Tag Archives: nicu

the eric update – day 44: almost closed pda. bugs? and more bugs?

August 17, 2004 snowdeal Leave a comment

i think eric is enjoying dragging out the drama of doubling his birthweight. he was up 10 grams today, topping the scales at 1270 grams or 2 pounds 12.8 ounces.

we finally received word on his patent ductus arteriosis and it’s almost amusing – it’s not closed, but it’s not open wide enough to warrant additional measures to try to close it. although everyone seemed quite confident that it would close on its own, it’s still slightly disconcerting to not be able to give a definitive answer to the innumerable questions regarding the status of the hole in his heart. i didn’t follow up as rigorously as i might normally as to why they weren’t going to pursue another round off indomethacin simply because everyone seemed so confident that the hole wasn’t big enough to have any physiological consequences and that it would close on its own accord.

unfortunately, i don’t have any good an answers as to what may or may not be the source of his sepsis ( if, in fact, he does have a blood infection ). remember, they caught a gram negative bug in a blood sample that was being used to determine if he had a yeast infection. they’ve been having trouble determining the exact type of bug in the sample because, as a person from “infectious diseases” said today – “fungus is funky”. in other words, they are trying to grow enough of the bacteria to allow identification in a media that was meant to grow fungus and it’s not working well. all you armchair microbiologists in the crowd could perhaps speculate as to why they can’t transfer the small amount of the bacteria they did find into a more suitable media. then again, i might have some of the details confused so it might not be worth your effort. luckily they haven’t found any bugs growing in any other samples they’ve drawn, so all this might be much ado about nothing.

we also received the results from another round of “trach aspirate” tests, which indicate if he has anything growing in his trachea ( being intubated on the vent greatly increases the chances that strange bugs will grow in his trachea ). six days ago, they discovered small amounts of enterobacter and klebsiella growing in his trachea and today they said the bugs were still there, despite being on antibiotics for nine days. the staff seem to not be overly concerned about the bugs sticking around for now. things might be different if they are still there after they finish the antibiotic regime, which will last for about 6 six more days.

oh. and his arm was quite red around the entry point of his IV line, which would strongly indicate that a superficial bacterial infection was starting. they moved the line and applied a topical antibiotic which will hopefully prevent any further complications.

i was joking with the nurses that i didn’t have any of these problems with bugs when i was a 26 weeker, 32 years ago, and that one couldn’t help wonder whether or not eric IV had the misfortune of finding himself in a “dirty” unit ( really, it was all in good humor ). aside from being continually astounded that i survived the ordeals of being a micropreemie in 1972 ( indeed, one nurse commented that when she started in the nicu at about that time, they would have never tried to save a 28 weeker, little less a 26 weeker ), the nurses all remind me that we can thank indiscriminate usage of antibiotics for causing all the “bug” problems that are seen in the modern nicu.

so think about the micropreemies the next time you jump for the medicine cabinet to grab an antibiotic for a minor ear infection.

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the eric update – day 43: readin’, feedin’ and nicu noise.

August 16, 2004 snowdeal Leave a comment

another day of quiet recovery, which is a good thing these days. slightly frustratingly, we still haven’t heard the results from the echocardiogram which will tell us if his patent ductus artierosis has closed, but his blood gasses are so good that i think everyone is assuming that it’s closed. also, they are apparently having trouble determining what the bug was that showed up in one of his blood samples and haven’t been able to find any more of it, so it’s likely that we’ll never know for now if it was contamination or is simply lurking in the background at undetectable levels while he’s on the antiobiotic regime. or maybe it’s gone for good.

they started eric’s breastmilk feedings again, which means that they are getting more confident that he’s recovering from his recent “troubles”.

technically, they aren’t really feedings as they are giving him such a small amount – only 1 cc every 3 hours, but it’s a start. rather than sending the food directly to his intestines via an “o.j.” ( oral to jejunum ) tube, they’ve decided to see if he’s can tolerate sending the milk directly to his stomach via his “o.g.” ( oral to gut ) tube. this is another small sign that they believe he’s getting stronger, despite his pneumonia.

