From January 11

Max pulls on his ND tube
Originally uploaded by andreas.lehnert

Here's a video from the archives. Max is still at Georgetown, in the high-intensity side of the NICU. This video was taken during the period when Max had his NG tube pushed into his duodenum in an attempt to cut down on his reflux-related aspirations. At the time, these aspirations were seriously damaging his lungs' ability to maintain a high blood oxygen concentration.

Max can be seen pulling at his tube; in fact, later that night he would successfully pull it out.

He pulled out his NG tube here at home a couple of nights ago. Fortunately, placing an NG tube is relatively simple matter. Forcing a tube into the duodenum or further (e.g. into the jejunum) is a more serious matter, requiring skilled nurses, an x-ray and a couple of hours.

I may try placing an ng tube into my own stomach just to see what it's like.

ND tubes mean continuous feeding

Carolyn just phoned the NICU and got the nightly update on Max. She also reminded me that, with his new ND tube, Max is not fed every three hours as he had been. Instead, he gets a continuous trickle (20 ccs/hour) because the the duodenum cannot handle large quantities at a time. Max's food now hangs on what looks like an IV bag.

Max's night nurse, J., has had him for three nights now. She felt that his breathing was perhaps a little easier (he was "retracting" -- a sign of respiratory distress -- less often). She also thought that his head felt better, i.e. the fontanel was softer. As always we update his head circumference every night. Over the past few nights, Max's cranial growth rate has run just a little faster than the 0.5 cm/week rate that it had averaged since late November. No one seems to be concerned about this.

Finally, Carolyn informs me that Max has outgrown a lot of his preemie outfits and is now being dressed in normal newborn clothes. Can it be long before the "statistically significant" onesie reappears?

First day on an ND tube

Like lots of people all over the world, Max spent last night throwing up. However, unless there's been a sudden increase in the popularity of barium-based cocktails, I think Max was vomiting for a completely different reason than, say, the college kids who live next door to us. Max's swallowing study yesterday required him to drink some barium-laced milk, which can cause stomach upset. I think he settled down starting with him 8:30 AM feeding.

Max also got a different kind of feeding tube installed today. The NICU put in what I believe is called an "ND", or nasal-duodenal, tube (as opposed to the previous "NG", or nasal-gastric, tube). If I have this right, the tube passes through the pylorus and delivers food to duodenum. The idea is that this reduce Max's habit of inhaling the contents of his stomach that pass up the esophagus because of his reflux. The NICU team think that this "reflux aspiration" is affecting his lungs. They hope that the ND tube will lessen the reflux and give his lungs a chance to develop.

In the spirit of the season, a picture from one year ago today (we've got to quit spending the holidays in hospitals):