Going without a cannula (again)

Though bathtime is usually in the middle of the night, Max got a midday bath & shampoo today (for reasons that are still not clear to me) from Nurse M. This happened just before I arrived, and I was sorry to have missed it. We haven't seen Max get a bath since one time in early November. They took off Max's cannula today at noon to see how he would tolerate it. Max's nurse today seems to think that he has things too easy and that it is time for him to start experiencing new things ("peel my grapes" she said as she walked by him today). I suspect the cannula move was her idea. During my visit this afternoon from 1:30 - 5:30 p.m., he seemed to be doing well breathing on his own: no bradys, just one apnea (according to the monitor, but I was holding him and I could swear he was actually breathing), and his usual pattern of quick desats into the 80s and occasionally the high 70s. His typical sats were in the mid-90s, and his respiratory rate seemed pretty stable, with little retracting. Our phone call into the NICU tonight continues good news on the cannula-weaning front, as Max's breathing pattern continues to be pretty stable. This is the 4th effort they've made to take him off the cannula, so maybe the 4th time is the charm.

Max spent his time with me mostly sleeping, though he did wake up for some calisthenics and to receive his public (our friend Margaret stopped by for an afternoon visit). He seemed to tolerate the activity pretty well, only turning beet-red a few times. Tonight's head circumference measurement is the same as last night's (37.5 cm) and the nurse reports that his head feels good. I think a head ultrasound is scheduled for sometime this week (the last one was just before Christmas).

Max's new year's resolutions: (1) keep head circumference growth stable and hydrocephalus in check; (2) breathe better, and (3) get the ND tube out and learn to eat from a bottle.

Lasix works

Nurse T. (a first-timer with Max---we're always surprised to meet someone new after almost three months in the NICU) reports that Max is having a quiet night. He was awake and alert for his 8:30 PM diaper change but is currently snoozing. The Lasix has continued its work all day and Max has had a series of very heavy diapers and lost 45 grams over the past 24 hours. Nurse T. got Max to suck on a pacifier. His sats remain in the high 90s, suggesting that either the Lasix or the ND tube is in fact giving him some respiratory support. However, Max is still prone to sudden but brief drops in his oxygen saturation. We think he's doing a little better on this front too, though.

Even after losing some weight, Max now weighs in at a hefty 3.3 kilos, or 7 lbs 5 ounces. One of the outfits Carolyn is dressing him has paws for feet. Also, Max now has several frog-themed outfits.

The ABDs of the NICU

In the NICU, babies are said to have "A"s and "B"s. In addition, I think they should also be said to have "D"s.

A is for apnea, babies' disquieting habit of forgetting to breathe. Max, and many other preemies, are reminded to breathe by being giving IV caffeine and having air blown at their face (hence Max's continued use of a nasal canula). Many a nurse and doctor has taken us aside to explain that "caffeine is a stimulant". Seven years of grad school taught us that, thanks very much. But if the idea of giving your infant a big cup of coffee every morning strikes you as odd, welcome to the NICU.

B is for bradycardia; in infants, when the heart rate falls below 100 beats per minute. There doesn't seem to be a good explanation for why preemies have bradycardia episodes (or "bradies"), but it seems related to their underdeveloped brains; the episodes are correlated with apneas as well. Usually, Max comes out of apnea/bradycardia episodes on his own, or with gentle prompting.

D is for desaturation; NICU patients have a red light bulb taped to their feet. This measures (sort of) the oxygen saturation of the tissues near the surface of the skin as far as I can tell. This saturation can drop because the infant is experiencing an "A" or "B", or simply for no reason at all that I can divine. Interestingly, Ada's sats were pretty good until the end, but direct measurement of the oxygen content of her blood showed severe oxygen deprivation, so the sat monitor isn't perfect.