Tuesday, November 30, 2010

11.30.10

First of all - Happy 2 week birthday baby girl!

It's been a busy day today. We got a call at 6:00 a.m. (when NICU flashes on your phone at 6 a.m, that'll freak you out) saying that they needed to put her back on the CPAP (Continuous Positive Airway Pressure). Translation - she takes every breath by herself, but a steady flow of air comes into her airway under pressure, even when she exhales, holds the air sacs open and keeps them from collapsing after each breath. She was on the CPAP right when she was born, then went off of it, then back on a couple days later, and has been off of it for about a week. But, today, back on she went. The reasoning - her chest X-ray came back even hazier than yesterday's, and her CO2 level was elevated. The low-flow oxygen they had her on was making it hard for her to exhale the CO2 out. This could all have been being caused by the fact that she wasn't able to sleep on her belly (which I've mentioned before). On a bright note (I guess), they had to take the IV out of her foot because it was old and was leaking, and had to put it in her arm, so she can now lay on her belly!! She is much happier, I can tell!! Since I have been here they have turned down the CPAP to 30% though, and her monitor keeps dinging that even that's too high, so we shall see how things turn out with that. I was bummed that we had to go back to this, but I know that I would prefer to have her spend her energy getting bigger and stronger, not spending it trying to breath if there is a way they can help her out with that.
She doesn't look as puffy to me today, so that's a good thing. And she's doing okay with her feedings. She had about half of her 7:30 feeding left in residual at her 10:30 feeding, so they gave her that back and then just gave her half of a feeding. But at the 1:30 feeding, she had digested it all, so they went back to her full feeding (7 cc's).
When I arrived to hold her for her 1:30 feeding they had just gotten done taking a bunch of labs and poking and proding her, so the nurse kind of hinted that she didn't know if getting her out and holding her would be a good idea. This bummed me out, but Matt and I have said all along that it's what's best for Harper, so the second she started hinting at that, I immediately told her I agreed and that we were not going to be selfish about holding her. She's had a stressful morning, so let her rest.
Hopefully, she can have a bit more peaceful of an evening.

Monday, November 29, 2010

11.29.10 Part II

Well, today's challenge is the fact that Harper's breathing seems to be more labored. There are a couple of reasons for this - could just be that she's not laying on her tummy. I think I may have mentioned before that it's easier for preemies to breathe on their tummies, so that could be it. They have to do this because she still has that IV in her right foot.
Her breathing hasn't been an issue for her, so the doctor thought something might be up, so they took an X-ray and it showed that her lungs looked a little hazy, so they are 3 courses of action for this. She's still a little puffy all over, so the haziness could be from that, so they are giving her another dose of the diuretic to see if that helps. Then they will do their normal labs in the morning to see if that helped. If it didn't they will give her another medicine that will dilate her lungs which will help open them up. If that doesn't work then they will up her flow from a 1.5 tube to a 2.0 tube. Bottom line - it's just something to keep an eye on. It seems like they say that a lot, but that's really all they can do at this point.
Good news though - they may not put the PICC line back in. Basically, the line has been providing her nutrients when she couldn't have the my milk, and it's been delivering her antibiotics. Well, she will only be on the antibiotics until Wednesday and if she can handle the feedings, they won't need to keep supplying her with extra nutrients. They have increased her feedings to every 3 hours (instead of 4), so we should be able to see if she can tolerate more milk. So, the reasons for the PICC line seem to be disappearing. If they would need to give her antibiotics or nutrients down the road for something and they don't need it for an extended period of time, they will just put an IV in. UGH!! Mommy would HATE that option, but it doesn't seem to bother her to get poked with needles. Keep that up little girl!!

11.29.10

Pretty good morning update today!
The blood transfusion went great and her red blood cell count looked fantastic this morning, so that really seemed to do the trick. Because of the transfusion, her oxygen level has become more stable, which is to be expected now that her blood is back to normal. It wasn't ever bad, but her little monitor kept going off, because she couldn't maintain a consistant flow, it would drop below the standard number by one or two points then raise back up, then drop, etc.....
She is doing great with feedings and is up to 4 cc's. She will be going up to 5 today, so let's hope she can handle it, this is where we got to the last time before the infection kicked in and we had to stop for a few days.
Only bummer was that they had to take the PICC line out late last night. The PICC line is like a better option for a long-term IV. It's less likely to clot than a regular IV, that's why it lasts longer. She had it put in her left leg a couple days after she was born. Last night, it started leaking, so to avoid any infection, they took it out. Thankfully (odd that I'm saying this, since I was so stressed out about the transfusion), they had another IV put in for the transfusion, they are just using that until they decide when and where to put the new PICC line. She has really great veins (unlike her mother), so they got the first one in on the first try, so the nurse said they shouldn't have any problems getting another one put in. They will probably put it in one of her arms.
As for the swollen knee issue from yesterday - The nurse practitioner said that she thought Harper looked a little puffy all over yesterday, not just in her knee, probably because of all the fluids they had been giving her and the extra sodium. So, they gave her a little diuretic basically, so she could pee off some of the excess fluid. Her knee was a little extra swollen because she sleeps on her tummy with her legs all bent up and her knees are where the fluid pools up, she just must have been tipped more to her left side the night before. But, the swelling has gone down and she looks great today! The same nurse has had her for the last 3 days, so she would know. I love when we get repeat nurses, so comforting when they know her so well.
Very pleased with the morning report - but, as we have learned, the day is still young, more challenges may await us and we will face them. She's a little fighter and she faces each problem head on.....her mother on the other hand.....well, hey, I made a big leap today - usually, I have Matt call in for the updates because I didn't think I could handle it if they told me something bad, but today I called in! So, yay for me! Good thing it was a good report, otherwise, Matt would be doomed to call in for the remainder of her stay. :)

