Day 4 (GA: 28 Weeks) Part II

Nanette is very low on her hematocrit.  Normal for women is about 38%, but hers is down to 23%.  Transfusion is an option if she feels really light headed and feels like she needs it.  If her crit continues to drop and hits 19-20%, she will get a transfusion regardless of how she feels about it.  She is still losing blood so a transfusion is very possible.

Zeke is off the bili light!  They will monitor his bilirubin for a day and see if it remains low (~3 right now).  His feeding volume is up to 20mL/day.  His head ultrasound came back and it is normal.  Yea!  (This is understated, but there is not a word sufficient to communicate how great this news is.)

Gabe was a peeing machine last night.  He had 143mL during the night shift and over 100mL in the day shift.  His size and puffiness have decreased remarkably.  In addition, his arms and legs have been active fro the first time.  Because of his urine output his electrolytes look better.  His potassium is almost half of what it was 24 hours ago (which is a good thing).  He is completely off dopamine and his blood pressure is quite high today (high 40s).

Gabe is also off the bili light.  Today is the first time Nanette has seen him without the eye mask to protect his eyes from the light.  His is really cute.  Dad also got to change his diaper twice.  Dad is still a pro.

They put Gabe on a Drager ventilator this afternoon.  It is pretty cool.  It measures his breathing and actively finished his breaths if Gabe doesn't do it on his own.  The Drager also adds breaths between his spontaneous ones.  The breath rate, tidal volume per breath, PEEP (positive-end expirator pressure), and PIP (peak inspiratory pressure) are adjustable.

We also got Gabe's head ultrasound official results back today.  Dr. Chan, Dr. Bridget Burshear, and the nurse practitioner, Karen, came to Nanette's room to discuss the results.  While in utero, probably 3-5 weeks ago, Gabriel had a grade 4 intraventricular hemorrhage (IVH).  This means that there was bleeding in the brain.  Some white brain tissue did not get the oxygen needed and no longer functions, creating cysts where the tissue should be.  These cysts show up as holes in the brain.  The term for this event is PVL (periventricular leukomalacia).  Once it has occurred, there is no treatment for PVL.  Most babies who have PVL develop cerebral palsy (CB) and other moderate to severe neurological impairments.  Dr. Chan told us that they advise parents of babies given this severe of damage that they may discontinue care if they choose to.  We have chosen to continue care.  The diagnosis of PVL does not necessarily mean that any or all of those problems will occur, it simply means that there is a very high likelihood.  There is still a chance (maybe 10-15%) that he will not have any major problems.  We will not know whether he has CB or other problems until we watch his milestones in his early months and years of life.  Some of these milestones include rolling over, crawling, smiling, walking, and speaking.