One Step Forward

Jeff and I had a frustrating experience last night (6/5). Kim was his nurse again. Melissa J., who is one of Henry's primary caregivers, was on duty and wanted Henry, but Kim had him the night before and didn't want to switch. Melissa really likes Henry and got him a 5-week birthday present (a cute blanket and an adorable small bull blanket).

When we arrived, Kim mentioned that Henry had been so quiet that she didn't want to disturb him to change his diaper. That was OK, I suppose...although he had had quiet day yesterday and his diaper had to be changed some time. Jeff and I let him sleep for a half an hour longer and then said we were going to change him.

He started spitting up during the changing. Kim told us to suction it out, which we don't mind doing, but she didn't seem to pay attention to how much he was spitting up. This bothered me because spitting up is obviously an indicant of feeding intolerance (hence you'd want to track how much there is).

While changing him, we noticed that his mottled color looked worse. The previous evening (6/4) when Henry looked mottled, I was very concerned. Jeff couldn't see the mottling. Well, last night, Jeff became a bit concerned because he could definitely see it. Henry's stomach had a gray tinge, distinguishable from his chest color.

When Kim comes over to inspect Henry's stomach, she told us how preemies can make it. She once took care of a baby that was very small, and the baby made it. Of course, her twin brother died (who happened to be named Henry). You are probaly wondering why anyone would tell this to the parents of a 25-weeker named Henry. I was wondering the same thing. Rather absurd.

Kim didn't seem to think that there was anything unusual in Henry's state. She thought his color looked better than the previous evening. It wasn't. Jeff and I asked her to get one of the nurse practitioners. We wouldn't have been able to sleep without making sure that everything was OK before we left.

Mary Ann Roberts came over to look at Henry. I explained my concerns to Mary Ann. I told her about how his color seemed worse to me than the before. Kim interjected that she had noticed the night before how he looked mottled and how that was bad (mind you, that's a bit different than how I remembered the evening's events; I seem to recall that I had raised the concerns, not Kim). Mary Ann did a thorough inspection of his stomach. She could feel some air in one of his digestive loops but said the stomach was soft. That was a relief. We really like Mary Ann. We talked with her for about half an hour about various microbiology issues (including the biology behind handwashing). We left feeling comfortable, knowing that Mary Ann was keeping watch.

Jean was Henry's nurse this morning. She told my dad that Henry had been restful. She said that his weight was 840 grams. They do the weighings in the evenings. I thought that his weight had been 860 grams, but perhaps he had been weighed again after we left last night. Or perhaps last evening's nurse had entered his weight incorrectly.

When I arrived at the hospital in the early afternoon, Sherry had taken over for Jean. The big news was that they decided to try him on the cannula again. They had put him on it at 10AM. He wasn't quite as steady with it as with the CPAP, but he was doing OK. His sats stayed in the 90s for the most part, but he did do a little surfing. He had a few apnea and brady episodes, but he got out of them himself. Sherry was on top of the situation. Anytime the alarms went off, she was there in an instant.

Sherry had him swaddled, which seemed to keep him relaxed. He got un-swaddled during 3PM cares and was active. His sats were great during cares. My mom arrived during cares and stayed for about an hour after I left. Sherry told her that she thought that they were experimenting with the cannula, but that given the bradys and apnea, she thought they'd switch him back to CPAP. I'm not surprised. I am glad that his face was getting a bit of a break from the CPAP at least.

He's still on continuous feeds (3ml per hour). They are talking about having him go back to regular feeds soon. Don't know when this will happen. And, they decided to give him one dose of Lasix while I was visiting.

So all in all, things look OK. The move to the cannula is one step forward, but realistically, we might move one step back by this evening.