Bump in the Road

It was a stressful afternoon. We arrived at the hospital around 5 PM. They had increased James's feeds to 11 ml at 2 PM, but he spit up some of it and also had a 2 ml residual that had just a slight greenish color to it. When the doctor examined him, she heard bowel sounds that seemed to indicate that there was a blockage, so she stopped his feedings and ordered the X-ray to check.

We were nervous, especially because when I changed James's diaper, he seemed a little more lethargic than usual. But then after that he woke up and held my finger for a while and was looking around, and didn't seem like he was sick. His breathing and heart rate were also good, and he was on the same amount of oxygen he'd been on (just a little bit above room air). So those were promising signs.

At this point he does not appear to have a recurrence of NEC (thank goodness!) Instead, it looks like he has some kind of blockage, so that the food is not getting all the way through his intestines. It may be that part of the intestine just isn't moving things along the way it should, and that giving him a rest from more feedings will give it a chance to get going again. However, it's also possible that he has a stricture, which is a possible complication from his previous NEC. This happens when scar tissue causes a narrowing of part of the bowel. They're taking another X-ray later tonight to see how things are looking, and if the problem is persisting, they'll probably do a contrast study (where they put a dye through the intestines to see if there are narrow or blocked areas). We hope it's not a stricture (because that may require surgery to fix it), but given his history, we wouldn't be surprised if it is. We'll just have to wait and see. So, it's not a good thing, but our impression from the doctors is that it's also not something that puts him in immediate danger.

Matthew is doing fine. When we arrived, the nurse told us that they had increased his feeds to 48 ml (from 38 ml). That didn't sound right to me, because they usually increase by 3 ml -- not by ten! The nurse hadn't had Matthew before (in fact, both of the boys had nurses we'd never met before, which didn't help our stress levels), so she just assumed that they were adjusting for weight gain or fluid levels. I asked the doctors about it, and they didn't think it was right either -- so they changed it back to 41. Mike gave him a bottle tonight and he did pretty well (drinking about 20 ml). He was sleeping soundly during his 8 PM feeding, so we didn't even try at that one.

Mattie is still on medication for high blood pressure, but at least for today's readings, the medicine seemed to be controlling it, which is good. They're running some additional tests to hopefully rule out some of the more rare (and serious) causes of high blood pressure, but we won't know those results for at least a few days yet. (I hate that kind of waiting.) He's not showing any clinical signs that would indicate something more serious, so they still think the most likely possibility is just a small blood clot in the kidney that will resolve on its own.

Added from Mike: Here is James from today. It looks like he is pooching out his tummy a little bit. The doctor showed us his 5 pm x-ray, and we saw what looked like a few loops of bowel that were dilated. And the video is of Melanie with Matthew.