the nicu is packed these days and when it gets packed it gets noisy. it’s a small nicu with only 15 beds, but it’s a small space and can get quite crowded when all the beds are filled, if all the babies have visitors. there’s and ebb and flow to visitors and during peak hours it the constant din of conversation and bells ringing can make it sound like a surreal cocktail party.

if you’re paying attention when it’s noisy, you’ll notice eric sending little signs that things are getting too loud, such as grasping his ear tightly in an attempt to block out the sound. subtle signal, no?

kris finished reading eric jonathan livingston seagull. he liked it a lot.

“poor fletch. don’t believe what your eyes are telling you. all they show is limitation. look with your understanding, find out what you already know, and you’ll see the way to fly.”

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the eric update – day 42: two birthdays!

August 15, 2004 snowdeal Leave a comment

it’s eric’s and and kris’ birthday today! we all know eric turned 6 weeks old today, but i’ll leave it up to kris to decide whether or not to reveal her age. grandma and grandpa snowdeal came into town just to take us out to lunch; and we celebrated a quiet birthday in the evening with some of her family. it’s hard to put much mental energy into really celebrating outside the nicu, but that didn’t stop me from eating more than my fair shair of cake.

the nurses all knew it was kris’ birthday and decided to give her an extra special present by letting her wash him. as you can imagine, it’s a little difficult to give him a good scrubbing while trying to not extubate him, but kris did a great job.

eric is continuing to really pack on the weight. he weighed in at 1240 grams or just under 2 pounds 12 ounces. he looks a little puffy from water retension related to the intravenous drip, but i think a lot of his recent gains are real thing. amazingly, he just needs to gain 2 more ounces to have doubled his birth weight! over the past few days, nurses that haven’t seen him for a few days have been commenting how much different he’s been looking as he fills out and today was the first day that i really could see what they were talking about. ( as i’m writing this, a nurse walks by and exclaims, “ohmygosh! he’s big! oh my!” i swear that she doesn’t know what i’m writing at the same moment ).

during his bath, kris cleaned his hair and we both noticed that it was long enough to get “mussed” up and it stayed that way, as if it might be wavy. so august 15, 2004 was the first day and probably not the last day, if he’s anything like his pops, that eric’s hair was messy.

kris was also able to sneak in another brief bit of holding by picking him up while the nurse changed his bedding around. after a week of no holding or kangaroo care, these brief interactions which were made possible by an incredibly thoughtful nurse, made kris’ birthday quite special. all the nurses are great, but some of them are much more attentive and thoughtful and have not forgotten that any contact, however brief, is magical.

random observation, his fingers are getting bigger.

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the eric update – day 40: return of the patent ductus arteriosis. and sepsis.

August 13, 2004 snowdeal Leave a comment

eric seems to be having a tough time catching a break this week. the doctors determined today that the hole in his heart, called patent ductus arteriosis has returned after being closed a few days after his birth.

the hole can reopen due to stressors, such as pneumonia, so it’s more normal than not that it has reopened. he’s still a micropreemie, so his body thinks that the hole should be open as it would be in utero; whenever something stresses his system, his body forgets that it’s been tricked into thinking the hole should be closed and it opens. the treatment strategy will be the same this time as last time, as eric will get 3 treatments of indomethacin at 12 hour intervals ( dose one at time zero, dose two at time zero plux twelve hours, dose three at time zero plux twenty four hours ). after 24 hours he’ll get an echocardiogram to see if the medicine closed the hole. if the hole hasn’t closed after the first round of treatments, they’ll try a second round and then maybe a third. if it hasn’t closed by the third round of treatment, then he’ll need to be transported to a different hospital for heart surgery.

eric responded excellently to the indomethacin the last time we went through this and there’s no reason to expect that he won’t do as well this time, despite having pneumonia. however, it’s impossible to tell for sure before he gets the echocardiogram, late saturday or sunday. although his risk for brain hemorrhage is less with this incidence of pda than it was immediately after birth, it’s not zero and, unfortunately, indomethacin itself can increase the chance of a “bleeder”; so, hopefully it will close as quickly in response to medicine as it did last time, because as a general rule, the less holes one has in their heart the better.

