Friday, January 9, 2009

Evening Update (Friday 1/9)

(Late night update: Nurse N. reports Max's sats are holding up and she measured his head circumference at 38.0 cm, down -0.5 cm from yesterday.)

Today Max marked his 11th week in the NICU, or the first week since his original due date. Carolyn arrived at the NICU this morning to find Max wide awake and alert in his bouncy seat, sucking on his pacifier. Nurse J. reported that Max had been awake since before the start of her 7:00 AM shift. Carolyn did a full set of physical therapy exercises with Max, including head lifts, bicycles and a new arm exercise Carolyn has developed that she refers to as the "stretch--and then center". Carolyn saved for last the exercises that require Max to be fully cuddled (the others take place with Max on Carolyn's lap). In the middle of second rep, Max conked out completely and fell deeply asleep. For the rest of the day he was quite sleepy.

Carolyn and I both noticed that Max's breathing seemed much easier today. His oxygen saturation measurements were in the high 90s continuously while I was there (and I normally cause him to have at least one desat). The alarm record on his monitor showed that he's going up to two or three hours between desats, and even those are relatively mild. The docs are pleased with Max's respiratory performance off the cannula, and attribute its success to his steady dose of a diuretic (aldactazide).

In other news, our friend D. visited Max today and the two of them hit it off immediately. D. has skills as a baby whisperer that are eerie to behold. She clucked at a sleeping Max and his eyes popped wide open and he stared at her in total fascination.

The main medical issue we've been worrying about over the past few days is the acceleration in the growth of Max's head. In addition, Max's fontanels "feel full". Personally, I'm too scared to palpitate Max's head, but Carolyn, the docs and the nurses agree that they can feel more fluid through Max's fontanels. All of this suggests that we might be seeing a return of Max's hydrocephalus, something we were starting to think he'd managed to shake off. As a precaution, the NICU team ordered a head ultrasound, or HUS. The results of the HUS showed that Max's ventricles were stable; that is, that they hadn't swollen further. Max's ventricles stopped growing at about the same time that his head circumference settled down. This is evidence (we think) that whatever is going on, it isn't a dramatic resurgence of Max's hydrocephalus.

Dr. B., the attending, thinks that Max's head growth is perfectly normal. She told Carolyn today that babies' heads typically experience a growth spurt between one and three weeks after birth (one presumes that this is different from the rebound in a baby's skull following its compression during labor itself). Further, the timing of this growth spurt is, Dr. B. said, associated with gestational age as opposed to calendar age. Thus, although Max is 11 weeks old, he's only one week past his due date, putting him in the prime age bracket for a head growth spurt.

Carolyn asked why babies' heads grow so quickly at that stage. My theory--which Carolyn advanced to Dr. B.--was that it had something to do with bone growth as the fontanels closed. Dr. B. said it wasn't bone that was growing; she said that it was babies' brains that were growing.