Luke Guerrero – Page 5

13 Days Old: Evening Update

May 6, 2016 No Comments

Update from the day.

Feeding paused after a mid-day check showed she was not digesting the volume being given. They refed her residuals so it will remain in her stomach, and they’ll check again at 8:00 PM to see if she has digested more. If she digests what was fed back, they’ll restart feeds accordingly.
Neuro informed us they are waiting on a pediatric neuromuscular specialist to assess Olivia, since she is a non-standard case. The specialist returns on Wednesday. We are holding until then.
The GI team updated their testing plan to include a HIDA scan. This is an assessment of the flow and functioning of her liver. This testing uses radioactive traces that act like bilirubin to map the flow of digestion. Since it’s a complex test and requires transporting Olivia multiple times, the core team may recommend holding this until after neuro weighs in.
Respiratory remained the same.
Olivia had some holding time with momma. She otherwise was asleep most of the day.

No other major progress or declines today. This weekend will likely continue to focus on feeding.

Finally, her NICU core team is switching under the care of attending. Dr. S’s rotation ends tonight. The transition started today. Dr. P rotated off as well, replaced by fellow Dr. M, however, she is covering nights this coming week and will continue to monitor Olivia.

Update: the 8 PM review found she had processed 5 MLs of breastmilk (and returned only 3). They are restarting now, and adjusting for the difference. That’s good news!

Daily Rounds

13 Days Old: Morning Rounds

May 6, 2016 No Comments

Updates from the morning & rounds.

Olivia continued to progress with feeds: giving back a net 2 MLs in a check last night and nothing this morning. They will increase her to 2 MLs per hour. She also had a stool last night, which means she’s digesting. At her current age and weight the goal is to get her to 15 MLs an hour. Getting from 2 to 15 MLs an hour will take time but they’re continuing to closely to monitor her tolerance for feeds and will increase volume when appropriate.
Overnight her CO2 levels increased slightly and they adjusted her pressure support accordingly. They continue to look for opportunities to ween back on this. Her X-rays do look better but they need to wait for the next round of blood analysis before adjusting the ventilator.
Bilirubin increased slightly overnight. The rate of increase is lowering, which is positive, however we are hoping for a decrease in total amounts, especially direct bilirubin.
A bunch of tests came back normal so they continue to rule various conditions, helping us to focus our search for a diagnosis.

Some good and some bad updates today, but mom and dad are really excited for the feeding progress. We hope it continues.

Daily Rounds

12 Days Old: Evening Update

May 5, 2016 No Comments

Updates from today. Good day.

Olivia started her feeds today. She received 4 MLs and gave back 4 MLs, however this is being viewed has okay since she usually gives back a 3-6 MLs of stomach secretions. She is continuing feeds throughout the evening.
Respiratory was good today and the amount being suctioned is decreasing.
She got about 1.5 hours of skin-to-skin time with mom today.
She also had a visit from her Grandparents.

Daily Rounds

12 Days Old: Morning Rounds

May 5, 2016 No Comments

Good morning. Updates from rounds.

Primary goals are improving respiratory. No changes in ventilator settings, but continuous PT and repositioning. We may expect another attempt coming off the ventilator in the coming days, based on performance.
She will start a small, but continuous amount of mamma’s milk today.
They are going up on total fluids to 120/kg/day from 110 based on her improved kidney performance. They are slightly decrease her sodium intake (as positive sign).
They will discontinue (DC) the catheter (as we thought they may do yesterday).
They also slowed the rate of several tests and DC’d others. These are positive events as they reduce the amount of blood drawn, equipment attached, and other tests.

Daily Rounds

11 Days Old: Evening Update

May 4, 2016 No Comments

Olivia was excited to have a special visit today from her Grandparents (the Priors)!
No major updates on her condition.
They have closed out her kidney issues as they believe it’s back to normal. They will be removing her catheter later tonight as regular urine samples are no longer needed.
She had a large blood draw around 4 PM for a bunch of tests ordered from the core and GI teams.
Holding time with mom was cancelled today as she got a little fussy post blood draw.
Dr. P presented her case today to the hospital department heads in a scheduled monthly meeting. We have some new ideas flowing for tests and areas to investigate from that meeting.

Daily Rounds

11 Days Old: Morning Rounds

May 4, 2016 No Comments

Good morning. Updates from rounds.