it’s good to see him getting mad again. it’s a little tought to tell from the picture, but his face is turning bright red and he’s trying to push my hand off him. if he wasn’t intubated, he’d likely be testing his vocal cords.

last week he started getting less mad and we thought it was just because he was content. really, it was because he was getting sick. having enough energy to get mad means that he’s getting better.

and check out that double chin. that’s the micropreemie version of getting chubbby.

lab results from today also indicated that eric officially has sepsis, or a bacterial blood infection. while running a test to determine if he had abnormal amounts of yeast growing in his blood ( he didn’t, which is good ), they were surprised to find that he had gram negative bugs growing in the culture. considering that just a few days ago, they found two gram negative bugs, enterobacter and klebsiella, growing in his trachea, one would tend to immediately suspect that one or both of them was the suspect bug in his blood. since the bugs were nosocomial, or hospital derived, there’s always the chance that things could get Real Bad, Real Fast; we had hoped that they they’d remain pleasantly colonized in his trachea and not go invading the rest of the system, but unfortunately it looks like the bugs had different plans.

the good news is that eric appears to be responding to the antibiotics that are being given to help him fight the bugs. initially, they were going to give him a 7 day “short course”, but now with the sepsis diagnosis, they are going to continue to give them to him for 14 days. if he continues to respond the way he has been, then this will all be an interesting sidenote, but if not, things could get very, very nasty.

if you’ve continued to read this far, it might be tough to keep a proper perspective, so i’ll summarize the summary. the pda is “normal” and if it closes quickly, there’s little risk of complications due to a “bleeder”. we’ll know within 24 to 36 hours if it has closed quickly. eric’s white blood differentials show that he’s responding well to the antiotic regime for the gram negative bugs that are doing their best to cause him great grief. if the antibiotics continue to work as well as they have been over then 14 days, he’ll probably come through just fine, but if not – well – things won’t be so fine.

despite everything, eric isn’t losing weight and, in fact, gained 5 grams for a grand total of 1080 grams or just over 2 pounds 6 ounces, which is quite a feat for somebody on intravenous fluids and spending all his energy on fighting infections.

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the eric update – day 39: improving. or not, depending on your perspective. and poundcake!

August 12, 2004 snowdeal Leave a comment

in the new world that kris and i live in, the world where things can go from good to horribly bad in three hours and we’re constantly trying to come up with new and innovative strategies to prevent us from turning into the weak-willed people with the small brains who run shrieking into the burning wreckage, it still would have been impossible to predict ahead of time exactly how we’d react to a 6 a.m. nicu phone call that resulted in us discovering that eric had been diagnosed with pneumonia, mere six hours after being told that his clinical picture was improving.

instead of shrieking, we found ourselves confusedly attempting to discern the implications of the cruel laws that we apparently must learn to abide by in our new world. “but you said he was improving?” kris queried. “oh, he is!” the caller stated, perhaps a bit too emphatically. i pondered what we should prepare ourselves for if he really starts improving. slowly, we discovered that, occasionally, the progression of pneumonia is such that you really can start improving before you ever get diagnosed as having the condition. in other words, the classic hazy x-rays which conclusively indicate pneumonia can appear after you’ve already started to gain ground on the bugs that cause the effect. so he was improving, in terms of his blood count differentials and other immunse system indicators, but our mistake was in believing that by using the word “improving” the staff really meant that eric had escaped getting another diagnosis put on his permanent record. apparently we were wrong.

getting the pneumonia diagnosis is quite normal for a micropreemie, as nurse donna’s unscientific estimate was that 90% of babies born prior to 28 weeks get the condition ( incidentally, i suspect that a micropreemie parent can’t not begin to hate to hear the various trials and tribulations that their child must suffer through described as “normal”. ), and 50% of children born so soon will develop pneumonia more than once during their stays at the nicu. since eric’s lung x-rays indicate that his lungs are already beginning to recover, i suppose we need to focus on the fact that things could have been much, much worse. even so, barring any complications, eric probably won’t fully recover from pneumonia for 2-3 weeks. while he likely won’t need to be on the vent for the entire time, we’ve noticed that the staff has stopped making predictions as to when he’ll be off the vent.

