Hopkins told Live Science.

Written by James McIntosh

www.medicalnewstoday.com 

Researchers testing the origins of human breast milk samples available for purchase online found that around 10% of the samples they examined contained significant amounts of added cow's milk.

The pressure on parents to feed newborn infants with breast milk may be leading many to purchase human breast milk online. However, the milk they receive from online vendors may not match up to what is being offered.

"They purchase the milk online based on a posted description of the type and quantity of the milk or the health habits of the seller," writes study author Dr. Sarah Keim. "But when they think they're getting nutritious, high-quality breast milk, some of them are actually receiving human milk mixed with cow's milk."

Human breast milk is widely recognized as providing many health benefits to young infants. According to the American Academy of Pediatrics (AAP), breastfeeding can protect against diseases and conditions such as diarrhea, diabetes and childhood obesity.

However, many new mothers find themselves unable to breastfeed. In 2012, a survey published in Pediatrics found that two-thirds of mothers nursing newborns are unable to manage breastfeeding for as long as they intended.

"Some women are unable to produce enough milk for their infant or perceive they cannot meet their infant's needs, yet they may be reluctant to feed formula," write the researchers of the new study. For these mothers, the Internet represents an alternative way of providing human milk for their children.

'You do not truly know what you are receiving'

For the study, published in Pediatrics, Dr. Keim and her colleagues purchased 102 samples of what was advertised as human milk from sellers on the Internet. These milk samples were subjected to DNA testing in order to verify their human origins and to assess whether any cow's milk was also present.

While all of the purchased Internet samples contained human DNA, 11 also contained bovine DNA. Of these, 10 contained bovine DNA concentrations significant enough to suggest that cow's milk had been added to human milk, being so high that accidental contamination was unlikely.

The inclusion of cow's milk in human breast milk can be problematic for babies. It can potentially be harmful due to cow's milk allergies, health conditions or formula sensitivities. The inclusion of cow's milk could also reduce a baby's access to the essential nutrients and fats that are in formulas and human breast milk but not cow milk.

"The truth of the matter is that you do not truly know what you are receiving when you buy milk from a stranger over the Internet," explains Dr. Keim.

"Selling breast milk gives people an incentive to add cow's milk or formula to the milk in order to sell more. When money is involved in an unregulated process like this, you cannot know for sure that the milk is safe to give to your baby."

Although the sample used in the study is acknowledged as small by the authors, they state the sample is representative of Internet sellers and has given the researchers findings that may at least generalize to milk being sold via the Internet.

"Our findings confirm the previously theoretical risk that human milk being sold via the Internet may not be 100% human milk," the authors conclude. "Because buyers have little means to verify the composition of the milk they receive, all should be aware of the possibility that it may be adulterated."

Previously, in a report published in The BMJ, experts claimed that breast milk purchased online can pose serious health risks to infants, largely due to a lack of regulation. Human milk is not tested for contamination or disease and could be stored incorrectly.

www.sciencedaily.com

Pushing new frontiers in dementia research, Nanyang Technological University, Singapore (NTU Singapore) scientists have found a new way to treat dementia by sending electrical impulses to specific areas of the brain to enhance the growth of new brain cells.

Known as deep brain stimulation, it is a therapeutic procedure that is already used in some parts of the world to treat various neurological conditions such as tremors or Dystonia, which is characterised by involuntary muscle contractions and spasms.

NTU scientists have discovered that deep brain stimulation could also be used to enhance the growth of brain cells which mitigates the harmful effects of dementia-related conditions and improves short and long-term memory.

Their research has shown that new brain cells, or neurons, can be formed by stimulating the front part of the brain which is involved in memory retention using minute amounts of electricity.

The increase in brain cells reduces anxiety and depression, and promotes improved learning, and boosts overall memory formation and retention.

The research findings open new opportunities for developing novel treatment solutions for patients suffering from memory loss due to dementia-related conditions such as Alzheimer's and even Parkinson's disease.

This discovery was published in eLife, a peer-reviewed open-access scientific journal published by the Howard Hughes Medical Institute, the Max Planck Society and the Wellcome Trust.

