Wednesday, December 17, 2008

Mid-morning update (Wednesday 12/17)

Today's watchword is "measurement error".

Carolyn went in this morning quite early. When she got there, Max was repeating the sort of desat I had seen last night in reaction to his feeding, despite the fact that the feed was going in over an hour (and the same thing happened overnight too). Last night Carolyn developed the theory that Max's new feeding tube was to blame for the sudden onslaught of problems eating, although the NICU team were dubious. The pure time series correlation is suspicious in my view.

At morning rounds, Dr. M. looked at the chart and said "something's not right here." Carolyn advanced her theory again, Dr. M. gave it a sympathetic hearing. He said that sometimes the feeding tube is too long and curves back up the esophagus. The NICU team determine the how much of the feeding tube's to run into the baby based on the baby's length, and Carolyn noticed that more of the tube was inside Max now than before (the tubes have length markings on them). But we know from peeking in his chart that measuring Max's length is an error-prone business, unless he has the habit of routinely shrinking and growing 2-3 cm every few days. The NICU team are going to look seriously at the feeding tube issue: not quite sure how they're going to do that.

Nurse J. measured Max's head circ again at morning rounds, and again got a circ of 35.5 cm (35.5 is the new 35.0). You may recall that Nurse A. got a reading of 36.0 cm at last night's official measurement, and that's what is currently up on the spreadsheet. A couple of members of the NICU team felt Max's fontanel and said it felt "good". Ominously, absolutely no-one suggested that Max's recent problems might be related to hydrocephalus. This had been their fallback explanation for everything up until now, including a now-hilarious episode where they tried to treat Max's constipation with a spinal tap.

For now, Max is resting comfortably, and is back on a nasal cannula to give him a little respiratory support.