it’s hard to imagine what tomorrow will bring.

oh. and in an attempt to accentuate the positive, i should note that eric weighed in at 1075 grams or almost 2 pounds 6 ounces.

update: in my tiredness when i posted this last night, i forgot to mention the highlight of our day – the arrival of two pounds of rowena’s pound cake with “curd” sauce that my sister candy sent to celebrate eric hitting the two pound mark! it was a very sweet gesture. literally 🙂

candy mailed the pound cake to my home ( she’s family, so she gets to do that ) and i cleverly took it to the nicu right before the shift change, so that both the day and night shifts could enjoy the gift ( bonus points for me! ). i can say without a doubt that everyone enjoyed the cake.

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the eric update – day 38: improving. but bugs and decreased lung function looming.

August 11, 2004 snowdeal Leave a comment

the good news is that eric’s overall clinical picture is improving, even though he is still on the vent, which is to say that his blood counts are showing that his systemic infection is nearly gone and his blood gas profile is looking great. the shortest answer as to why he’s on the vent for longer than he’s ever been is that they are concerned that they want to make sure that his bowels are completely recovered after shutting down the other day before they put him back on cpap. the armchair reseachers in the crowd can investigate why cpap is bad after an illeus ( the technical term for the lower bowels stopping to function ) because i haven’t had the time to put all the pieces together.

although his overall status is improving, we were warned about a few new issues that are developing. after 5 weeks of not needing much supplemental oxygen, eric is starting to need to have his ‘ooooooh’ increased; in other words, while he’s done remarkably well in the past breathing unenriched room air ( with around 20-21% oxygen) , he’s now consistently needing 25-40 percent oxygen in his air supply. of course, there are several reasons why he might be needing more oxygen.

most innocuously, he might simply be getting comfortable on the vent and getting lazy, taking fewer and shallower breaths. breathing takes a lot of work, and if the machine is going to do the heavy lifting, many micropreemies are more than happy to take a breather from breathing and require a little more oxygen to keep their blood gas levels at appropriate levels. while this might be partly the cause, he respiratory profile doesn’t indicate that he’s getting too lazy, so my guess is that it’s only playing a minor role.

slightly more disconcertingly, he may also be developing a tracheal infection, which can irritate his mucous membranes and produce more slime and goo than normal; more slime and goo makes it more difficult to breath and increase the need for supplemental oxygen. he certainly seems to have more secretions than normal of late. and indeed, while we were discussing the potential for trach bugs, eric’s latest labs came back and he was positive for enterobacter and klebsiella which are gram negative nosocomial bugs – in other words he got an infection from bugs that you find in the hospital. while it’s not something that you want to see, it would be more remarkable if he didn’t get a nosocomial infection from all the tubes entering various parts of his body. technically, the bugs have simply colonized and have not shown any evidence of becoming particularly invasive. simply put, they are just hanging out and slowly multiplying around his ET tube and don’t seem too concerned with overtaking his system. it’s very difficult to pummel colonized nosocomial bugs into complete submission so they are going to wait and see if eric’s nascent immune system can keep them in check. i guess you could call this a developing story that could “get legs” and hit the front page soon.

perhaps even more problematic is the fact that eric could be developing a lung condition known as chronic pulmonary insufficiency of prematurity (cpip). essentially, this means his lungs are not growing fast enough to keep up with the oxygen requirements demanded by his growing body. cpip presents itself similar to bronchopulmonary dysplasia (bpd), but they are actually different enough to warrant different treatment strategies. this evening nurse practitioner dawn was not willing to say that he definately had cpip, but she said it wouldn’t surprise her at all to see him get the official diagnosis over the coming weeks. the good news is that if he does have cpip, he will quite likely eventually regain normal lung function ( perhaps by year 2 ). the not-so-good news is that cpip could necessitate that he leave the nicu with an oxygen tank.

just in case you’ve started to miss the forest for the trees, the good news is that eric’s overall clinical picture is improving.

and we’re still getting postcards ( scroll down to the bottom of the link )!

