Some roller coasters are longer than others

Calder appears to be living by one of my 90s pop-star idols' hit lyrics, as he has most decidedly taken "two steps forward ... two steps back."

Let me paint a really pathetic picture for you. It's dreary outside, nighttime, drizzling rain. Two first-time parents functioning on no sleep and mentally exhausted gather some books and blankets into their arms and crawl into the front seats of their sedan to make the nightly sojourn to see their newborn. But the tire in one car is flat, and the battery in the other car turns out to be dead, and while they ponder the path of least resistance to the hospital, the doctor calls.

Never good!

Calder had had a good run on the SiPAP vent but had given all he could give and needed more assistance. The doctor told us our options were to administer more Decadron or to re-intubate, and that there wasn't a clear answer (story of our life right now.) It did not take us long to decide we wanted to avoid the drug and move Calder back to the vent; this route avoids (or at least delays) more risk of side effects from the Decadron but still puts him at continued risk of incurring damage to his lungs from the conventional vent.

Once we used the car with the flat tire to jump the car with the dead battery (in the rain), we were on our way to the hospital. We consoled ourselves with the fact that surely he'd be on lower pressures when back on the vent. When we arrived we found this was not the case, and since Wednesday night, his settings have only been increased. We now understand that, in the most basic terms, while on the SiPAP his lungs shrank, and we need to blow them back open. Not to mention that the little man was working overtime and is just plain exhausted! He has since needed a dose of lasix (diuretic) and a blood transfusion, which means his feedings were also temporarily halted. The nurse said she suggested the docs to do another echo to check for a patent foramen ovale (PFO), a hole between the left and right atria (upper chambers) of the heart, so it sounds like there may be an echo in his future. He has been satting in the 80s and 90s with his new blood, and the nurse told us she got him down to 40 for a bit on his oxygen level last night. They tried weaning his rate but he didn't respond well so they are back up, and now he's needing low 60s. To stave off the ROP, it's really important we keep this level low -- definitely under 60! -- and avoid drastic swings. Poor little guy is clearly plumb tuckered.

But all is not lost! Calder is looking really dapper these days. In fact, he was the hit, you might say the heartthrob, of the NICU on Wednesday night in his very adorable NICU-friendly, preemie-sized cowboy get-up, courtesy of Veena (sorry, folks, no pics yet of this one!) All the nurses were hooting over his new outfits, especially since these are designed to easily fold over all his lines anyway. The next day he sported his turtle-patterned outfit, equally cute. For the first time, I am excited about going shopping for little-boy clothes and see many online preemie purchases in my near future. Kraemer has already tried to ward me off.

The plan now is, you guessed it, to wait. We want him to get bigger and all the while be as aggressive about weaning him as he is willing to stand. When he comes down on his pressures and oxygen requirements, it's back to the SiPAP we go!

This video is from about a week ago, before he was extubated. I had hoped to remove the audio to spare you from my baby talk but am not having any luck. Turn down your volume. :)

The weight

Calder is now off the Decadron and the wait is on. According to his doctors we should expect that his stats will decline as the drug wears off. The hope is that he made enough gains while on the drug that his lungs will be able to support him on the SiPAP ventilator (which does much less damage). He is up to full feeds, so they have removed his PICC line (used to administer the baby Gatorade) -- one less opportunity now for infection. This also facilitates holding, so on Monday (his first full day off the drug), as he was doing well, Taryn got to hold him for the second time. Always exciting, but also a bit scary. Calder was also doing well on Tuesday and I got a chance to hold him. Definitely made my day!

First kiss

On Tuesday Calder had his second eye exam, which, when we arrived for our nightly visit, we learned showed that he has Stage 1 Retinopathy of Prematurity (ROP). There are five stages, and with the first two the condition is considered "mild."

The black arrow shows where the blood vessels don't grow all the way across.

