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.

on a day that statistics will tell you will probably be a bad day, we received some great news! at noon, we found out that the hole caused by the patent ductus arteriosus (pda) had closed in response to the medicine they gave him over the previous 24 hours. so, at least for now, there doesn’t appear to be any reason for him to get transferred to a different facility for surgery. he also has a greatly reduced risk for a class IV “bleeder” ( our neonatologist’s term for a brain hemmorage ). one of the side-effects of pda is that it sends five times more blood to the brain than is actually necessary, which in turn stresses the brain vessels. he’s still at risk for a bleeder, but much less so.

speaking of brain hemmoraging, when our neonatologist was explaining the effects of pda, he took the opportunity to launch into a discussion of bleeders. it turns out there are four classes of them, with ‘class one’ being not visible with the naked eye and not typically associated with negative outcomes and ‘class four’ being visible through the scalp and often fatal. in what was one of the many conversations we’ve had over the past few days that can be quite disorienting, we found ourselves listening to him calmly tell us that he probably wouldn’t even bother telling us about class one or two bleeders, as he’d end up driving us insane with that much detail.

there are many other physiological consequences of the ductus arteriosis closing , the most notable being that they can reduce the percentage of oxygen that he’s getting via the ventilator. we normally breath air that has 20 percent or so of oxygen. for the past few days, eric has been getting anywhere from 30-60% oxygen. after the duct closed, they were able to move towards a schedule of letting him breathe ambient air with occasional enrichments of oxygen. also, they have been actively managing his blood pressure with dopamine and his blood sugar with insulin and they’ve stopped both of those treatments. later in the day, they also told me that they stopped giving him antibiotics to reduce the risk of infection. these are all stupendously wonderful signs that he’s stabilizing and setting himself up for the long haul. of course, he’ll still have bad days and downturns, but things are looking positive.

as donna, eric’s nurse today, was giving me an update about the pda and how good things were looking she stopped and laughed, “you know – he’s not a wimpy white boy!” she went on to explain that, when compared to other races, white male micro-preemies ( a technical designation for preemies that are born less than 26 weeks in gestational age and weigh less than 1 pound 11 ounces ) typically get more sick, have more bad days and have longer hospital stays. “i’ve been doing this for over 20 years and i don’t think i’ve ever seen an explanation for it. but lil’ eric ain’t no wimpy white boy. and that should make you very happy.”

indeed.

unfortunately, kris is still not progressing as quickly as she’d like and she’s three days post delivery, which means perfectly natural post-partum emotions are beginning. a bad morning was made worse when the nurses told her they didn’t want to even try to see if she could make it down to see eric, given her current condition. she’s still at an increased risk for a seizure if she has too much sensory stimulation, so they want her to have another day of quiet rest.

her blood pressure is still dangerously elevated even after starting an additional blood pressure management medicine; her platelets has also been down throughout the day, while her liver function is elevated, all of which are trends in the wrong direction. it’s nerve-wracking to anticipate each new lab result and continually discover that she’s not only not stabilizing, but technically getting worse ( although thankfully she’s not in any pain ); however, the doctor reassured us that she’s not atypical for cases of severe preeclampsia such as she developed. he expects her to have another day or two of trending in the wrong direction, followed by a gradual normalization process. first her kidneys will start working more efficiently, followed by better liver function and finally her platelets will go back up. he said her kidneys are looking better, so we’ll patiently wait for the others to follow.

her doctor also gave us a little more information about the specifics of her case. about 10 percent of preeclampsia cases have similar etiologies and, as we discovered, if the baby isn’t delivered immediately it will die and the mom will quite likely die. to highlight the point, as a consequence of the disease process, kris’ placenta had become 30% calcified over a very short time ( possibly 24 hours ). had we waited even a short period of time to go to the ER, the placenta would have become completely calcified and eric would almost definately have died from a lack of oxygen. it’s also more likely than not that an undiagnosed underlying condition will be found that is known to amplify the effects of the preeclampsia ( essentially “causing” the severe “10 percenter” cases ); so, after everything settles down, they will start testing her to see if they can find the root cause.

amidst all the disappointing lab results, kris is feeling better and making other important signs of progress. she’s started to regularly produce milk with a breast pump, which is getting stored down in the nicu ( neonatal intensive care unit ) for when eric is stable enough to start feeding. she also had her first solid food today, after days of nothing but an IV and the occasional juice. she happily enjoyed what would have otherwise been a bland cheese sandwich. and she also had her catheter removed! if you’ve ever had a catheter, you’ll understand why this made her very happy.

update: later in the evening kris finally got her first set of postive lab results and her blood pressure, while still high, seems to be gradually trending downward. her results are promising enough that they aren’t going to pester her every few hours over the night to draw blood and it looks like she might have a realistic chance of seeing eric some time tommorrow.