Another day older, another day closer to coming home.

Sunday, November 28, 2010

11.28.10 Part II

She did have to have the blood transfusion. Every time they have to do something that requires "parental consent", I get pretty anxious. They said they will know within the first 15 minutes if her body won't handle it, and we are about an hour or more into it, so she seems to be doing well. The doctor said that she has actually made it farther than most preemies do without needing a transfusion. With all the blood tests they have to do on preemies, their little bodies can't quite keep up, so it's very rare for a preemie to leave the NICU without having to have at least one transfusion.
The nurse noticed her left knee looked swollen this morning, so they have done some X-rays. This afternoon the nurse said it looks better, so the doctor wonders if she just slept on it funny. We will know more when the X-ray's come back though. Unfortunately, because of the swelling, they want to keep her leg pretty straight, so they have a little foam board taped on it. So, she has a board taped on one leg and the IV for the blood transfusion on the other leg. Because of this, she has to lay on her back, which she does NOT like one bit. Plus, preemies breathe better when they are on their tummies, so she's having to work a little harder to breathe. Ick!

11.28.10

Just called for an update -
She only had one Brady episode last night, but the nurse went in there and she had her chin bent all the way down into her chest, so that cuts off her air which can cause the episode. Little girl just needs to learn to not bury her chin in her chest.
Really good news!! Infection seems to be cleared up!! Her CBC showed that her white blood cell count is normal! But, on the flip side....her red blood cell count is low, basically because she just had an infection and they were attacked and haven't recovered. She is right on the border line of having to have a little transfusion in order to fix that count, so the nurse said don't be surprised if they call and ask if it is alright to do that later.  We still don't know what the infection was, since the blood and urine cultures have not grown anything.
Her feedings are going well, still on the 2 cc's every 4 hours. Her electrolytes came back normal so they don't have to give her any supplements, just normal IV fluids.
Last night, when we called before bed to get her weight, the little porker is up to 2 lbs. 8 oz. Now, yes, when she was born they recorded her at 2 lbs. 9 oz., but it has since been established that there is no way she weighed that much. They think she was more around 2 lbs. 4-5 oz. Then, as most babies do, she dropped some weight in the first few days. Her lightest weight was 1 lb. 15 oz., so we are very excited that she has gained so much back!
That's all for right now....all in all, pretty good update!

Saturday, November 27, 2010

11.27.10

Thank you for the great comments!! I'm kind of excited about doing this. Other, than the fact that I think I will be able to keep all of this information straight (pregnancy significantly destroyed my brain cells :) ), but it will be a great way to keep everyone updated.

Yesterday, we spent a good chunk of the afternoon/early evening up with our little pumpkin, and Matt got to hold her FOR 2 HOURS!!!! The nurse got tied up with another baby, so he got a pretty extended session with her....I'm so jealous! But I guess I've held her more times, so it all evens out. Mom got some amazing pictures before they left us to have our little family time.

Even with her infection, the doctor came in and told us that Harper had a very good day yesterday. Yay!!

This morning, we called for an update and here is what we got -
They upped her oxygen just a little, so when she has her "Brady" episodes, she won't have to work so hard to get her respiratory rate back up. "Beth - when you say "Brady" episode, are you referring to an episode of the Brady Bunch?" Excellent question, no, I am not. A "Brady" episode is defined as the slowing of a baby's heart rate from its usual range of 120-160 per minute to a rate of less than 100 beats per minute. This sound very frightening, but is really is EXTREMELY common with preemies. It's almost like they forget to keep their heart rate up. Sometimes, when a baby has an episode, you have to stimulate him/her in some way to "startle" them, so they "wake" up. It only takes a couple seconds for their heart rate to return to normal.
Harper (who has about 5-6 Bradys a day) has always been able to bring her heart rate back up on her own though, she's never had to have any additional stimulation. So, the reason for the oxygen support is when her heart rate drops, so does her oxygen. It has not been a problem for her, but why make her work harder to get her heart rate AND respiratory rate back up? They didn't up it very much though, just a little.
They did a test on her blood to see the level of antibiotic saturation and it was a little low, so they will give her a little more. It's okay that it was a little low, that just means they weren't over medicating her. Nothing has shown up yet on the blood or urine culture, so we are still not sure what type of infection it is, but they are doing another CBC tomorrow to check her immature blood cell level to see if the antibiotics have helped. She still doesn't act like she's sick, so that's always a positive.
Her sodium level has returned to normal, so they will take her off the additional sodium support today.
They will resume her feedings today at noon, but with only 2 cc's. Start her off slow and then check after 2 hours to see if she has digested anything, if she has - great. If not, we will reassess at that time. In the future, I will mention something called "residuals". She's being fed through a feeding tube, so they hang a syringe (minus the plunger) from the top of her bed and then add the milk to it and it slowly drops into her feeding tube and into her belly. Typically, after 4 hours, they put the plunger back into the syringe and suck out anything that is still left in her stomach to see how much she was able to digest - that is the "residual". We always hope for no residuals, that means she digested everything. That's how we knew something was up the other day, because after a feeding of 5 cc's, she had a residual of 5 cc's. They gave the residual back to her, but it took her almost 12 hours to digest it. That's why they stopped the feedings to do some investigating. Hopefully, whatever was keeping her from digesting the other day (infection or just giving her too much) will have worked itself out, because her bowels looked good on X-ray. I want her to eat! Good grief, our freezer is quickly filling up with milk, she needs to get going!