The high oxygen level of the air he is breathing causes the blood vessels in his eyes to grow incorrectly. We'd read that one of the side effects of Decadron was an increased chance of ROP, and as a 24-week preemie he was already firmly in the at-risk category. Stage 1 can often resolve itself but with the extended amount of time Calder will be on oxygen there is the increased possibility that the ROP can increase to stages that reduce vision and can even result in blindness. His next eye exam is in two weeks so hopefully the ROP won't progress.

Now we just wait, and we hope that his lungs hold up on SiPAP and his eyes don't get worse!

holding our breath

Whew! What a long week. Which apparently, as you will see, calls for a long post.

Re-intubated, rocking Gram's hat

 Before administering the Decadron, my biggest worry about it was that its potency would mean fixed lungs, but with a side of some effect we didn't want. Now that we've done it and there's "no looking back," my biggest worry is that it won't be potent enough. (Okay, I'm still worried about those side effects.) C'mon, Calder! The doctors and nurses all knew we were hesitant to okay the use of the Decadron but have also all reassured us that we made the right choice, or the only choice we had.

On room temp for awhile, so got the swaddle

On Sunday, hours after the drug had been administered and Calder had been reintubated, his body started responding, albeit slowly. His gases were getting progressively better, to the point where you could legitimately call them "good." Each time those results came in we'd anxiously await the orders, but they were always only to wean on the respiratory rate, never the pressures. Of course bigger steps would have been wonderful to see, but we could appreciate that the doctors wanted to take it slowly after the first attempt at extubation failed. Still, we tried talking with one doc about what factors they use to determine how much to wean and where, but some things got lost in communication, and we didn't come away with much better an understanding.

Our little angel :)

When we walked in Wednesday night, we were greeted by yet another new machine – this time, it was SiPAP. This wasn't too much of a surprise, given that earlier in the day the nurses had been optimistic about the progress Calder's lungs had made the last couple days, and that his primary doc, Dr. R, had returned from a couple days of leave. 

In summary, in the grand scheme in terms of how they would move him from vent to vent, it goes jet ventilator --> conventional vent --> sNIPPV ---> SiPAP --> CPAP --> nasal cannula. We've hit the first four so far, somehow or another. There are other machines, for sure, like an oscillator, but I've listed those used by the units at the two Inova hospitals we've been in. Also as an aside, we've learned that which doctor is working makes a world of difference in how our little man gets treated. When we first arrived at Fairfax and I asked the nurses how the docs made their decisions, whether they consulted with other docs, she said for the most part, whoever was on that day, specifically on our baby, made the call. They may discuss approaches during rounds but oftentimes had differing opinions. We saw this play out this time when Dr. R was anxious to extubate before he left, presumably because he knew others wouldn't, and when he returned, he was shocked (so we heard) to see that in his absence Calder had never been weaned on pressures.

SiPAP

Anyway, that night, we knew it was more wait and see. Although Kraemer and my novice assessment was that he was handling the SiPAP well, no one else last night seemed willing to verbally agree. When I made my usual 4am call early Thursday morning, he was still doing very well, but the nurse cautioned us that this may have been his honeymoon period. 

SiPAP bonnet

SiPAP helmet

He appears to have been correct. During our visit Thursday night, precisely as the nurse was pulling up his stethoscope after listening to Calders' lungs and telling us that they were sounding the best they had been, Calder's vitals crashed. His oxygen saturation dropped into the 20s, maybe the teens (I quit watching), and his heart rate into the 30s. They bagged him, which means they used a handheld device (looks like an old-school bike horn to me) to keep him breathing and another nurse called the nurse practitioner (NP) on at night to get to Room 4 stat. Not my favorite way for an evening visit to go down. NP L arrived just as he was stabilizing, checked him out and ordered X-rays and a couple more blood tests to check for infection. Though it was getting to be way past my bedtime, we decided to hang out a little longer to see the results. When the X-rays came back, the lungs were whiter than the time before, indicating that they were further collapsed than they had been yesterday. Just as we were reviewing these, Calder tanked again, and NP L summoned. This time, the NP had seen the X-rays and decided it was time to move him to something that could provide him with higher pressures. Instead of intubating, the very last resort, she ordered he be put back on sNIPPV. She suctioned deep into his sinuses and came up with a couple good-sized globs. Once he'd stabilized and gave us a really big smile, we left for home.

sNNIPV stocking cap

He'd really been doing quite well on SiPAP until that point. The nurse postulated that the reason he'd dropped was either those globs or the fact that he lost his PEEP (internal pressures) at one point and just wasn't able to take deep enough breaths on his own to recover. 