Assistant Professor Ajai Vyas from NTU's School of Biological Sciences said, "The findings from the research clearly show the potential of enhancing the growth of brain cells using deep brain stimulation.

"Around 60 per cent of patients do not respond to regular anti-depressant treatments and our research opens new doors for more effective treatment options."

Dr Lim Lee Wei, an associate professor at Sunway University, Malaysia, who worked on the research project while he was a Lee Kuan Yew Research Fellow at NTU, said that deep brain stimulation brings multiple benefits.

"No negative effects have been reported in such prefrontal cortex stimulation in humans and studies have shown that stimulation also produces anti-depression effects and reduces anxiety.

"Memory loss in older people is not only a serious and widespread problem, but signifies a key symptom of dementia. At least one in 10 people aged 60 and above in Singapore suffer from dementia and this breakthrough could pave the way towards improved treatments for patients."

Growing new brain cells

For decades, scientists have been finding ways to generate brain cells to boost memory and learning, but more importantly, to also treat brain trauma and injury, and age-related diseases such as dementia.

As part of a natural cycle, brain cells constantly die and get replaced by new ones. The area of the brain responsible for generating new brain cells is known as the hippocampus, which is also involved in memory forming, organising and retention.

By stimulating the front part of the brain known as the prefrontal cortex, new brain cells are formed in the hippocampus although it had not been directly stimulated.

The research was conducted using middle-aged rats, where electrodes which sends out minute micro-electrical impulses were implanted in the brains. The rats underwent a few memory tests before and after stimulation, and displayed positive results in memory retention, even after 24 hours.

"Extensive studies have shown that rats' brains and memory systems are very similar to humans," said Prof Ajai who is a recipient of NTU's prestigious Nanyang Assistant Professorship award.

"The electrodes are harmless to the rats, as they go on to live normally and fulfil their regular (adult) lifespan of around 22 months."

The research was funded by the Lee Kuan Yew Research Fellowship which supports and promotes young and outstanding researchers in their respective areas of specialisation.

Written by Honor Whiteman

www.medicalnewstoday.com 

Progeria or Hutchinson-Gilford Progeria Syndrome (HGPS), affects around 1 in 4-8 million newborns worldwide. There are approximately 200-250 children living with the condition across the globe at any one time.

Progeria is caused by an abnormal protein in the LMNA gene, called progerin, which interferes with the production of lamin A - a protein that stabilizes a cell's nucleus. This disruption causes children with progeria to age up to 10 times faster than normal.

On Thursday evening, it was announced that 17-year-old progeria sufferer Hayley Okines - from Medical News Today's hometown Bexhill in East Sussex, England - had passed away.

Hayley's mother, Kerry Okines, posted the sad news on Facebook: "My baby girl has gone somewhere better. She took her last breath in my arms at 9.39 pm."

Hayley - who BBC News say had the "body of a 104-year-old" - was being treated in the hospital for pneumonia, but she returned home shortly before she died. "She came home for an hour and she saw her puppies, little brother Louie and her sister Ruby," Hayley's father, Mark Okines, told BBC News on Friday.

"I think she wanted to come home to say goodbye to everybody," he continued. "I think she knew that yesterday was going to be the time."

'We remember her tremendous courage and determination'

Children with progeria rarely live past the age of 14, often passing away from ailments that affect the elderly, such as heart disease and stroke. 

Hayley was told she would not live past the age of 13, but in 2007, the teenager began undergoing pioneering treatment at Boston Children's Hospital, MA, as part of the first clinical trial for the condition.

In September 2012, MNT reported on the success of this trial, revealing how a farnesyltransferase inhibitor (FTI) improved the weight, bone structure and cardiovascular health of children with progeria.

In a statement following Hayley's death, the Progeria Research Foundation praised the teenager for her contribution to progeria research:

"The entire PRF community mourns the loss of one of our shining stars, Hayley Okines. Hayley was one of the first participants in the ongoing progeria clinical trials. Hayley was a pioneer - and one of the reasons that we now have the first treatment for progeria. Today we remember her tremendous courage and determination."

