a little speed bump

Madilyn had a little bit of a tough weekend. Saturday she was pretty agitated with no apparent cause. She must've been pretty tired from Saturday because she had several apnic/brady spells that she didn't self-recover from. The nurse had to stimulate (usually means agitate) Madi to get her breathing again. Her chest started to sound a little crackly so they ordered a chest x-ray and found fluid around her lungs. They also did a blood draw and found her hematocrit had dropped in 4 days from 35% to 29%, normal is 35-40 for preemies. The third whammy was that Madi appeared to be hanging onto some solid waste. Thus we began the adventure of trying to find what will reduce her apnic/brady spells instead of waiting to see if she grows out of them.

The hematocrit they were going to watch and see if she bounced back on her own. Solving the waste problem was easy - suppository time. To combat the fluid around her lungs Madilyn got a diuretic (lasix). Add those two together and we were anticipating some pretty hefty diapers.

Sunday night she did as expected - 20g diaper. But she also wighed 60g less. They introduced feeding her on a pump over 20 minutes to see if that helped with her sats. Fill her belly slow instead of in about 5 minutes. Our opinion was that it didn't help since Madi didn't get an empty tube to reflux into.

Monday morning's blood draw showed Madi's creatinine had creeped up to .7 but since it was less than 1 they weren't overly concerned, just another something to keep an eye on.      fluid in lungs - hematocrit - sats after feedings - waste output + creatinine, our new checklist    The doctor heard less fluid around the lungs so she ordered another lasix to continue the drainage. They increased her caffeine amount because Madi had gained weight since the original order. Hoping the increased caffeine would slow down the apnic spells. Madi was still getting milk from the pump and desatting after eating. Monday night they'd discontinued using the pump, yay! We felt Madi did better with an empty syringe to reflux into than getting a slow feed yet trapping the gas. Monday night she was very alert and active. She'd lost more weight, down to 2lb 1oz, but had a pretty hefty diaper again - lasix still working. We had to stop her feed because of an apnic/brady spell that required a little bit of stimulation to recover from. Madi usually does well on her stomach so we moved her to her belly, increased her oxygen to 26% and she was doing better when we left.

This morning's report was that Madi had 4 more apnic/brady spells overnight with only 2 related to feeds. Her lungs sound better than yesterday, praise! Madi's hematocrit was still 29% so they're going to give her a blood transfusion. The transfusion should immediately increase her hematocrit 5-10%.

In summary we've tried to solve the apnic problem with increased caffeine, slow feeds using a pump, eliminating the fluid around her lungs and a blood transfusion. Pretty busy three days! Our prayer is that one of these does the trick.

She's regained some color since Sunday so I'll leave you with a picture of her on the move.