Monday, December 1, 2008

Midday update (Monday 12/1): Bring on the prune juice

Carolyn is at the NICU and reported back the morning's developments.

On the northern front, no major developments, although we may be getting a clearer picture of how much damage Max sustained in the next few days. The docs have ordered a further head ultrasound to check the evolution of the ventricle swelling and to look for signs of PVL. As always, they are keeping in mind that some of Max's respiratory and gastric problems might be neurological in origin and hence might call for further taps to relieve intracranial pressure.

The docs confirmed something we've heard often, which is that they won't implant a shunt until Max's GI system is in working order. The shunt drains CSF into the abdominal cavity; also, in babies, there is a large built-in coil of tubing that allows the shunt to go without revision for several years.

On the southern front, the big news is that the NICU team have decided to roll out the most powerful drug in their arsenal: prune juice (more on that below). In other news, Max's NICU attending votes against his fellow and an unnamed radiologist, but with the surgeon, and casts his lot with the Max-doesn't-have-Hirschsprung's crowd. (That makes the score 2-2 pro-con Hirschsprung's.) Other possible causes for Max's gastric distress include an electrolyte imbalance, neurological function, and an upper GI problem that hasn't otherwise manifested itself. However, this latter possibility is unlikely because of the relief provided by suppositories.

In addition to using prune juice, the NICU team are going to up Max's caffeine dose. Max will be getting three ccs of prune juice twice a day. Carolyn tells me that the dietitians rolled their eyes at this; it's the equivalent of the nuclear option and they expect his bowels to begin seismic activity. We can only hope.

In other news:
  • Max is anemic and they're going to start him on supplemental iron.
  • They're not that concerned with his desats: Max's measured oxygen sat will often dip into the high 70s, set off an alarm but then return. The thinking is that this is related to his reflux or gastric distress.
  • The neurosurgeons commented on how cute he is.
  • The prune juice went in at the noon feed; Cj reports smelling something but we'll know for sure at his 3:00 PM cares.