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the eric update – day 37: more of the vent. and a little levity.

August 10, 2004 snowdeal Leave a comment

more of the same today, by which i mean gagging on the vent endotracheal tube. hopefully he won’t have to put up with it much longer, although the staff is being a little cagey about when they might take him off. the party line is that it might be tommorrow, or maybe the day after that. so it’s time for another exciting round of The Waiting Game. of course, there’s not much to do in this round because being on the vent means he doesn’t have many alarms since the vent is doing all the work, and there’s no holding or kangaroo care to be had. apparently some nicus allow some ‘roo time while babies are on the vent, but ours isn’t one of them, because of the risks involved of moving an such a little thing around while being intubated. watching him as he tries to launch the tube out of his throat, i can see how they might come to that conclusion. eric is still gaining weight despite being only on intravenous fluids; tonight he weighed in at 1040 grams or 2 pounds 4.7 ounces, although it’s tough to know how much of that is “fake” weight due to the transfusions and water retension.

they are taking a lot of blood out of eric to track his progress on fighting his infection, which means lots of blooding of his blood and pricking of his foot to get blood to test his sugar levels.

in one of those small pieces, loosely joined moments, i was reading susan dennis’ post on how she had become so enthralled with following eric’s progress ( or lack thereof, as the case may be ), while also reading An Innocent, a Broad by ann leary, who happens to be dennis leary’s wife. as soon as i learned that the book is her account of having an micropreemie while on a business trip in london, i knew that i had to run out and immediately get the book to help me pass time while playing The Waiting Game. jeez louis. we managed to get to page 11 before kris and i broke into hysterical fits of laughter complete with tears rolling down our faces, as ann and dennis try to come to grips with the fact that she’s just has a premature rupture of membrane ( PROM or, simply, her water broke too early ).

“It’s true that at times like this we learn of what we’re really made. I used to think that if I were in a major disaster – say a plane crash or an earthquake – I would be the one to take charge. While the weak-willed people with the small brains ran shrieking into the burning wreckage, I would be the one to stop them and lead them to safety. In my mind most people were handwringers, unable to take action, while I was a doer, the who could coolly Heimlich the choker and tourniquet the bleeder. It was easy to hold these beliefs about myself, as I had never actually been involved in any kind of real-life crisis. I identified with the heroes and heroines in literature and felt sure that I would have been able, for example, to deliver Melanie’s baby in Gone With the Wind or rebuild a plantation with nothing but my bare hands and razor-sharp intellect. It never occured to me that nobody sees herself as Prissie the useless slave girl, and that it’s easy to feel brave when the most immeninent threat is an overdue cable bill. So it came as a bit of a surprise that afternoon in central London to learn that I am, in fact, the shrieking, running-into-the-burning-wreckage type.

“Maybe you just peed your pants, “Dennis offered hopefully, between my wailing cries.””

it’s hard to remember exactly how i held up on the day that this all began. i think i started off as more of the calm, cool and collected type than even i thought i was capable of, but slowly as the day wore on, i’m fairly certain i transmorgified into the shrieking, running-into-the-burning-wreckage type. luckily, at that point we were already surrounded by a cadre of trained professionals and not standing on the corner with nobody to turn to but dennis leary 🙂

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Tag Archives: nicu

the eric update – day 44: almost closed pda. bugs? and more bugs?

the eric update – day 43: readin’, feedin’ and nicu noise.

the eric update – day 42: two birthdays!

the eric update – day 40: return of the patent ductus arteriosis. and sepsis.

the eric update – day 39: improving. or not, depending on your perspective. and poundcake!

the eric update – day 38: improving. but bugs and decreased lung function looming.

the eric update – day 37: more of the vent. and a little levity.

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