The Plan for the Week

As I was washing up to enter the NICU this morning, my dad was coming out. He found out some information on how decisions are made in the NICU. Each baby is assigned to a resident. The residents are assigned to the NICU for one month. A doctor is assigned to supervise the residents on a three week cycle. The residents make recommendations that the doctors either approve or disapprove.

Dr. Cahan is currently supervising the residents. Each morning from 9AM to 12PM, the residents have rounds with the doctor in charge. The NICU handbook that they give parents suggests that parents and guests should not visit at that time. But Jeff and I quickly figured out that they don't pay attention to this policy. The only time that parents really can't visit is between 6:45-7:45 in the morning and evening when the nursing staff does its shift change.

During 9AM to 12PM rounds, the residents and doctor begin in pod 1, discuss the patients in that pod, and then move onto the next one. Today, I was in our pod (pod 2) before they started discussing the pod 2 babies. I was hidden in the corner behind Henry's isolette, so I got to hear the discussion about him. Nothing that we didn't already know. Dr. Cahan referred to Henry as a "trooper" and said that he was doing "awesome." That's nice to hear.

Someone had questions about his ultrasounds. Dr. Cahan didn't say anything we didn't already know. She's seen babies where the slight bleed (if it is a bleed) resolved itself, and she's seen babies where the bleed worsens and becomes hydrocephalus. They are monitoring his head circumference each week. I found out from Janice, his nurse today, that his head circumference (taken last night) was a little smaller than last week's measurement, but is essentially unchanged. Some of the head measurements are a little different because the nurses have probably measured it from slightly different spots.

As the residents gathered their things to move onto the next pod, Dr. Cahan stopped by and gave me their plan for the week. Dr. Cahan reiterated that she measures progress by week to week changes (something she told us on the first night that Henry entered the NICU). By this time next week, she'd like to see the following: (1) Henry off the Lasix, (2) Henry's weight increased, and (3) Henry on nasal cannula. She is quite methodical in her approach to achieve these goals. She doesn't believe in making all three changes at once, because if something goes wrong, she wouldn't be able to tell what triggered the reaction. So, today Henry's Lasix dose will be reduced by half. Tomorrow, they will begin adding calories to the breast milk to help him gain weight. His weight, taken last night, was 810 grams (same as the day before). If all goes well, then on Thursday, they will try him on the nasal cannula.

Since we have used the cannula during kangaroo care the last two times, I asked Dr. Cahan if it was OK to continue to do so. She said that we could do 1 hr of kangaroo care with the cannula twice a day if we wanted. I gather from talking to my dad who talks with the nurses that the 3-4 hour mark is when Henry's system is probably most tired out by the cannula. So 1 hr on the cannula should be just fine. And, it gives his nose and face a break from the CPAP.

I had missed his 9AM cares by a couple minutes this morning, so I decided to stay past noon, so I could do his 12PM cares. They went well. He had very little residual in his stomach before the feeding. When I left the NICU around 12:45PM, his oxygen set at 30% and his sats were in the 90s.

I'm happy that his feedings are going well. He has had a little reflux, but I heard Dr. Cahan say something about the vitamins being the suspected culprit in causing him to urp. He did have one questionable bout of throw up that had some green color in it on Beth's shift yesterday. But the rest of his residuals have looked OK, and his stomach is still soft. They will continue to monitor it closely.