Tag Archives: sepsis

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

day 44: do not reuse

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.

day 44: tubes in tent

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.

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

day 43: creased palm

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.

day 43: feeding again!

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.

day 43: ear clasp

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?

day 43: jonathan livingston seagull. I.

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.”

day 43: jonathan livingston seagull. II.

the eric update – day 41: closed pda? a bigger diaper and growth curves.

day 41: the fuzz keeps growing

eric received his round of indomethacin to treat the recurrence of patent ductus arteriosis, but we won’t have any decisive answers as to whether or not the hole in his heart has closed until monday; there’s only a small number of people who are skilled in doing the diagnostic echocardiogram on micropreemies and, apparently, they don’t work on weekends. it’s actually a good sign that the nicu staff don’t feel the need to call the technicians in for an emergency procedure, since it means that they think that the hole has closed. eric’s blood gasses have improved and his need for supplemental oxygen has decreased to 22-24%, which is almost the same as room air. also, none of the nurses can hear the characteristic “murmur” that they’d expect to hear with pda, so everyone is fairly confident that the hole has closed quickly in response to the medicine. good news!

as for the sepsis, we won’t know anything definitive for quite some time. we’ll probably know tomorrow exactly which bug is causing the problems, but that knowledge won’t change his treatment protocol. as i stated yesterday, eric will be on antibiotics for a full 15 days in an attempt to beat the bug into submission. however, we learned today that it’s likely that they won’t get rid of it completely and they will probably change tactics after 15 days and move towards a protocol that involves giving him short, sharp bursts of antibiotics. it’s a delicate balance, as giving eric a continuous feed of antibiotics obliterates the good bugs along with the bad; and dampening his natural immune capability increases the chance of eric getting a systemic yeast infection, which is really, really difficult to get rid of and can cause all matter of ugly and unspeakable problems. so for now, all we can go is hope that he continues to respond as well as he has to the current protocol. the good news is that his overall immune system profile is excellent, so we can only hope that it stays that way.

day 41: mama takes over the weigh-in. I.

we haven’t been able to hold eric as he’s been back on the vent while he’s fighting pneumonia, but the nurses cleverly found a way to let kris sneak in a little touch time by letting her put him on the scales for his weigh-in. eric’s nicu nurses are so incredibly thoughtful and considerate that it really is impossible to imagine how to properly convey the gratitude we felt at the kind gesture.

also, we talked with his caregivers for quite some time about how long he’d be on the vent and the possibility that he’d suffer from the negative side effects that are known to accompany the vent, including respiratory distress syndrome. luckily, eric’s vent settings are at the lowest that they can be and, while nobody can predict the future, they don’t think he’ll suffer any adverse consequences from being on the vent.

day 41: mama takes over the weigh-in. II.

eric tipped the scales at 1170 grams which is just over 2 pounds 9 ounces. that’s right he gained just over 3 ounces, despite battling pneumonia and sepsis.

day 41: mama takes over the weigh-in. III.

they say that every baby excels in one area of development and eric seems to be doing great with gaining weight. some of the gain can be attributed to water retension, but i think much of it is real. speaking of weight gain, eric also graduated into a new, bigger diaper! his previous diaper was only appropriate for babies at or under 1200 grams, so he’s crossed quite a milestone.

day 41: a new, bigger diaper!

the new diaper looks amusingly large on him, but with any luck he’ll quickly grow into it.

day 41: growth curves

while we’re on the subject of gaining weight, it’s interesting to note that eric is following the “normal” gestational growth curve as if he were in the 10th percentile. in other words, if he were born today, his weight would be in the 10th percentile of all babies born. not bad for a guy who’s been out of womb for nearly 6 weeks.