This morning the nurse told us they're trying him on SiPAP again. I had a quick conversation with Dr. D (his other primary doc, you could say), where he explained that they might be back and forth on these two machines for a little while, in fact. This is mainly because the pressure on the face that's required to maintain sufficient suction takes its toll on the skin around his nose, and the indentations it creates winds up limiting the quality of the suction you can achieve. They pull it so tight on his poor little face that I can only imagine how uncomfortable it must feel, especially on top of fragile skin that's been pulled at repeatedly already as they tape and re-tape his feeding tube to his face. But his gases this morning have been great (pH 7.37; CO2 52; H&H 43) and his Os were at 30 when we talked. His pressures are 10 over 8 (pressure in the lungs when breathes in over pressure left in the lungs when he breathes out). He's continued to advance on his feeds so that he's almost at full feeds for his weight; they'll take him off his TPN (aka baby Gatorade) tonight to see how he fairs and if all goes well, take out his PICC line, which means one less place where there is chance of infection.

So we were holding our breath. Holding our breath to see whether the drug will work its magic to the extent that he can stay off the conventional ventilator. Holding my breath to see whether the drug will do what it’s supposed to and only what it’s supposed to know. I know that some of the side effects may not be visible for days or weeks or longer. I think I may be holding my breath for another 18 years.

running to stand still

We woke up knowing that it was going to be a big day but not quite knowing how it would unfold. We called the NICU around 9 a.m. to flesh out the approach and find out when they would extubate. The plan was to extubate to SNIPPV (synchronized nasal intermittent positive pressure ventilation -- basically a ventilator through the nose and without a tube) and hope that Calder would transition successfully. While we had a lot of hope, we didn't think that his chances were very good. As a backup plan, if Calder weren't doing well on the new vent arrangement we would administer Decadron with the hope of keeping him extubated.

Taryn and I arrived at the hospital around 1 p.m. thinking that the procedure would be done (we try to avoid peering over the doctors' shoulders when they're "at work.") Although the nurses and doctors were gearing up for the procedure the attempt had not yet been made so we went to lunch; when we returned Calder had been moved to SNIPPV... he was also on 100% oxygen. This means that when he struggled to breathe, he was already at the highest setting and thus had nowhere to go. The nurses reassured us that he would need a while to adjust, but he would, so Taryn and I settled in to giving words of encouragement and inspecting the getup that was SNIPPV.  Essentially it's the same ventilator machine but with a nose cone, which is velcroed to Calder's head. So that the velcro has a place to stick, they put  him in a stocking cap, turning him into a mix between a fighter pilot and a swimmer. The tension on the mask is so tight (to get a good seal) that Calder's eyes are squinched shut. All in all it was quite the getup. After about two hours sitting at maximum oxygen and continuing to desat, the doctors were sure that he would need the Decadron to get off the vent. After all of the anguish deciding about whether or not we should do it, it became pretty obvious that we didn't have much of a choice. The nurse administered the drug and Taryn and I went home to wait.

By 6 p.m. we were feeling fairly good that the doctor hadn't called to tell us he was reintubated; 30 minutes later the doctor called and told us he was reintubated.

From here we wait for the Decadron to do its thing (reduce the inflammation in his lungs and throat), let Calder build his strength back up, try to wean his pressures over the coming week, and then extubate successfully on the next go. Calder gets most of the heavy lifting but his cheerleaders (and fashion fan club) plan to have a nice supporting role. It's been an emotional week, but in some ways having made the decision about the drug has taken at least a little bit off our plate. 

a dose of reality

A couple posts ago I talked about the easy days versus the hard days. No, not much has changed -- don't fret yet like me! -- but that's what has made the last several days this week so hard.