That's all for now. Off to see her shortly.

Friday, November 26, 2010

11.26.10

We wanted to start this blog so people could follow Harper's progression through her stay in the NICU at Overland Park Regional.

So, here goes....

Okay, this first blog will be longer because I will try and update you as to where we are so far -
She has been doing pretty well for as little as she is, but we are told to expect ups and downs, and I think you will see that as you read on that is very much the case.
Her respiratory system has always been very impressive, and she really has had very few problems with this. She has been on 1.5 liter low flow for quite some time now, which is a great thing. She's breathing room air, but still has a nose cannula in with, basically a humidfier blowing air into her lungs just to make sure they never completely deflate. A nurse the other day said she wouldn't be surprised if they don't start weaning her off that soon.
They did a brain scan the other day, which Matt failed to tell me came back clear. So, no brain bleeds, which is a great thing for a preemie! I've been worried about this since she was born and never knew that they had done the scan, so I was a little surprised when she told me "Oh, and you knew her brain scan came back clear, right?" Matt received a stern look from me, poor guy, he's had to try and remember so much while I was stuck down in my hospital room waiting to see my own doctors.
A couple days ago we learned her sodium level was down, so they have been giving her sodium supplements ever since.
That same day, she had another spell of not digesting her feeding like they would want. So, she's back off of feeding. I'm bummed about this because I want that little girl to eat so she can grow! She was up to 5 cc's every 4 hours, which was great.
Yesterday we found out that Harper's CBC was shifted. What does that mean? Well, I shall tell you. Your bone marrow shoots out white blood cells, but when you have an infection, it will shoot out immature white blood cells as well (kind of like, rookie blood cells, they aren't quite ready for battle) . When your body has an infection, your CBC will show that you have a higher level of immature white blood cells. So, we know she has some sort of infection. We aren't sure where the infection is though. They are growing a blood culture and a urine culture, to see what type of an infection it is. But, it takes days to grow the cultures (although, they will check them every day). They put her on 3 types of antibiotics, which will hopefully kill whatever infection she has, maybe even before we know for sure what it was. One of the antibiotics will kill any infection in her bowels and the other 2 will wipe anything else out. They are being very proactive by giving her all these, trying to wipe out absolutely anything they think it could be. Their two best guesses right now are something related to her bowels since she has had a couple of spells now where her bowels haven't been able to handle her feedings. Or a urinary tract infection because when she was 2 days old she had a little rash in her groin area (which they cleared up right away with an ointment), and that was awfully close to her urethra so it could have gotten up in there and caused a UTI.
It sounds worriesome to me that my little girl has an infection, but the bright spot is that Harper must not know she has an infection because she doesn't act like she's sick. The nurses still say she is feisty and cries when she's supposed to and is playful with them. I just want to be able to hold her and make her all better.
Okay - with all that said, this is what we know from today so far.
Today - her red blood cells that carry hemoglobin count is low, which is yet another sign she has an infecion. Just another thing to keep an eye on. They did a X-ray on her bowels this morning to see if there was something going on in her bowels but we don't know those results yet. Hopefully, they will be clear and they can resume feedings. She's had several poopy diapers (of which Matt has been changing), so you would think that things are moving down there.
Her sodium levels have increased, but they will still keep her on supplements for awhile. The sodium level may have something to do with the infection, but it could also not be related at all. We shall see.

Well, there you have it. Medically, that's a pretty good update for you. I'm sure these will be shorter updates from here on out. :)
Non-medically speaking, Matt and I do get to take her temperature and change her diapers. And we have been able to hold her several times. We get to do skin-to-skin holding for an hour at a time. I've held her 4 times and Matt just once. As much as I would like that to be more even, they prefer mommy to hold more. I still hate leaving her at the end of the evening, but I know that she is in EXCELLENT care and we can call in for an update whenever we want.

Looking forward to seeing mom and dad today, they will be here in a little while and then we will head up to the hospital.

More to come....