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Wednesday, March 31, 2010

Roller Coaster Ride

The past few days have been a kiddie-size roller coaster for CA. Nothing has been too bad, nothing's been too great. We met with the doctor again last night and here's the tentative run down for the week, plus a few extra things:

Weight: Currently weighing in at 660 grams (1 pound, 7 ounces).

Neuro: They will be doing another head ultrasound this week to rule out any brain bleeds. They are also checking to make sure the white matter in her brain is developing properly/in the right places. So far she's had two head u/s and has passed with flying colors-- which is phenomenal. Brain bleeds usually occur within the first week of life, so we're mostly out of the woods with that one, (of course, anything can happen, right?) but they just like to check to make sure.

Gastro-Intestinal: She's up to 7mL every 3 hours, and they are still increasing her feeds by .5mL every 12 hours. Tomorrow they will be adding fortifier to the breast milk, which adds protein, salts and a bunch of other stuff. This takes the breast milk from 20 calories/ounce to 22 calories/ounce. If she handles that well (sometimes it sets the little ones back a bit) then they will add another fortifier which will make the breast milk 24 calories/ounce. She should be up to "full feeds" by the beginning of next week.

Heart: Her heart has returned to "normal" size and is functioning really, really well. Her arterial line (the line monitoring her BP) came out on Monday and so she's not quite so tied up anymore. Her blood pressures have been fine and they are letting her do her own thing without medication.

Lungs: These have been the cause of the ups and downs all week. The doctors are trying to find a happy medium where she is working enough on her own to get strong, but not too much to wear her out. They've been playing with her vent settings for the past few days, but it seems that one pressure over inflates her lungs and the next setting under inflates her lungs. She has experienced Atelectasis (the sacs in her lungs have collapsed in some areas) off and on this week, which in turn means her CO2 levels have been too high, which means they have to take more blood, which means she's not oxygenating as well, which means they have to change the vent settings, which causes more atelectasis... phew. Thus the roller coaster. They'll figure it out, but for now, it's a guessing game. In an effort to stabilize her lung function, they are going to give her a bolus (one large dose of medication) of a steroid called Decadron. It's a pretty powerful steroid that will clear out the inflammation in her lungs (the fluid that's making it hard to breathe). At that point, they will try to take her off the vent and put her on the CPAP machine.

Sorry... that was really long.

Adrenals: Currently, CA is not making enough cortisol (the body's stress hormone) to compensate for the amount of stress she is under. This qualifies her as having "adrenal suppression" but it isn't something that should be a problem long term. She's continuing to receive hydrocortisone to help balance this out until she is capable of meeting her own needs.

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