While we were visiting Calder Wednesday night his oxygen saturation dropped precipitously as we stood there, only because the nurse turned him over. Such a small thing, and something they do at least every four hours when he has his hands-on care. For so long I'd thought to myself, as so many assured me, that everything was going to be fine soon. All I had to do was brace myself for this "roller coaster ride," tentatively scheduled to end with a happy ending of some variety at the end of October. But on Wednesday, I was made painfully aware of just how sick a baby Calder is and how far he still has to go. And how we may have some very big decisions to make in a very short time.

In short, Calder has some degree of bronchopulmonary dysplasia (BPD) (not officially diagnosed, I don't think, until he reaches his original due date), which means that scarring or inflammation in his lungs is making it difficult for him to get the oxygen he needs. To help his lungs develop properly, it's really important that we get Calder off the conventional ventilator, which only continues to add to the damage already there. To do this, at the moment, the doctors are trying to use relatively benign, though not without side effects, treatments: a diuretic to get rid of the extra fluid in his lungs, a form of caffeine to dilate his airway passages (bronchi and bronchioles) in the lungs to decrease resistance and increase airflow, and plenty of calories.

His gases have been consistent, which means his lungs aren't getting worse, but they really aren't getting better, either. To get over that hump, sometimes doctors will prescribe steroids, but the one most commonly used, dexamethasone, can have extreme long-term side effects, like cerebral palsy or death, and short-term effects that aren't very desirably either. Another steroid option is hydrocortisone, although its effects on the intestines are debatable, a dangerous risk to take with preemies. In short, the evidence available at this time isn't very solid, and it's not a decision you want to be faced with. The plan now is to try to extubate him on Sunday, to give him a chance to shine on CPAP (support through the nose rather than the mouth), before we are faced with the decisions on steroids.

As down in the doldrums as that all sounds, we're still optimistic about that happy ending! We are moving out of our 1BR into a 2BR nearby in just a couple weeks to make space for our little guy when he finally gets to come home. Today we are pulling the trigger on our glider, and this weekend I will be back to researching that perfect car seat since we're going to need a good one!

We also finally got some Calder footprints, thanks to one of the nurses who noticed he didn't have any fun paraphernalia yet at his new home (they made us take home anything we'd had up at Alexandria.)

We know Calder is a fighter, and we are praying that he really shows his stuff this Sunday. Please pray for him, too, or send some extra-potent positive thoughts his way. :)

Bedtime stories

A couple weeks ago we asked my mom to send us some of my paperback childhood books, just a couple. Of course, not one to under-do anything (see the amount of food she serves at any party ever), she shipped somewhere around 15 lbs of reading material.

Because there isn't much privacy in the NICU, especially in Fairfax, where babies are lined up against the wall like ducks, it took me a while to get up the nerve to sing to him. But everyone tells you to do it, so I did. I've run out of lullabies, though (you can only sing The River Lullaby and Evening Prayer so many times), and expect that this weekend I'll be downloading some Disney tunes to refresh my memory and bulk up my stock.

In the meantime, we've started reading. He seems to like it a lot, or so we believe based on his steady vitals and calm demeanor as we regale him with tales of Miss Nelson, Corduroy and the witch "next door."

Today we also found out that they want to try him, on donor breast milk. He's had some loose, green (I know, TMI) stools the last few days as they have increased his feeds, and while all other signs are good (i.e., soft abdomen, no fever, etc.) they want to see whether my breast milk is causing him problems. Everything I've read says that green and loose are really NBD in the early stages (see this page, this page or this page ... I could go on, but I'm guessing you'll just skip all those sites and take my word). It could be that he's not getting enough hind milk (the milk from the end of a feed) or maybe that he's allergic to dairy [in breast milk]. But it also could be diarrhea. All told, I'm feeling defensive and discouraged since right now, providing that is one of the few things this new mom gets to do.

