It's Always Something

Beyond the high blood pressure, Matthew didn't seem to be quite himself yesterday. His temperature was a little low, which may have been due to the fact that he was undressed and in the open air for quite a while in the morning while they did the kidney ultrasound (which showed normal results, according to the initial report). Then he didn't do well on his cannula; he started having breathing problems after only about an hour, whereas usually he can do three hours with not much trouble (and ironically, this was right after the orders to give him up to six hours on the cannula per shift). And his belly was big, something which they'd been keeping an eye on for a few days. (There are some benign possibilities for why his belly was big -- the CPAP can introduce extra air into the belly, for one, and for another, we thought it was possible that it was just his build and his weight gain.) Of course, after James's experience, we are paranoid about the possibility of necrotizing enterocolitis (NEC), so we asked them whether it made sense to do an X-ray to check. In the afternoon, they said no, because he really had no other symptoms (he was still pooping, still had bowel sounds, was generally stable with his vital signs, etc.). But although he was still mostly tolerating his feedings, at his afternoon feed, he pushed a lot of milk back up into the venting tube. (They attach an empty, open syringe to the feeding tube after the milk has been given, to help air get out. But when a baby tenses his stomach, sometimes some milk gets pushed out as well. Matthew has pushed out a tiny bit of milk before, but this time it was a lot.)

Then when the night shift came on, the nurse measured his belly and it was two centimeters bigger than earlier in the day. This was enough to cause them to order the X-ray. (Of course, we always get a big song and dance about how they don't want to expose the babies to unnecessary radiation -- which is true and perfectly sensible -- but once again, there was a problem with the first X-ray and they had to do it again! It is possible that this time it was Matthew's fault, since he is a squirmy one.) The results came back and the findings were not consistent with NEC (thank goodness) but he did have an ilius, or air in his intestines. (This is air inside the intestines themselves, rather than the air bubbles between the layers of the intestines which are a sign of NEC, or air bubbles outside the intestines which indicate a perforation.) This suggested that things were not moving through the intestines in the way they should, and so they suspected that he might have some kind of blood-borne infection. His white blood cell count was a bit low, which also may indicate infection (although it was not low enough that they were 100% sure).

They put him back in the radiant warming bed (so he's temporarily demoted from his isolette), took blood and urine samples for cultures, started antibiotics, and stopped his feeding. (I was a little upset that they had to give him an IV again and also had to use a catheter to get the urine sample, because any time you have something going into the body like that it can be a pathway for infection -- but then I realized that since he was already getting two kinds of antibiotics, that was probably the least of our worries.) They also gave him a blood transfusion because his hematocrit was low (anemia), and even though his body was making more red blood cells, they didn't think it was going to get back up to speed quickly enough.

His night nurse thought that he was looking much better after the first dose of antibiotics, and he was definitely feistier then. And his nurse this morning (his primary) thinks that he's pretty much his normal self -- when we called, he was crying and fussing, and she thinks it's because he's hungry. (Poor kid! He had a little tiny feed today and they'll see how it goes; he may get IV fluids or they may try to move him back to milk.) His blood pressure is still high, though; they're giving him some medicine but haven't quite figured out what's going on with that.

The cultures to test for infection generally take about 48 hours; if something grows, they'll know he has an infection and they'll know what it is. They also use that information to figure out which antibiotic is best for treating that particular infection.

Obviously it's not good that he has a possible infection and some intestinal troubles, but at least so far it looks like the antibiotics are helping get rid of whatever it was. We know that things can change quickly, though, so keep your fingers crossed for him!

James is doing fine, still on the CPAP with no problems. His X-ray today showed a very slight improvement, and they're hopeful that tomorrow might be a clean X-ray.