Lauren managed to work the breathing tube out this morning and had to be reintubated. Her oxygen saturations and her heart rate dropped some, but they got to her in time and no damage was done. She is resting quietly on the vent again and her vital signs are stable. Her last dose of Vancomycin was early this morning, and there are no signs of MRSA infection any more, but the nurse says that they will probably keep her on contact isolation for the duration of her stay due to infection control guidelines in place to keep cross-contamination to a minimum. Mommy and Daddy will have to gown up and wear gloves each time they visit.
10/30/01 11:00AM:
Baby Lauren had a good night on the vent. Her feedings have been increased to 17 cc's every three hours. She has not had any bad apneic periods on the vent. Her weight last night was
1 lb, 12.4 oz, a big jump. Her belly looks more distended this morning, but she is still having stools from her ileostomy site.
10/30/01 6:30PM:
Lauren is not having a good day today. Her belly is more distended and is tender to the touch (she cries when they touch it). They are putting her on a combination of two antibiotics (Vancomycin and Tobramycin) in case there is an infection in her bowels. They are stopping the feedings for now and are starting her on IV fluids. They are putting the gastric tube to suction to evacuate the contents of her stomach. Some of the possible causes for the distended abdomen include an infection in the bowels, an infection in her abdominal cavity, a blockage of her bowels, an ileus (when a piece of the bowel does not work but is still viable), recurrent N.E.C., or feeding intolerance. Of these, NEC is the worst and feeding intolerance is the least dangerous.
10/31/01 11:00AM:
Lauren's condition is deteriorating. Her belly continues to get bigger, and she has stopped passing stool from her ileostomy site. They did an abdominal x-ray this morning and it shows lots of stool and air in her bowels. It is starting to look like she has either a blockage, an ileus, or NEC. Her abdomen now looks red in addition to being distended, and it now feels hard to the touch. The neonatologist is adding Amphoteracin to her antibiotic regimen in case it is a fungal infection. They are going to have Dr. Bufo, the pediatric surgeon, come examine her.
10/31/01 7:00PM:
Lauren's status has deteriorated further. Her breathing slowed down, so they increased the vent settings to full support. They attempted to put in an arterial line so they could monitor her blood gases, but were unsuccessful. Dr. Bufo examined Lauren and was unable to pass a catheter into the ileostomy stoma, indicative of some sort of blockage. He did a contrast GI study under fluoroscopy (put a contrast agent into the bowel under continuous x-ray) to see where it went. The results showed that Lauren has a perforation somewhere in her bowel that is allowing bowel contents to go into her abdominal cavity. If this is not fixed it could lead to a fatal infection, so Lauren is going to undergo emergency abdominal surgery once again. Dr. Bufo says he is very concerned because if the cause of the problem is N.E.C. and it has spread throughout the entire bowel, our baby girl will not survive. We are afraid for our litte girl - we don't want anything to happen to her. I wish I could trade places with Lauren so she doesn't have to go through this...
10/31/01 11:50PM:
Lauren is back in the NICU in stable condition after her surgery. Dr. Bufo informed us that he found a piece of bowel that had formed a loop, stopping the passing of stool, restricting blood flow, and causing it to become necrotic (dead). He took out the bad piece (3-4 inches) and made another stoma. Other than that, he said the rest of the bowel looked good. He said Lauren is lucky that the loop didn't form on the other side of the stoma - that side is the one that absorbs fluids and vitamins. They are going to keep her off gastric feedings for about a week and are going to start her on TPN intravenous feedings again. They will then try to start her on gastric feedings little by little again. Mommy and Daddy were both supposed to work tonight, but Little Lauren just wanted them by her side on halloween...