A Little Longer

The doctors left it up to us whether to take Mattie home today or have him stay in the hospital just a little longer. For the reasons we mentioned in our previous post, we felt that today was just a bit too early. They took him off one of his three blood pressure meds today, and if he does fine without it (as they expect), it'll at least be nice to only be giving him two meds (and vitamins) at home. Also, he's been losing a little bit of weight rather than gaining the last few days, and we'd like to see that he's doing well enough with his feeding to be gaining before he comes home. I think another couple of days will allow us to just celebrate his homecoming when it arrives, rather than having these lingering concerns.

We were upset this morning because Mattie had been back on a monitor after his vaccination (which he received late last night), and the doctor told them to take it off. That didn't make sense to us, because although the risk of Matthew having apnea after the vaccine is very low, the cost of monitoring is essentially nothing (it's just a little probe taped on his foot, and the computer setup is already right there by his bed), and the cost of him having an apnea that goes unnoticed is very very bad. So we went into the hospital earlier than we had planned to talk to them about this.

The doctor's reading of the research literature is that for babies like Matthew who have not had apnea immediately before the vaccine, there isn't an increased risk afterwards. He actually gave us a research article reporting a clinical trial that showed (nonsignificantly) lower risk of apnea after vaccination -- but, that article cited five or six previous studies (I'm assuming not randomized trials) that reported increased risk, and even in that article, both the study and control groups had about 16-20% of the babies who had apnea after vaccination (but I didn't see any analyses separating out babies who had been having apnea before versus those who had outgrown it). He said we could look at the literature ourselves if we wanted (and we have indeed done that for some of the other issues the babies have faced), but that didn't seem the most helpful suggestion given that the increased risk is just for 24-28 hours, so by the time we did the research, it would be a moot point!

From the doctor's perspective, the risks of monitoring are that false alarms would encourage unnecessary interventions (and the alarms do indeed go off when there's not a real problem; for instance, bearing down when they're working on a bowel movement causes a temporary drop in breathing, etc., but that's not something that needs any intervention), and that in a broader sense, having a lot of "false" alarms raises the chance that the staff would miss a real alarm. I can certainly understand those concerns.

I'm pretty sure he was right that Matthew was not at risk for apnea, and I'm confident that none of our doctors would intentionally put a baby at risk (and this doctor is extremely experienced and very well-respected), but I did not want to take the chance that he was wrong (or that Matthew was an exception to the general rule) when preventing a problem was so easy to do. So I asked them to please humor us and do the monitoring just for a short period, and they agreed.

James (top picture, with Mike) is continuing his recovery. He'd had a tube that was suctioning the secretions out of his belly (a replogle), and things looked good (that is, a lower volume of secretions means that things are starting to move through the digestive system), so they took that out. (I'm sure he's much more comfortable without it!) He also doesn't have quite as many IVs in as he did a couple of days ago. They tried taking away his cannula to see if he was ready to go back to room air, and it seemed like he wasn't quite there yet, so they put it back on after about an hour. He's still on the lowest cannula setting (so, he just needs a little breathing help, but not much.) They're planning on starting to feed him soon, probably tomorrow. Keep your fingers crossed -- hopefully this time will be the charm!

Grandma Green is back for a visit -- Matthew enjoyed hanging out with her (bottom picture)! She would have been happy to bring him home right then. :)