It was a dream come true for Dennis and Cassandra Edwards when they adopted their newborn twin boys, Peyton and Patrick, just before Christmas in 2009. But one of the newborns faced a serious medical problem.
"They informed us that Peyton potentially had some medical issues," Cassandra Edwards said.
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The Edwardses took their son to the West Virginia University Health Sciences Center, where they learned their newborn son needed surgery to separate a fused brow bone.
"If you look at his brother and you look at Peyton, you can tell his brother has more of a rounded forehead," while Peyton's "is pointy," his mother said.
A baby's brain doubles in size during its first year of life, so if doctors didn't address Peyton's condition right away, his expanding brain would have no room to grow. When left untreated, his condition could lead to severe developmental delays.
Dr. John Collins is head of pediatric neurosurgery at WVU and was in charge of the newborn's case. He explained Peyton's condition.
"A baby's head bones are in separate plates, but there is a space in between and in this child, there's supposed to be a dark squiggly line, but there isn't," Collins said. "That's what creates the deformity."
The congenital deformity is called craniosyntosis, and it affects one in 2,000 babies every year. Young Peyton would have to undergo major reconstructive surgery to reshape his forehead and brow line.
"Being a pediatric neurosurgeon ... is one of the greatest challenges and the hardest jobs there could be," said Dr. Julian Bailes.
Bailes is chief of neurosurgery at WVU, but does not specialize in pediatric neurosurgery. "Not only do you have this newborn, you have often two additional patients in a way. You have the parents."
WVU's center is a teaching hospital. Dr. Cara Sedney is a third year neurosurgical resident there and was also part of Peyton's surgical team. When she finishes her training, she will join an elite minority -- only 189 neurosurgeons in the country are women.
Surgery on Babies Different Than on Adults
Sedney said the first time she ever operated on a baby, it made her feel sick.
"Emotionally, [it was] just weird. ... I definitely got a little queasy." she said. "There's something psychologically different between operating on an adult and operating on this tiny baby."
Sedney explained that one of the biggest concerns when operating on Peyton, or any baby, was blood loss. According to Collins, four tablespoons of blood loss is the maximum allowed with newborns before they become an emergency on the operating table.
"They don't have that [much blood] when they are only 3 months old, so we are really meticulous about that," Sedney said.
"They are not just miniaturized adults; they have their own unique problem," said Collins.
During Peyton's surgery, each gauze pad and sponge used to stop bleeding was weighed throughout the procedure so doctors would know how much blood had been lost, and whether they needed to set up a transfusion.
"Gotta stay rock stable," Collins said.
Peyton's brow bone was removed and pieced back together to create a flatter, more even shape. Bailes explained how incredibly careful pediatric surgical teams have to be when doing a procedure like this, or any other surgery on a baby.
"It's a very important operation in pediatric neurosurgery," he said. "It can affect the brain's growth and development. It can be a cosmetic problem. It can affect vision in some cases."
Sedney said she found Peyton's reconstructive surgery fascinating, and that reshaping the bones was like putting together a sculpture.
"At the end when you take the drapes down and it's like a totally different kid, it's pretty neat," she said. "The kid looks pretty cute. I would definitely call it a success."
For Peyton's anxious parents, who had been in the waiting room throughout the six-hour surgery, seeing their son afterward was like meeting him for the first time again.
"You hate for them to go through that ... he's so small, and when you see somebody like this, it's, oh my golly, but he will be fine. He's a little trooper," Cassandra Edwards said through tears. "Just wish you ... could experience the pain instead of him."
Peyton Edwards Recovers After Surgery
"You just worry about him being so small and going through a major surgery," Dennis Edwards said. "We knew it's the best thing to do for him, you know, there is never any doubt."
Peyton has to wear a special helmet for six months to help mold his skull correctly, but it hasn't stopped him from trying to keep up with brother Patrick.
"[The helmet] is supposed to be on two to 24 hours a day," his mother said. "He wants to play. It's just so heavy on his head."
It's a small price for the Edwards family to pay. The surgery transformed Peyton's future, because now he has a chance at normal development.
Two months after surgery, Cassandra said she watched her son become more active and begin to mimic his brother.
"[He's] a healthy little boy," said her husband. "He can go on and do his regular routines, what a boy would do, sports and everything. It's definitely given us joy and hope."