Hayley was an avid campaigner for progeria awareness, hailed locally and nationally as an inspiration for people with and without the condition. The teenager penned two books detailing her experiences of living with progeria - "Old Before My Time" and "Young at Heart" - and took part in numerous interviews.

As well as for her contribution to progeria awareness and research, Hayley was highly admired for her positive outlook on life, writing in "Young at Heart:"

"My life with progeria is full of happiness and good memories. Deep inside I am no different from anyone. We are all human."

Our thoughts and prayers are with Hayley's family and friends at this difficult time.

The news of Hayley's death comes just 15 months after it was announced Sam Burns, a boy from Foxborough, MA, had died from progeria aged 17.

By SYDNEY LUPKIN

abcnews.go.com

The Easter Bunny has some sweet competition in the form of two therapy rabbits at NYU Langone Medical Center in Manhattan.

Nutmeg and Clovis, both 5 years old, live on the 13th floor of the hospital, and this week, they visited patients for Bunny Day, the hospital's nondenominational springtime celebration. They wore rabbit ears (yes, really), a bonnet, and sat on a basket of eggs.

"The bunny cart is decorated to the hilt, and then we'll go and see patients and work with patients," said Gwenn Fried, manager of horticultural therapy services at NYU Langone. "The patients adore it."

As she travels the hospital with one rabbit at a time (Rabbits need breaks, too!), she said she hands patients a plastic Easter egg, and it contains either a sticker or a bunny treat.

"The bunny is very excited about the bunny treat," she laughed.

The bunnies visited 15 patients on Thursday and will visit more today and tomorrow, Fried said.

The rabbits are part of a therapy program that's been at the hospital for about 13 years. Sometimes, doctors recommend the bunny therapy, and sometimes patients request it, but Fried said she's seen them work magic on children and adults alike.

"One dad just said, 'I really think Clovis changed our lives,'" Fried told ABC News last year. "He's the most patient animal I've ever seen in my life."

By Michelle Matthews

Source: www.al.com

Shortly before their baby, Eli, was born, Brandi McGlathery and Troy Thompson talked about the physical qualities they hoped he would possess.

"I said I wanted him to have blond hair," Brandi said. "And Troy said, 'I hope he doesn't get my nose.'"

At the time, it was just a joke between two parents anxiously awaiting their baby's arrival. After Eli was born, though, it became the kind of memory that now makes them wince at its irony.

When Eli was born at South Baldwin Hospital on March 4, weighing 6 pounds, 8 ounces, Dr. Craig Brown immediately placed him on Brandi's chest. As the doctor helped Troy cut the cord, Brandi looked at Eli for the first time.

"I pulled back and said, 'Something's wrong!' And the doctor said, 'No, he's perfectly fine.' Then I shouted, 'He doesn't have a nose!'"

The doctor whisked Eli away, and for about 10 minutes Brandi was left alone in the delivery room thinking surely she hadn't seen what she thought she saw - or didn't see.

When Dr. Brown returned, he put his arm on her bed and took a deep breath. "He had the most apologetic look," she said. She knew something was wrong with her baby. She started to cry before he said a word.

She looked to Troy, who, she said, never cries. He had tears in his eyes.

She'd been right. Eli didn't have a nose.

Meanwhile, he had started breathing through his mouth right away. She remembers that he was wearing a tiny oxygen mask. Not having a nose "didn't faze him at all," she said.

"I was the first person to see it," she said. "Even when they took him away, my family still didn't know something was wrong, due to being caught up in the excitement of his arrival. It wasn't until they opened the blinds of the nursery that everyone else saw."

Before she knew it, Eli was taken to USA Children's and Women's Hospital in Mobile. Throughout the night, Brandi called the number they'd given her every 45 minutes or so to check on her baby. She wasn't sure he would make it through the night -- but he did.

And her "sweet pea," her "miracle baby," has been surprising his parents and others who love him, as well as the medical staff who have cared for him, ever since.

Nothing unusual

The next day, her doctor checked her out of the hospital in Foley so she could be with her baby in Mobile. The doctor had also had a sleepless night, she said. "He said he'd gone back over every test and every ultrasound," but he couldn't find anything unusual in her records.