She was stable over the evening.
The roving atelectasis continued, with her right lung showing partial collapse in an overnight X-rays. Shifting her position appears to help. They continue her two lung medications.
Her feeds (mom’s milk) are delayed to let her continue to show signs of progress. She is back on TPN and lipids and her total fluids are increasing tonight (good).
The renal issue appears stable and they will continue to monitor (good).
We await liver tests. Her direct bilirubin continues to rise. They are starting phenobarbital as a treatment.
Official results from the MRI showed that she had bleeding inside the skull from birth trauma (previously suspected only between skin and skull). This is recoverable and not causing any harm. She showed signs of a stroke during birth, which is also expected to be recoverable.

Daily Rounds

10 Days Old: Evening Update

May 3, 2016 No Comments

Updates for the day.

Preliminary MRI results didn’t show too much, which is good. There was minor injury related to the stress at birth, but this is not of major concern to anyone at this time.
She continues to show positive signs from OT and is starting to show active range of motion (mean she’s moving more on her own, in addition to having a broader range of motion).
She is back up on her fluids.
She’s breathing well and continues to improve on ventilator settings (reducing the rate it’s breathing for her – she’s down to 45).
Feeding may resume again tomorrow.
GI came by and they are kicking off some blood tests check for metabolic issues and to look into her liver and gallbladder performance WRT direct bilirubin.

Daily Rounds

10 Days Old: Morning Rounds

May 3, 2016 No Comments

Good morning. No major updates to report from overnight. Her sodium came up. It’s still under the normal range but improving. We await news from rounds. MRI scheduled for 11.

Updates from rounds:

Olivia will be heading downstairs for an MRI today. Dr. P will give us a preliminary read tonight and a formal one will arrive in a few days.
They continue to try to work with her kidneys.
They are modifying her intake and may start protein today.
GI should be starting to consult today. They are expected to order up a host of tests.
She’s coming slightly down on her ventilator settings (down = less support = good).

So, it’s a lot of waiting for more tests today. Miss Olivia looks comfortable.

Daily Rounds

9 Days Old: Evening Update

May 2, 2016 No Comments

Updates from the evening.

She received consistent pulmonary treatments today and her lung opened back up to 3/4, which is a big improvement.
Kidney related test results indicate that she does have SIADH (so, no kidney dysfunction, it’s just getting the wrong signals). After testing and consultation with the kidney specialists and the geneticist, they suspect that the SIADH was caused by her recent lung issues, and it’s likely a one-time issue rather than a more severe, chronic challenge.
They are bringing in a pediatric GI doc tomorrow to help diagnosis her liver issues.
Dr. F stopped by to take another look at her. He didn’t have an update, but he expects to have the micro-array results by the end of the week.
The MRI is rescheduled for tomorrow.
We’ll likely have a cross-team review of her case towards the end of the week.
Otherwise, today was a great day for Olivia. She had a fantastic nurse that kept her lungs cleared consistently.
She is back down to 21% O2 and was awake for a good portion of the day. This was the most we have seen her awake and active since birth.
She had an hour skin-to-skin time with both mom and dad, too.

Daily Rounds

9 Days Old: Morning Rounds

May 2, 2016 No Comments

Good morning. No major updates to report this morning before rounds. Olivia slept well through the night and was really excited to see mom this morning. Her ventilator is on 36% o2. We’ll see what the plan holds for today. If she remains stable, we should have some more time skin-to-skin with mommy. More updates after rounds.

Updates following rounds:

The team is now looking into her kidneys, as test showed a drastic (and sudden) decrease in sodium. A pediatric renal specialist, Dr. R, will now be working with Olivia today. They suspect SI ADH (potentially an acute case resulting from the lung collapses, or a more severe scenario from her brain) or renal wasting (a kidney disfunction). Testing is ongoing and we expect updates today.
Her liver ultrasound was normal. They did not see blockage, but did see some sludge in her gallbladder. Tests continue around the liver concerns as well.
Updates about both her liver and kidney symptoms have been sent on to the geneticist, Dr. F. We may expect a visit from him today or tomorrow – but likely not results.
Her left lung was completely collapsed in yesterday’s X-rays. A positioning change seems to have opened it up. They are calling this “roving atelectasis”, which means her lungs struggle based on “mechanical” things like position and mucus plugging. They may decide to do a full suction on her lungs depending on progress in coming days, but that has not yet been ordered. In the meantime, nurses continue to suction her tube as needed. Her next x-ray is scheduled at 4 PM.
The MRI is postponed, due to all these events.
The continued issues are concerning but may get us closer to understanding her underlying condition(s). Mom and dad are still positive. She continues to receive top tier care and attention.