Emma continues to do well on CPAP. Her oxygen levels do drop from time to time, but I understand that is to be expected given her age. The nurse tonight mentioned that they may start trying her on nasal prongs (i.e. just a bit of extra oxygen) soon. They start with about an hour off CPAP and work their way up from there.
Emma and I did some multi-tasking today. During our Kangaroo Care Cuddle this afternoon, she had her lunch (milk mixed with a vitamin solution, hence the icky colour of the liquid in the gavage tube) while I rocked her. One of her nurses walked by and saw that she was trying to find/suck her thumb. Luckily, I’ve started bringing a camera with me every day, so we were able to catch the moment 
(click on the image for a larger version)
The pic also shows Emma’s CPAP, which sort of looks like itty-bitty scuba gear. A tiny little mask covers her nose and is connected to a tube which can deliver varying degrees of oxygen/air pressure making it easier for her to inflate her lungs.
As Eric mentioned last night, Emma continues to do well on the CPAP, and apart from the odd apnea spell, has been fairly stable over the past few days… She’s scheduled to have the first of several eye examinations later in the week, but apart from that, all she has to do now is grow and get stronger.
I had Emma out for an hour-long feed and cuddle tonight. She’s still doing well on CPAP, is tolerating feeds well, is gaining weight, and is off antibiotics. While she continues to need supplemental oxygen when she is handled, she spent much of the day cruising along at 21%.
Laurie and I are thrilled with the progress our little fighter is making, and I hear that she’s already somebody’s hero.
Emma has had another good day (except for one very scary spell in which her heartrate remained distressingly low for what seemed – to Mommy at least – like a VERY LONG time!). She’s doing so well, in fact, she’s being moved to another room in the NICU for babies who are not as acutely ill. That is a huge step in the right direction!
She’s still doing very well on CPAP and was even able to keep her oxygen sats. up while breathing unassisted (i.e., not receiving any additional 02) for about 2 minutes tonight while the respiratory therapist was doing her care.
Her weight today was 1032 grams (or about 2.4 pounds). As last night’s picture shows, for such a teeny little girl, our lovely Emma has half-pound cheeks
With the cooperation of a kind RT, I was able to get a pic of Emma’s face last night. She’s showing solid signs of weight gain.
(Click on the image for a larger version.)
Emma’s had another good day. She continues to to well on CPAP, is tolerating feeds well, etc. I was at the hospital for her 8pm meal and held her. She stared at me for a while and then drifted off to sleep.
Emma is 6 weeks old and has had a very good day. Her blood culture came back negative, meaning she does NOT have a blood infection (a possibility raised earlier in the week), so one of her antibiotics was discontinued. She’s still on CPAP and while her oxygen saturation levels drop from time to time, she is usually able to recover on her own without intervention by staff. The docs are pleased with her progress… here’s hoping it continues!!
After having a nice cuddle with Mom this afternoon, Emma was moved into a new isolette. Apparently she’s considered to be “a big girl” now and no longer needs the “Cadillac” incubator with an extra heating element and humidified air
Just as her nurse started her standard care (which includes taking her vital signs and suctioning her airway), Emma vomitted up part of her last feed and some of it got into her ET tube. The nurse wasn’t able to clear it all, so she decided to remove the tube entirely. The team was considering extubating Emma and putting her back on CPAP some time tomorrow, but our little diva, in her dramatic fashion, decided she wanted that darn tube out today! So, after a frenzied few moments involving two neonatologists, a couple of respiratory technicians, and several nurses, Emma is back on CPAP! As of this evening, she was doing very well on it. Let’s hope she’s able to maintain her oxygen sats. at acceptable levels and is rid of the ET tube and ventilator for good!
In other exciting news, Emma is now a full-fledged member of the “Kilo Club” (complete with a certificate signed by her nurse and doctor) as her weight has reached a full kilogram. Finally, a happy milestone to celebrate!!
Emma’s doing much better today. She does appear to have bacteria either in her lungs or the ET tube, but the antibiotics should take care of that. Most importantly, her urine output continues to be fine, she’s tolerating feeds, and they’ve started the process of slowly reducing her vent rate and oxygen concentration. As of tonight she’s down to 25 per minute (as compared to 50 last night) and they’re running oxygen around 27%.
Tonight Emma was the most active I’ve seen her so far. She was sucking on her soother and exploring around with her hand while I fed her. Looks like she’s finally on an upswing!
Despite the fact that Emma is back on the ventilator and is getting help to breathe, she’s not recovering as well as the team had hoped. There are a several issues we’re dealing with today:
1) While her oxygen requirements aren’t terribly high (typically running between 25-30% unless she’s being handled by the nurses when she needs as much as 50% O2), her ventilator setting remains high (i.e., she’s at 50 bpm and can’t be switched to the CPAP again until she’s stable at 15 bpm).
2) Although she received a tranfusion yesterday, her hemoglobin remains low (same as it was yesterday, pre-transfusion), so they’re giving her another unit of blood tonight.
3) Emma hasn’t had a pee since 3:00 p.m. yesterday. At first, the team wasn’t overly worried and thought it was due to a combination of the morphine she was given during the re-intubation procedure, the several doses of diuretic she’s had over the past few days (which “dried her out”), and the fact that she’s been exhausted. As the day wore on though, they became increasingly concerned about her, gave her extra fluids in an effort to get her to pee, and eventually inserted a catheter. She still wasn’t peeing, so they’re now wondering if she has a kidney or urinary tract infection. More testing to be done tonight.
4) The trach. aspirate culture came back positive indicating Emma has a bacteria in her lungs/airway. They’re not sure if it is the same infection she had a couple of weeks ago or not, but they’ve started her on another ’round of antibiotics.
We wish Emma could just get a break… it’s so hard to see her struggling.
** Update ** – Emma finally had a really big pee for her Dad who was waiting to change her diaper this evening, so the team is not as concerned about it now… One less thing to worry about.