I know that these doctors make knowing poo their business and have good reasons for wanting to try something else. This afternoon I gave consent for them to try donor milk, and they'll start him on it tomorrow night. They'll see whether he gets better over the course of a few days, and then they'll switch him back to mine to see whether he can tolerate it at that point. If he cannot, they'll run some tests on mine to see if they can pinpoint the cause. All I can say is that if they figure out it's all my ice cream consumption I am -- sigh -- willing to drop the habit!

Little Guy, little change

It's always easiest to write blog entries on the days we leave the hospital feeling as though Calder "looks good." I'm not exactly sure how Kraemer and I make this determination, since lately although a nurse may assert he's had a "good day," I might still leave deflated. And sometimes, although it may seem his uphill battle has grown taller, I leave invigorated, knowing he's up to the challenge. These days, the smallest change in either direction makes the biggest difference to me, and logic doesn't always play a part in my emotions.

So today is one of the easy days. There's been no ground-breaking news, but as Kraemer noted on Monday, Calder finally came down a couple points in pressure on his ventilator over the weekend. Although his blood gases haven't looked good enough the last couple of days to bring the settings down further, a chest x-ray taken Tuesday after he pulled out his feeding tube (yes, he pulled out another tube. At least we know he doesn't lack a good grip.) showed slightly more inflation than the previous x-ray. And his blood gas wasn't that bad; in fact his CO2 was a few points lower. As we sat by his isolette last night, the nurse would wean him slowly from his oxygen as we talked to him after it had needed a bump-up during his hands-on care (diaper, oral care, temperature, etc.). He'd de-sat initially, but slowly his saturation always climbed back up into the 90s, so that by the time we left his oxygen level need was back to 44 (room temp is 21 percent). He looked alert but comfortable. All very encouraging.

Calder had his first eye exam this morning, where they're checking for retinopathy of prematurity (ROP). He was diagnosed as Stage Zero, which means that there was no ROP present at the time. He had another head scan a few days back, his fourth, which once again came back normal. I hold my breath with each test, but so far, so good.

They've taken out his peripheral arterial line (PAL), since his blood pressure was doing okay, and otherwise it was just one more line that could get infected. Of course, this means they're back to pricking his poor little heels. Ouch! But he takes it like a trooper.

He's still seemingly handling his feeds okay, so they've upped his intake to 3 mls/hour. This means he's still not back to the level he was receiving at Alexandria, but he's close, and continues to make pretty quick progress in this area.

We also had a visit from Grandma Anderson and Aunt Kristen this weekend! (I know Grandpa Anderson and Aunt Corinne were devastated they couldn't come again - we'll see you guys next time!) Given the limit of four guests for the duration of our stay, poor Krist got to know the waiting room pretty well. And while I'm pretty sure they left exhausted, after a long car trip, helping clean our apartment and dropping off meals, I felt more relaxed by Sunday evening than I had in awhile. They're the best. Guess that's what family's for.

Lunch break from hospital at Great Falls

Gotta keep up my milk supply. :)

Shout out to my PEEPs

We, the parents, have been trying to be patient post surgery with our expectations for Calder's improvement. Apparently we are the product of the 30-second news cycle because we hate waiting. Calder rewarded our suffering by going down on his ventilator settings for the first time in three weeks. Prior to surgery his PEEP was at 17 and his respiratory rate was at 55. Thursday (surgery +3) they were able to bring his respiratory rate down to 50.  On Sunday morning Calder made his first progress by going down to 16.  We left from our morning visit and returned in the afternoon to be greeted by yet another reduction in settings. The little man was rocking a PEEP of 15.

While they are reducing his settings they are also weening him off of his fentanyl, which they started him on about a week after birth to calm him down because he didn't like the tube in his throat. Apparently, opiates are not an easy habit to kick so Calder tends to squirm a bit now.

