Thursday, January 8, 2009

Afternoon update (Thursday 1/8)

(Late night update: Head circumference now up to 38.5 cm, but nurse H. reports that otherwise Max is doing okay tonight.)

Carolyn called with an update from the NICU. She said that his head still felt full, i.e. she could feel more fluid under his fontanel than we've seen in the past. The nurses remeasured his head circumference a couple of times last night to see if perhaps it would fall, or they had mismeasured it, but to no avail. He's 38 cm around and that's solid. So there's something going on in there. Carolyn wondered if he might be starting to get interested and curious about the world around him, and his brain was expanding to accommodate all the extra thinking he was doing.

Indeed, Max seemed very engaged in the world around him today. Reports are that he spent the morning outside of his crib, in his bouncy seat, and was awake the whole time. He had a great physical therapy session this afternoon: he lifted his head, he followed sounds and motion, he brought his arms up to his chest--all the things that babies are supposed to do. Physical therapist J. also told Carolyn that it was perfectly normal, and indeed a good sign, for Max's arms and legs to sometimes be tense and other times to be relaxed. Problem babies sometimes are always tense or always floppy. Although I don't think Max had a speech therapy session, he sucked enthusiastically on his pacifier.

Max's breathing continued to seem easier, despite the greater demands on his system today. (The bouncy seat and physical therapy are hard work for babies.) Carolyn reports that his breathing rate was mostly moderate, and never escalated into the 100 breaths-per-minute range that we've sometimes seen. Although he sometimes "retracted" (i.e. visibly labored at breathing) it was never for long.

Nurse M. also administered his vitamins orally--a foul-smelling concoction. He spit the vitamins back up, along with some milk. (To be clear, I'm using "spit" in the way that parents, athletes and models do: to mean "vomit".) Of course, Max's stomach isn't supposed to have any milk in it because his feeding tube now goes past the stomach and terminates in the duodenum. How did milk make its way back up to the stomach? It's a mystery, and it elicited some truly odd theories from the NICU team, but it doesn't seem like a big deal.

So has Max's hydrocephalus come back? Somethings going on inside his skull. But he's not showing the classic signs of hydrocephalus, including "sunsetting"--having eyes chronically half-lidded. Indeed, he was bright eyed for much of the day. We'll just have to watch each night's head circumference reading closely. While we're waiting to see how this evolves, Max is becoming cuter and more engaged with the world every day.