There were a few aspects of her pregnancy that were different from her first pregnancy with her 4-year-old son, Brysen.

Right after she found out he was a boy, at around 17 weeks, she said, she lost 10 pounds in eight days because she was so severely nauseated. Her doctor prescribed a medication that helped her gain the weight back and keep her food down. She continued to take the medication throughout her pregnancy, she said.

On a 3D ultrasound, she and Troy even commented on Eli's cute nose. The imaging shows bone, not tissue, she said - and he has a raised bit of bone beneath the skin where his nose should be.

After going into early labor three times, Brandi delivered Eli at 37 weeks. At 35 weeks, her doctor told her that the next two weeks would be critical to the development of the baby's lungs and respiratory system. "He said, 'Let's try to keep him in as long as we can,'" she remembered.

Happy, healthy baby

For the first few days of his life, Eli was in one of the "pods" in USA Children's and Women's Hospital's neonatal intensive care unit. At five days old, he had a tracheotomy. "He has done wonderfully since then," Brandi said. "He's been a much happier baby."

Because of the trach, he doesn't make noise when he cries anymore, so Brandi has to watch him all the time. She has been going back and forth between the Ronald McDonald House and Eli's room during his stay.

"Between the nurses here and Ronald McDonald House, everyone has gone above and beyond," she said. "The nurse from the pod comes to check on her 'boyfriend.' She got attached to him."

Besides not having an external nose, he doesn't have a nasal cavity or olfactory system. (Despite that fact, she said, he sneezes. "The first time he did it, we looked at each other and said, 'You heard that, right?'")

Eli Thompson has an extremely rare condition known as complete congenital arhinia, said Brandi, adding that there are only about 37 cases worldwide like his. The chance of being born with congenital arhinia is one in 197 million, she said.

Even at USA Children's and Women's Hospital, Eli's case has baffled the NICU. "Everyone has used the same words," Brandi said. As soon as they found out he was on his way, she said, the staff started doing research. They only found three very brief articles on the condition. Now, his doctors are writing a case study on him in case they ever encounter another baby like Eli.

After he got the trach, Brandi wanted to start breastfeeding. The lactation consultant encouraged her, and together they searched the Internet for more information. Brandi became the first mother ever to breastfeed a baby with a trach at the hospital, she said - and now the lactation consultant "is actually using him to put an article together about breastfeeding with a trach to encourage mothers of other trach babies to attempt it."

Thanks to her Internet research, Brandi found a mother in Ireland, Gráinne Evans, who writes a blog about her daughter, Tessa, who has the same condition as Eli. She also found a 23-year-old Louisiana native who lives in Auburn, Ala., and a 16-year-old in North Carolina, she said. With every case she found, Brandi started to feel better and more convinced that Eli could not only survive his babyhood, but that he'll grow to adulthood.

Communicating with Tessa's mother in Ireland has been especially gratifying for Brandi. She knows she and Eli are not in this alone.

'He's perfect'

While it would seem easy enough for a plastic surgeon to build a nose for Eli, it's not that simple, Brandi said. "His palate didn't form all the way, so his brain is lower," she said. "It's a wait-and-see game."

His condition affects his pituitary gland, she said. He'll have to be past puberty before his nasal passageways can be built. Until then, she'd like to spare him any unnecessary facial surgeries.

"We think he's perfect the way he is," she says, nodding toward the sweet, sleeping baby in his crib. "Until the day he wants to have a nose, we don't want to touch him. We have to take it day by day."

Within a month after Eli goes back home to Summerdale, he will have to travel to the Shriners Hospital for Children in Houston and Galveston, Texas, to meet with craniofacial specialists. "They will work with him for the rest of his life," she said. "Every three to six months, we'll be going back for scans and checkups for at least the next ten years."

Brandi said that, of the people she's found online, some are opting to have noses and nasal passageways built (including Tessa), while others haven't.

"We're going to do our best to make sure he's happy," she said. "The rest of him is so cute, sometimes you don't realize he doesn't have a nose."

