Lucy had an exciting day today. First of all, she got to have kangaroo care time with her papa. That was very nice for both of them, and after an initial hiccup and bradycardia, she relaxed and was sat-ing in the high nineties the whole time. It was so sweet to see Lucy cuddled up on David’s chest. Sharing a daughter with him has made me love him even more, if that was even possible.
I was glad she was able to get in some snuggle time, because she had a busy morning. After we left, Dr. P did in fact put in a new shorter catheter and they took out her central PICC line. The idea is this: the catheter itself invariably becomes a place for the yeast to colonize, so by pumping fluids through the yeast-infected line straight into a huge blood vessel, you might seed the rest of her body with yeast. So by putting in a shorter catheter that only distributes fluids to blood vessels in her arm, you sort of minimize that seeding effect, thereby limiting distribution of the yeast. The problem is that not everything can be easily administered peripherally. I said yesterday that I wasn’t sure if she would still be getting TPN (IV nutrition), and that’s because many times, TPN at high concentrations can actually damage smaller peripheral veins. When it’s given straight into the vena cava, as it was with the PICC line, it’s dispersed much more quickly and doesn’t have time to cause damage. Dr. P assures me, however, that her TPN is not as bad as that. Nonetheless, he’s working to get her off of the TPN entirely as quickly as possible. Today he increased her milk feedings to 4.3 mL/hour, decreased the TPN to 1.5 mL/hour, and decreased the concentration of the TPN from 15% to 12.5%. She’s tolerating her new higher feedings well, too, with only about 1.2 mL of residuals, last I checked.
As if that wasn’t enough excitement for one day, Lucy went ahead and did the thing I’ve been most worried about all this time: she pulled out her breathing tube. She’s been producing a LOT of oral secretions (basically she’s been really drooly), and even though they’ve been re-taping her tube often, her saliva makes the tape really slippery. This morning after she had her new line in place, her nurse heard her making noises. Since she shouldn’t be able to vocalize at all with the ET tube in place, her nurse was alarmed, but also confused because her vitals weren’t affected yet. Sure enough, she’d managed to pull her tube all the way out and was trying to chat with her nurse, or something. After a minute (I don’t actually know how long it was), she was affected and had to be bagged before Dr. P could quickly re-intubate her. I’m always terrified that she will do that, but we actually learned something valuable from this, which is that Lucy may be closer to breathing without mechanical ventilation than we originally thought. Dr. P is now saying that maybe he will try her on CPAP (continuous positive airway pressure, the next step down after the traditional vent) when she’s getting full feedings and she’s no longer on continuous feedings. That’s because the continuous drip is a little hard on her tummy, making it a little distended, and the CPAP can force extra air into her belly. So when she’s getting a bolus of milk every 3-4 hours, he may try her on CPAP. Right now she’s getting almost 75% of her nutrition from milk, and she may reach full feedings within the week, so I’m very very excited about the prospect of getting her off the ventilator sooner than expected. However, just because they’re ready to try her on CPAP doesn’t mean she’ll be ready to succeed. Many times babies don’t last very long on CPAP the first time they try and have to be put back on the ventilator, so we’ll just see how she does when we get to that point. It’s just exciting that they’re starting to think about these things.
Lucy was down in weight a little today, to 1240 grams. She was given diuretics after her last blood transfusion, though, so that often causes her to drop a little. Her blood gas today was still within normal limits, although her CO2 was a little higher at 49. I was most excited about her CBC, though. Two days ago her platelets were at 19, and today they were 31. That’s such good news to me, because she did not have any platelet transfusions in the intervening time. She did have two blood transfusions, but those never helped her platelet levels before. We’re really hoping that this means she’s starting to clear the yeast infection, but we’ll have to see how it goes next time.
We’re in Ridgecrest now, and we miss our Lucy terribly, but it’s good to be home. We even managed to get a few things done in her nursery, and that was fun. We’ll be heading back either tomorrow evening or Sunday morning, if we can stand to be away another night. It would be good to actually get some work done. Today was a really good day for Lucy, though, and I’m really encouraged by her progress. Working in our new house, I can absolutely see us being a family there, and I cannot wait for that to be a reality.
Now, pictures of Lucy and her daddy:
Look how light her hair is getting!
Here she is just sleeping, but every time David spoke, she would try her very hardest to look up at him. I love how peaceful she looked.
He sure does love his little girl: