NICU Night #54 - No More TPN!!! (37 Weeks Gestation)

Sunday, June 13, 2010

Jenny was back on last night.  I so needed her to be.  It was a much better night than the night before.  Timmy is back up to 5 lbs. 6 oz.  - growing way too fast!  I barely got the preemie clothes and it makes me sad to think how soon he'll be too big for them! - and he is now 17.25 inches long with a head circumference of 13 inches.  Which means he is officially more than twice his birth weight (2 lbs. 6 oz.) and has grown almost 5 inches.  It all seems mind boggling until I think he's been here almost 7 weeks, 5 days already.  And then that becomes mind boggling!  If he had been delivered last night at 37 weeks, he would have been right about the same size the other kids were born at at 38 and 36 weeks, so he's right on target.

James gave me the treat of going over early so I was at Timmy's side by 8:30.  (I had put two of the kids in their jammies so hopefully it wasn't too hard for him to get them all down.)

Back to routine, I went to pump first and saw Melissa (nurse) in one of the rooms across from the lactation room so I went in to say hi.  On my way back to Timmy, I ran into Dakota's dad, Jason, and got to go visit Dakota and Brittany.  Dakota is doing really well.  He just needs to stop having spells during feedings and get his feedings down and he'll be headed home.

Charlie is also headed home soon.  (He was born a few days before Timmy with gastroschesis and in Pod 2 in the old NICU with Timmy.  His body didn't tolerate the surgery the first time or so and his parents couldn't even hold him for a couple of weeks.)  I ran into Alexis Friday night in the pumping room and she told me that Charlie was at 47mls per feeding and he just needed to make it to 65 to be discharged.  They are increasing 3 mls at a time, but I don't recall the frequency.  In any case, he should be headed home sometime this week.

Another baby, Nathan, who was with Timmy in Pod 1 and has been in the NICU for 7 months is also going to go home soon.  I never learned what he was in for, but 7 months just seems like an eternity Hard to believe Timmy has been there almost 2 months!  Praying he'll be home before 3.

Melissa (nurse) came in shortly after Jenny put Timmy in my arms and I gave her the quick update - now up to 32 mls, vent settings minimum.  She asked about extubation and I told her that I had talked to Dr. Tsai Friday night and she had said that we would probably try again after Timmy was up to full feeds and off the TPN.  At that point, I gestured to the TPN.  Or, better yet, where it had been.  Timmy is no longer on TPN or lipids!  He still has a dextrose/hydrochloride drip but the majority of his nutrition is coming from his milk now.  Happiness!

Not long after, the resident named Melissa came in to check on one of the new babies and then came over to talk to me andI was able to ask her the few questions that had popped into my head.  I was trying to keep a mental list and was so relieved to see her come through the door so I wouldn't have to try to remember for rounds this morning.

I asked her about when we would adjust the breastmilk/formula ratio and she thinks that when we hit full feeds in a couple of days they will be able to talk to the surgeons and adjust things.  His stool output has started going down a bit.  It increased when they first started the breastmilk, but they have adjusted his Loperamide and output has dropped. Residuals are still very small so Timmy is definitely digesting the milk really well.

Around this time, Margaret, one of the respiratory therapists, came in and we started discussing extubation in conjunction with the rectal biopsy.  This is sill not scheduled and we are getting anxious.  Apparently Dr. Cosantino will be the one to schedule and she hasn't been in for a few days.  In any case, Timmy will be sedated during the biopsy and reintubated during the surgery to reconnect his intestines.  Not excited about that.  the doctors are still planning on extubating before the surgery.  Hopefully that will help strengthen Timmy's lungs and he'll come off sooner the next time.  Poor little guy.  I so wish he didn't need to be cut opoen again.

The therapists hung out for a while after that and we talked a bit more about Timmy and possible causes for why he wasn't able to be extubated this week.  Venture mentioned how frequently he needs to be suctioned and that he may be having trouble clearing his airways on his own.  Definitely possibility.  We have all noticed on the monitor that there are times when Timmy is lazy and doesn't take a breath for a few seconds.  Not really scary because he's on the monitor and we know he's breathing.  Margaret also mentioned that that may be his way of regulating his CO2 levels as well.  She's such a funny lady.  We were also talking about age.  She mentioned that she didn't know how I do it staying there so late and getting up with three other little ones in the morning.  I told her I practiced in college and she had the nerve to tell me that that was years ago.  (True, but who wants to admit they're getting old?)  Her new philosophy is to tell people she's 10 years older than she really is so they can say, "Man, you look good for your age."

Aside from that, I think she's a good therapist.  She isn't sure why they won't drop Timmy's pressure anymore either but that's apparently how things are done at UMC.  As long as he can come off with a PC after PEEP of 16, I'm okay with that.

I've been working hard to make sure that I get my 8 pumpings in per day so I put Timmy down for his 11:00 cares.  He had done so well while I was holding him.  It was so nice to get there earlier and be able to start holding him at 9 and be able to have more alert hours of my own with him in my arms.

However, when I picked him up after pumping, he never quite settled down.  He even had a couple of bradys before I got him in my arms.  By 1am, I really felt that he just wanted to settle back in his bed.  It took him a little while to settle down in his bed as well.  I think he may just not like being moved so much.  One of these days when he's off the ventilator, I'm afraid he won't have much choice!  =)