Brandi's older son, Brysen, and Troy's four-year-old daughter, Ava, are too young to interact with Eli in the hospital. Brandi was grateful to one of the nurses who unhooked him and let the kids see him. "Ava asked me, 'When you were little, did you have a nose?'" Brandi said. "She said, 'I think he's cute.'"

Brysen pressed his hands against the window separating him from his baby half-brother and said, "He's perfect!"

'Facebook famous'

Brandi, who got pregnant with Brysen when she was a senior in high school, had planned to start going to school to become an LPN like Troy's sister and his mother. "That's all on the back burner now," she said. Because of her experience at USA Children's and Women's, she said she now wants to be a NICU nurse.

Her best friend, Crystal Weaver, logged onto Brandi's Facebook account and created the Eli's Story page to let friends and family members know what was going on. "It's easier that way to update everyone at once rather than to call everyone individually," Brandi said. "It's overwhelming. It's all on my shoulders." Within a day, she said, Eli's Story had 2,000 likes (it now has around 4,500). "People I didn't know were sending messages," she said.

Crystal also started a Go Fund Me account, which has raised about $4,300. "We've got years and years of surgeries and doctor's appointments nowhere close to us," said Brandi, who returned to her job as a bartender this past weekend. She plans to keep working two nights a week for a while. Being around her work family, she said, helps her maintain a sense of normalcy.

A fish fry is planned as a fundraiser for Eli's medical fund on April 11 at Elberta Park in Elberta, with raffles for prizes including a weekend stay at a condo in Gulf Shores and a charter fishing trip.

"It makes me feel really good that I have a support system," Brandi said. "Everybody's been awesome."

Updating Eli's page, adding photos and reading the positive, encouraging comments from hundreds of people, as well as reaching out to others who have been through what she's going through "keeps me sane," Brandi said.

Recently, Brandi posted a video of Eli waking up from a nap. From Ireland, Gráinne Evans commented: "I've actually watched this more times than I could admit!"

Eli is "100 percent healthy," she said. "He just doesn't have a nose. He has a few hormone deficiencies, but other than that he's healthy."

Brandi seems wise beyond her years. She is already worried about "the day he comes home and someone has made fun of his nose," she said. "We don't want anyone to pity him. We never want anyone to say they feel sorry for him. If other people express that, he'll feel that way about himself."

She jokes that Eli is "Facebook famous" now. "I can't hide him," said Brandi, who is a singer. "Eli's gotten more publicity in the past two weeks than I have in my whole life!"

She's been putting together a "journey book" full of medical records and mementoes to give Eil one day. "I'm excited to show him one day, 'Look, from the moment you were born people were infatuated with you.'"

'I'm doing something right'

In his short time on earth so far, Eli has brought his family together, Brandi said. She and Troy had been engaged, then called off the wedding and were "iffy," and then they broke up. A week later, she found out she was pregnant.

"Eli has made Troy my best friend," she said. "He has brought us closer than when we were engaged. To see Troy with him is really awesome."

Troy has been her rock, reassuring her since Eli was born, she said. "He tells me, 'Brandi, it's OK. It will end up happening the way it's supposed to be."

Last Thursday, Brandi posted on the Eli's Story page that Eli had passed his car seat trial and newborn hearing screening. "He now weighs 7 pounds, and we'll be meeting with home health to learn how to use all of his equipment so we can go home Monday."

Everyone in their family has taken CPR classes, and Brandi and Troy have learned how to care for Eli's trach. The couple has extended family nearby, and Troy's father and stepmother plan to move to Baldwin County from Mobile to be closer to Eli.

As she prepared to take her baby home from the hospital on Monday morning, almost four weeks since he came into the world, Brandi was excited to take care of him for the first time in the comfort of her own home, and to finally introduce him to his big brother and sister.

Though Brandi said her heart melts when Eli's little hand wraps around her finger, he's the one who already has her wrapped completely around his. He recognizes his parents' voices, and seems comforted by them. "As soon as he hears us, he looks around for us, finds us, then stares at us smiling," she said. "It makes me feel like I'm doing something right, that through the ten to twelve other women, the nurses who have been caring for him for the past month, he still knows who Mommy is!"