The Emma Report

Emma’s blood pressure remained distressingly low until mid-day, but eventually came back to normal limits after she was given several medications. There was some concern about her renal/kidney functioning for a while too, although that seems to be resolved now. The results of the echocardiogram were also normal, indicating good flow through her heart valves/vessels/chambers.

Overall, todays post-surgical developments were not unexpected in a preemie of Emma’s size although they mean that she will likely be staying at the Children’s hospital for a while longer until she is more stable (before going back to the NICU at the General).

Prior to surgery, the alarms from the machines monitoring Emma’s breathing and oxygen saturation rate were going off very often, indicating she was having frequent apnea spells (in which she stopped breathing on her own). As I mentioned last night, they hadn’t been ringing since she returned from her operation. While I had taken this to be a positive sign, her nurse conceded that they simply had not reattached the same leads to the monitors. I was disappointed upon hearing this, but Emma’s nurse reassured me that she is breathing much easier now and they will likely be reducing her ventilation requirements over the next few days.

On another positive note, Emma has gained a fair bit of weight… She’s up from 1 pound 8 ounces at birth to 1 pound 13.5 ounces today. Yay!

Emma’s blood pressure dropped last night, causing some concern. She was given some extra fluids and started on dopamine to increase her BP. Her hemoglobin levels are a bit low, and she’ll be getting a transfusion today to address that. They also just finished an echo to have a look at her circulation. She’s now stable and resting quietly.

I just got back from visiting Emma again and, according to her nurses, she’s had “an excellent day.” She’s been sleeping peacefully since the surgery this morning and the alarms on her monitors have not gone off a single time all afternoon/ evening! She’s been given a bit of morphine for pain management, but does not seem to be in any distress at all. She just *looks* so much better…

I think we’ll sleep better tonight.

We’re home now after having a chat with the surgeon and a quick visit with Emma, who is sleeping comfortably back in the NICU. As it turned out, the duct was quite large and had thin walls, so the surgeon opted to place a 4mm titanium clamp on it. He indicated that the lung he saw looked quite good, and that her blood pressure came up nicely when the clamp was applied. The only downside of the clamp is that it may apply pressure to one of the nerves connected to the vocal cords, and if it does, it could result in a hoarse sounding voice. We’ll have to wait and see.

Needless to say Laurie and I are both greatly relieved that things went well and that this hurdle is now behind Emma.

Just saw the anestheologist in the hallway – everything went well! We’re waiting to see the surgeon.

Nurse just dropped in – so far surgery is going well.

Waiting sucks…

I just spoke to the surgeon. Emma’s WBC remains elevated, and they have detected a small amount of bacteria in her urine, suggesting a UTI. She’s otherwise asymptomatic and the bacteria is possibly a side-effect of the antibiotics. They have stopped the two antibiotics they were giving her, and started a new one. They’ve also stopped feeding her breast milk to reduce the load on her digestive system. The surgeon, neonatologist, and physician from infectious diseases have discussed the case and believe that the benefits of proceeding with the PDA ligation outweigh the risk related to an unknown infection and they’re scheduling surgery for tomorrow morning.

Overall, Emma had a fairly stable day and she slept peacefully throughout my visit to the NICU tonight. As Eric mentioned earlier, her WBC count remains elevated although she is otherwise asymptomatic and shows no signs of infection. Given that the docs are still somewhat reluctant to proceed with surgery when the cause/ location of the infection remains unknown, they asked for a consult from the Infectious Disease service. The I.D. team was in to see Emma this afternoon but they too are uncertain as to the cause…

Emma received another blood transfusion today (her 3rd) but thankfully has not had any further episodes of prolonged bleeding after blood draws (as she had late last week). She didn’t tolerate her breastmilk feeds again though, so they have been discontinued. She is scheduled to have an abdominal xray tomorrow morning… hopefully there will be no evidence of NEC (necrotizing entercolitis, a common but v. serious gastrointestinal disorder seen in preemies). She’s also going to have additional blood tests and a chest xray. Once the results of all of these are back, the team will make a decision regarding surgery. We hope to know by noon tomorrow…

Thanks to everyone for their good wishes… I was finally released from the hospital on Friday evening and am feeling better. Apart from mild anemia and another week on antibiotics, I should be as good as new soon.

Emma’s white blood cell count, which had dipped to 18, is back up to 23.9. Blood cultures are still negative, she’s been treated with broad spectrum antibiotics, and she’s not showing any other signs of being sick, so the cause of the elevated WBC remains a mystery. She seems to be doing fine otherwise.

We all went over to see Emma before dinner. Her WBC is back up again, suggesting that she still has an infection, but a second blood culture is still negative after 48 hours, so we don’t know what the infection is or where. There also seems to be leakage around her ET tube, and the ventilator is alarming every few minutes. She had a two hour period this afternoon during which her oxygen levels became unstable, but things seem to have stabilized again. The plan is to insert a larger ET tube in the operating room in order to avoid the need to sedate her a second time.

Despite all this she’s resting comfortably and everything else looks good. She opened her cute little eyes a few times, and occasionally stretched her legs. We’re hoping that her condition remains stable and that they’re able to move forward with the PDA ligation surgery in the near future in order to reduce the load on her lungs and heart.