Day 20

Stressful stressful day in the NICU! When I got there this morning, Maks was having lots of "episodes" of bradys and desats. His hematocrit was low, so Dr. Anschutz ordered a blood transfusion of packed red blood cells. Premies have immature organs, and red blood cells, which are produced in the bone marrow, are released in response to the hormone erythropoietin, which is produced by the kidneys. His kidneys just can't keep up right now. This is a very common problem for premies to have until their organs are older and more developed. Your hematocrit is a measurement of the ratio of red blood cells to total blood volume. Red blood cells carry oxygen. A transfusion helps prevent episodes, because when your hematocrit is low, you lack energy and oxygen-carrying capacity, hence the decreased oxygenation and decreased drive to breathe. Therefore, we were hopeful that the blood transfusion would help prevent episodes. Sorry, again for the physiology lesson...
Other orders today were for decreased breast milk feedings, and a larger glycerine enema to he given one time, then a discontinuation of the previous order for enemas every 12 hours. I left this morning when the new IV was being put in for the blood.
When I came back to the hospital at 5, Maks was having a really hard time. The blood had completed transfusing, and it had clearly not helped reduce his episodes. He was now having periods of bradycardia, desaturating, and apnea (not breathing). This had been going on repeatedly, and for over an hour, the nurses had been at his bedside stimulating him to breathe. He just couldn't keep up. They called the nurse practitioner in, and lots of new orders were written. I was sad when they made the decision to put him back on the ventilator. Luckily they didn't have to intubate him with an endotracheal tube. He remained on the nasal cannula with the ventilator settings. I had been so hopeful that he would be able to remain off the ventilator, but his tiny body just couldn't keep up.
Other things that were ordered include placement of another Anderson tube on low intermittent suction to help reduce the amount of air in his belly; he was placed NPO (nothing by mouth) again; another chest X-ray and lots of labs were done to rule out infection; his caffeine dose was increased to help stimulate his drive to breathe; and he was started on a couple of antibiotics just in case there is an infection.
The chest X-ray looked good, other than his belly being full or air, but we will have to wait until tomorrow for the results of the blood work. Maks was responding well to the ventilator, and when Logan and I left this evening, he was finally resting comfortably.
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