Good morning. Olivia had a peaceful night and morning.
She is tolerating the ND feeds. She stooled 2x overnight, the indicator the docs look at to measure progress. We can’t use “residuals” as a measure of feeds progression anymore, since everything is going straight into her intestine. Another measurement is bowl sounds – they now “sound great”, whereas before they were “basically nonexistent”. Today her feed rate increased to 3 MLs/hr with a plan to go to 4 tonight.
Her direct bilirubin dropped to 10.1 from Saturday’s 11.5 – awesome. Her phenobarbital level is down to 7.7. The measurement last week was at 25. The significant drop is because they halved the dosage last week and stopped administration over the weekend. She may start a medication called ursodiol later this week to help with the war on direct bilirubin. Her indirect is up to 3.7, which isn’t abnormal, but Dad thinks she looks a little more yellow today.
Her oxygen levels, as measured by an AM blood test, look good. They weened her vent rate to 30 breaths per minute. This is one of the lowest settings for rate – a positive sign. There is talk about trying to get her off again, if she does well. If we go down this path later in the week, simulations will be done to predict how successful she might be before the team actually extubates her.
On the other side of breathing, blood, her hematocrit – the proportion of total blood volume that is composed of red blood cells – is at 26. Normal ranges are 33-55, and 30 is the threshold for a blood transfusion. Last week she was at 30. They are deciding to NOT transfuse and instead “follow” the rate. They see her Reticulocyte at 5, up from 2. This means her bone marrow is working to make red blood cells. The docs suspect this is the result of a normal cycle that happens about a month after a baby is born. They will watch this area.