The doctors have a goal of extubating Calder by the end of this week or next but they need his PEEP to get down to at least 12 for him to have a shot at it. Our impatience isn't unfounded. The ventilator damages his lungs because, as a preemie, parts of his lungs are mature and supple and other alveoli  are immature and stiff. The ventilator can't discriminate and simply inflates his entire lungs to the set pressure. Since each little alveoli is expanding at a different rate, some don't expand at all and some are over-expanded, leading to chronic lung disease (CLD). Since the severity of CLD increases the longer he is on the vent, the doctors will eventually reach a point where they determine that the ventilator is doing more harm than good. To prevent that scenario from persisting, they will then probably use Decadron, a steroid that works miracles on the lungs but which can lead to horrible side effects, brain damage among them.  Now that Calder's come down 2 PEEPs in a day its tough to revert back to being patient. Maybe we can get 1 a day. 

Post-Op

Surgery prep. Notice blue cap!

Last night, after a midnight rendezvous with my pump (and why not: it's World Breastfeeding Week!), I couldn't get back to sleep. I lay awake thinking about Calder, wondering how he was doing, what he was doing, who he was with (were the nurses being watchful?) and when he'd be home, thinking about just how nerve-wracking this having a child business was, realizing then that I'd probably still be asking the same questions sometime near the middle of the night when this guy is 16. At least for now I can be certain about where he is. :)

His recovery from the surgery has been slow, but we'd been forewarned he would fall "ill" after the operation. As the doctors predicted, on Monday night his blood pressure dropped, his ventilator support requirements increased and his body responded to the surgery by retaining lots of liquid, making him appear puffy and swollen. But Calder is making plenty of great progress, and I shouldn't shortchange him just because I'm impatient! He was off his blood pressure medication, dopamine, entirely by this afternoon. They've been able to wean him back down to 1mc/kg/hour on the fentanyl from 2.5, so back down to the level he has been on essentially since birth. He has received at least two blood transfusions since the surgery -- the first because his hematocrit was low (too few red blood cells) and the second because he was acidosic (too little expulsion of carbon dioxide) -- and both times the transfusions achieved their intended effects. While he was slow to wet his diaper, by today he was peeing and pooing up a storm, which we like. His ventilator pressures remain the same after having gone up on them during and immediately following the surgery, but his Os (oxygen) have come down from a high of 75 after the surgery to only 44. (Room air is  21, so he still has a bit of a ways to go, and he was in the 30s pre-surgery, but 44 is great progress.) They were able to remove the tube into his stomach that was removing extra air and bile since there was so little of it. And he's been very alert, eyeing us with interest and swinging his arms and legs around like he's on the dance floor.

Hospital break

He now weighs 1130 grams, a whopping 2.5 lbs!!

Also, just prior to surgery they reintubated him with a size 3 tube rather than a size 2, so no more of the sad little squeaking that always made me cringe knowing the tube wasn't fitting quite right.

Feeling puffy

I was also reminded that we really need to leave a camera at his isolette so that the nurses can capture the little moments we miss. When we showed up today the nurse exclaimed at his cuteness (admittedly, they probably do that to everyone) and then went on to describe how her efforts to adjust his feeding tube were delayed by his constantly licking her fingers. Sounds cute to me.

All in all, he's doing well for the time being, and we probably have a few more days until I can legitimately worry about his progress.

In this time, everyone has been so wonderfully, incredibly supportive. I know I've said it before here, and I'm not very good at being sentimental, but I truly cannot put into words how touched Kraemer and I are by what I have to consider an outpouring of support from friends and family. I cannot imagine how much more difficult this journey would be without you. As Kraemer said recently, it's so reassuring to know we've brought Calder into a world full of such warm, caring folks. I wish I could hug every one of you!

Titanium

Hope the little guy likes Sia cause he's Ti ta ni um. Surgery was a success! At least the cardiologist and thoracic surgeon both said that it should definitely help Calder on his road to recovery, and Taryn and I have never heard a doctor in the NICU speak in absolute terms, and have definitely never had two doctors independently corroborate something. Relieving to say the least. In essence they made an incision in his back, spread his ribs, deflated a lung, moved it over and put a titanium clip on the duct between the aorta and his pulmonary artery...then pinched said clip until it was closed, but not all the way closed where it might cut the vessels.  Finally, they reversed everything and sealed the wound with superglue.  TA DA, one of the easiest heart surgeries in the book. Makes me glad I'm not a heart surgeon.

