March 19-March 25
Sunday, March 19, 2000
Monday, March 20, 2000
Tuesday, March 21, 2000
Andrew: 3 lbs, 4½ oz
Cassie: 3 lbs, 9½ oz
Elena: 3 lbs, 6½ oz
We have been really busy and have not been able to update.
Andrew is still on his nasal canula. He is barely receiving any oxygen through it, but when they try him on room air he de-saturates. We are still trying to get him to breast-feed. He also has to begin putting on more weight. The staff is having trouble regulating his temperature in his isolette. He is either too hot or too cold. So, they think he lost some weight burning up calories to heat himself. We hope he catches up with his sisters soon.
Cassie extubated herself tonight and was doing well breathing on her own so they put her on nasal CPAP. She did well for the first half hour, but then her CO2 shot up and they had to re-intubate her. They are going to check her today to see if she has tracheal malasia like Elena.
Elena is still as feisty as ever. We gave her a bath tonight and she enjoyed it. She really relaxes after her bath. She extubated herself twice in three hours yesterday, but today she remained pretty calm.
Wednesday, March 22, 2000
Andrew: 3 lbs, 6½ oz
Cassie: 3 lbs, 11 oz
Elena: 3 lbs, 8½ oz
Andrew's hematocrit was 31 and they like to see it above 35 so they are starting him on higher doses of iron. His feeding went well today. The lactation consultant came in and helped Mom and was impressed at Drew's latching on skills. She says that the sucking reflex is just now getting established and he should begin to do that soon. He can now have rounds done by a pediatrician rather than the neonatologists since he is doing so well. He is now on 30 ml of fortified breast milk every three hours. That is about one ounce.
Cassie had the bronchoscopy done today and it revealed a more serious tracheal malasia than Elena's. It just means that it will take more time for her to get off of the respirator. Every week they will try her off and see how she does. When Dr. Stoddard was doing the procedure he also noticed that there were pulsations in her trachea. It could be a disorder that would require surgery or it could just be anatomical. The procedure that was done today is not normally the one used to diagnose this disorder, so it may be nothing. The cardiologist will see her tomorrow and will let us know. She is on 33 ml of fortified breast milk every three hours.
Elena spit up on Aunt Marcie as she was being held today. Cassie spit up on Aunt Marcie last time, so next time it is Drew's turn. Elena is still gown and glove because of the infection, but hopefully not for long. She is on 32 ml of fortified breast milk every three hours.
Thursday, March 23, 2000
Now that Andrew is a big boy he gets to see a pediatrician rather than the neonatologists. If there is a problem the pediatrician will refer back to the neonatologists. Today he again fed well for one feeding. He had a few episodes where his heart rate would drop, but if we repositioned him it would go back up. He is still on that tiny bit of oxygen and any time they try him on room air he desaturates. So, we will let him hold on to that little bit.
Cassie saw the cardiologist today and he did not see the tracheal rings that Dr. Stoddard was wondering about when he did her bronchoscopy. We are so pleased that she does not have the rings. Both Elena and Cassie were switched to volume cycle on their ventilators. This will make it easier to wean them off of the ventilators and also gives the doctors a better view of how they are going to do off. When we were there last night they were both doing really well on that cycle. They were not swinging as much as they usually do. The respiratory therapist was pleased. She was a little puffy and a whopping 1676 grams, so they gave her some diuretics to take away the edema.
Elena extubated at 6:00 this morning. She looked better than she has when they were giving her oxygen, but it was a large amount of oxygen and they decided to put her tube back in. We got in with her to get her ready for her bath and she was so mad! However, when she got put in the bathtub she immediately calmed down and stayed that way for a long time, even after we put her back in her isolette. We told the nurses that instead of Valium every six hours, they should give her a bath!
Friday, March 24, 2000
Andrew is doing well. He is on even lower oxygen, but is holding onto the little bit he is getting. At night Mom gave him a bath shortly after he ate and he then spit up his dinner and pooped in his blanket. He was really sad that he spit up. He just hates spitting up!! Mom then dressed him in a cute outfit and he calmed down and was just looking around. He is starting to outgrow his really, really preemie outfits. We may have to start using his just regular preemie outfits!
Cassie is still swinging on her oxygen needs. However, since she was switched to volume cycle on her respirator she is doing much better. She had a photo shoot at night since we dressed her up too.
Elena is being weaned off of her respirator and is also doing well on volume cycle. The only time she gets really mad is when she needs to have her secretions suctioned. Her heart rate shoots up to over 200. However, as soon as the therapist suctions her, the second he does, her face un-scrunches and her heart rate returns to normal. She is a girl who knows what she wants!
Saturday, March 25, 2000
Andrew: 3 lbs, 11½ oz.
Cassie: not weighed by the time we left
Elena: 3 lbs, 10½ oz.
Andrew is doing well on his oxygen needs and his feedings. His pediatrician came to see him today and said that his head is getting a little narrow so he wants him to be with his head midline (facing up) as much as possible. He also heard a murmur when he listened to his heart. This could be one of two things: the PDA could have opened back up and if it does not close again on it's own it would require surgery. However, the neonatologist came to listen and she does not think it is his PDA because of the sound of the murmur and also he is not showing any symptoms associated with PDA. The other and most likely possibility could be an ASD which is a small opening in the ventricle. This is just monitored for the first year of life and if it continues past that a cardiologist is brought in to assess. The cardiologist will do an echocardiogram on Andrew tomorrow morning to diagnose him. He still likes sucking on his binky and is not too interested in breast feeding. The nurses say that one day he may just decide that he is going to do it. However, if he is ready to go home except for the feeding, there are other options that we can do to get him home. As far as going home...the pediatrician said to expect to take him home on the little bit of oxygen that he is holding onto. He also needs to gain 12 more ounces before going home. We pray that will be soon.
Cassie extubated soon after Mom left her early in the morning. She again did not do well off of the respirator so she was re-intubated. She has had major swings in her oxygen needs. It may not be because of her pneumonia. Mom thinks that she is just clamping down and holding her breath. She turns a not-so-pretty shade of purple and her oxygen saturation falls. Some older babies do hold their breath when they are mad or when they are tired of the respirator. She was still on volume cycle by the time we left, but it was being discussed if she would do better back on the time cycle. We just pray that she will be able to breathe on her own really soon and get off of that respirator!
Elena is on really low vent settings and is doing well. She had a few spells of either periodic breathing or apnea early in the morning where her oxygen saturation and heart rate would fall. She was pretty angry until she got a long hold with Mom and she just stayed really calm. She also got a bath and afterwards was so calm that she just laid in bed awake looking around. We put a book on the top of her incubator so that she had something to look at.
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(c) Dane Seeley, 2000