Medically speaking, Clara had a pretty good day. By this morning they had weaned her Nitric Oxide down to 2 (we started at 20, so that was a pretty quick wean). They planned to take her Nitric all the way off at about 12:00, but when we did it, Clara let us know that she did not approve. She very rapidly desated and turned gray and wasn't breathing. It was a little scary. Fortunately, all the doctors were standing around and they bagged her (manual ventilation), ended up turning the Nitric Oxide back on again and she did recover. Other than that little incident, her sats have stayed pretty high today and she's been good. We have been able to wean some other vent settings and have continued to wean hydrocortizone, too. We went back up to 4 on the Nitric after her little hissy fit and up on her oxygen too, but we are going to keep trying to wean both back down. The goal is to have the oxygen down to 60% (last I talked to the nurse we were at 72%) and will wean the Nitric by 1 every six hours beginning at midnight (12:00am- we go to 3, 6:00am go to 2, 12:00pm go to 1, and 6:00PM tomorrow, try turning it off again...) We're hopeful that she will tolerate this slower wean and we'll be able to have the Nitric turned off by tomorrow evening. Other than that, we just continue to check blood gases and wean vent settings with hopes that we'll be able to extubate sometime this week, whenever she shows us she is ready. She is still not consistently tolerating moving and messing with her. Her sats dropped some today during a diaper change/repositioning and sometimes when she needs to be suctioned she gets a little finicky. She has been desating (usually not too serious and with relatively quick recovery) 2-3 times a day. So we also just need for her to show us that she can keep her oxygen saturations consistently higher before we extubate because saying goodbye to the ventilator is another safety net removed. She continues to diurese well. Today she was down to 5.3kg (11.6 lbs) from 5.6kg yesterday. Her birth weight was 3.7kg, so we're aiming for somewhere between that and 4kg. Tomorrow she will have that triple lumin central line in her neck removed and a new line put in her chest called a broviac line. This procedure is fairly routine, but we did have to give consent for it and hear the list of potential complications, so please pray that goes smoothly. It is a surgical procedure. The neonatalogist who has been caring for her since we arrived in the NICU on Tuesday is Dr. Yang. She has been wonderful and really given Clara excellent care while helping her make great progress. Tomorrow, a new attending will take over service so we'll have to learn the style/philosophies of a new doctor and see if that will change any of our strategies. Please be in prayer about that transition, too.
She had some more alert and awake time today - a little bit this morning and again this afternoon. It's great to see her be awake and look around and interacting some with the world around her. This afternoon, we left the hospital a little earlier than usual and left Big Daddy and Sweet Mama in charge of watching Clara. It felt like leaving her with a babysitter for the first time. I had a big list of things for them to watch and keep an eye on and make sure the nurse did and numbers I wanted reported back to me. Don't worry, they did a great job. It was nice to come home and get a little nap in. For those concerned about my mastitis, I'm much better today. I started an antibiotic last night and the fever is gone. I've just been pumping a lot more frequently, am doing the whole warm compress thing, and am riding it out. As I told my mom last night, "Don't worry about me. Clara is a whole lot sicker than I am!"
Now, what you've really been waiting for. Easter photos of Clara!
|Her Mama K gave her this precious pearl bracelet for Easter. That charm is boxing gloves - for our little fighter!|
Happy Easter Hairbow!
|Clara in her first Easter dress|
|She may end up with a dent in her head for all the kisses her daddy gives her there....|
|A father's love, on Easter|
|Easter family shot|
|Our hearts are so full.|
|Detail of the smocking on her Easter dress|
|Those big blue eyes say, "Happy Easter to you!"|
- Continued diuresis, and especially that the fluid will leave her lungs, then her tissues, then her body. Her chest x-ray the last few days has looked very wet and showed some partial lung collapse from all the fluid. We need the fluid gone! For good!
- Transitions ahead: line change, physician change, weaning of nitric oxide
- Continued weaning of vent settings that will lead to extubation
- Better toleration of movement, positioning and other stimulation
This Easter, we are so glad to say that God conquers death! Praise be to Him! Life is sweet.