As new-age parents Taryn and I don't care if Calder's room is pink or blue or any of the other gender stereotypes.  That said, it's way cooler for your son to have a big scar than your daughter. I figure Calder should get some quality time out of showing this beaut off in the future.

The hardest part of the day was when Taryn spotted the surgeon walking down the hall and said oh no he's not smiling, something went wrong. It was a long minute (and a long hall and a slow surgeon) but all's well, heart surgeons just don't smile a lot...in my book they get a free pass.

Clear cut

After a lot of being in limbo and a lot of uncertainty, the cardiologist called me this morning with some definitive news: Calder needs the surgery.

The doctor tells us that while they don't always see improvement after PDA surgery -- even though that's always the goal -- he expects that given the signs, Calder will improve rapidly after the ligation. (That is, after a period of being sick ... apparently, most babies get pretty ill immediately following the operation.)

Because Calder's surgery is "elective" and "non-emergent," his surgery is not a priority surgery for the day. Instead, he is slated for the second tranche of surgeries, which only get started after the first tranche wraps up. And that could take some time, because the morning surgeries are the real whoppers. We expect that Calder will go in around 2 or 3 pm today, but he may also get pushed until tomorrow. The surgery should take an hour. (I'm starting to think I need a Twitter feed to keep you all up with this little man's many updates!)

I have to admit, I'm basically scared out of my gourd for him since he's so little (and so cute!), but I believe this is the best route.

We'll do our best to keep you all posted!

Oh, what a pretty color yellow

Inova Fairfax, his new corner

When we arrived at Fairfax from Alexandria we were shown how to put on isolation gowns and glove up. Simply a precautionary measure for babies transferring in from other hospitals.  They took culture samples from Calder's skin and his nose and sent them off to the lab for screening...all routine.  I now know that I should pay much more attention to movies because they lay out in easy to comprehend fashion the way the world works.  If a doctor tells you something is routine, and makes you put on a silly gown....you will be QUARANTINED.  Fortunately nobody is wearing the outbreak style face masks yet: Calder simply has a healthy colony of Staphylococcus Aureus, a name worthy to lead a gladiator rebellion.

There are a wide variety of staph. The MRSA (super-bug) variety are the ones that hospitals freak out about and nobody wants.  Calder's is not MRSA but good old run-o-the-mill variety. Run-o-the-mill staph is common (almost a a third of all grownups have staph on their skin) but it can become problematic if it gets into open wounds or if you have an immunodeficiency -- like preemies do -- and it gets into your lungs. Calder is not symptomatic for the negative effects of staph: his hermatocrit is low, he doesn't have a high number white blood cells (which you would expect to increase to fight infection), his esophagus is not inflamed, and they are not getting a large amount of secretions when they suction his breathing tube. They are putting antibiotic ointment on his heel, which has an IV chemical burn, and he's getting the same ointment dabbed inside his nose to clear up his sinuses. The ointment is just like Neosporin ... which I swore I would not use on my kids because it's sissy juice. Calder has me breaking a lot of my preconceived parenting rules. Because Calder is still a surgery candidate they are also giving him an IV antibiotic, which they hope will reduce the staph count on his skin and thus reduce the chance of an infection if they have to do surgery.

So far, they've found the staph both on his skin (in his wound), in his mucous and on his ET tube. They sent another culture to the lab this morning to see whether it's in his blood.

For the grownups in the room, his staph means that we get to wear yellow gowns and gloves for the rest of the time that he's in the NICU.  Not too bad, but with limited baby interaction already the loss of skin contact is a bit of a bummer.  But what a pretty color yellow.

Taryn got to do a bit of mouth care on the little guy today...very nice technique. (video to come, if Blogger let's us!)

Thursday's echo showed that his PDA had increased in size from 1.7 to about 3. But because he is still clinically "stable," they aren't rushing to perform the ligation. They also want to see whether the antibiotics have any effect; if an infection is present, it could be causing dilation of blood vessels as well, so taking care of any infection may also have a positive effect on the PDA. To give the antibiotics time to work, the next echo is scheduled for Monday.