Daily Rounds

36 Days Old: Daily Update

May 29, 2016 9 Comments

Good morning.

Medical updates

Respiratory. Today we’re starting a “sprinting” regiment. Her rate support will be completely shutoff for 30 minutes so that she has to breathe completely on her own. She’ll still get pressure support as she’s breathing through a little air tube. She’ll do this 2x a day to gain strength and demonstrate whether she can be off the vent. Here’s a picture of her sprinting!
Feeds. Olivia continues to leave large residuals that flirt with the limit (36 MLs). We’re adjusting her Reglan dosage up slightly, corresponding to her weight increases.

Olivia will get to see her Guerrero Grandparents and Aunt today before they head back home. She dressed in her bees for the occasions.

Daily Rounds

35 Days Old: Daily Update

May 28, 2016 7 Comments

Olivia had a quiet night, and snoozed the night away cuddling with her lovie from cousin Wyatt. Today she’ll get a visit from the Guerrero clan: Grandma and Grandpa G and Aunt Lauren!

Medical updates:

Slightly rougher morning on the respiratory front. Nothing critical, but Olivia has been fussy for a few hours, harder to settle, and doesn’t seem to like any position she’s been put into. In addition, there were more desats (minor ones) and our nurse was getting a lot more secretions from her tube than normal. The team has ordered an x-ray to see if there’s any signs of collapse or atelectasis. That will most likely be taken within an hour or so.
Feeds remain the same, at 18MLs per hour, for at least another day. Residuals are still within bounds, but have been slightly higher (two checks were in the 20s), so we’ll give her a bit more time at this amount to ensure she continues to digest appropriate amounts.

Daily Rounds

34 Days Old: Daily Update

May 27, 2016 4 Comments

Olivia had a good night, and is getting some holding time with Mom and Dad this morning.

She’s on a “lab holiday” today, meaning her usual tests/exams will be put on hold until tomorrow to give her a break. She’ll be getting her work up again in the early hours tomorrow following her Tuesday, Thursday, & Saturday schedule.

Medical updates:

Feeds are going strong. She had small residuals most of the night (3-10), which means she’s processing all of her feeds well. We’re at 18 MLs/hr with 1.5 teaspoons of pregestimil/100 MLs. Note: I previously reported pregestimil as per kg, which is how they size other drugs; it’s actually per 100 MLs of fluid. Whoops!
Her supplements will be switched to vitamin D only for the weekend, as she’s been spitting up the other vitamins. They will reassess on Monday.
Respiratory was stable overnight. No planned changes for today.

Daily Rounds

33 Days Old: Daily Update

May 26, 2016 6 Comments

Good morning. Here are today’s medical updates:

Feeds went up to 16 MLs/hr overnight. She had a great residual this morning, 3 MLs at 8 AM. We were in the 20s & 30s yesterday. She will increase to 17 MLs/hr today and go to 18 tonight. Olivia has lost weight in the switch from ND, so the supplements of pregestimil remain.
Direct Bilirubin is back up to 9.7 from 8.6 on Tuesday. No immediate concern, as the reading fits within the (slope of her) trend line.
Respiratory will remain the same today. Her blood gas was higher overnight and she’s had several desat events. This area started acting up towards the end of the day yesterday, despite a strong day on Tuesday.

Dr. C & team stopped by today to round. They were impressed with her OT performance. They expect results from genetics tests in mid-June.

Below are some photos from Mom’s morning holding session. We brought in a boppy today.

Daily Rounds

32 Days Old: Daily Update

May 25, 2016 5 Comments

Good morning. Olivia had a great night. We found her changed into new gear overnight, after pooping all over her outfit from yesterday, so today it’s hot air balloons.

Overnight Olivia did great with her new NG tube (see our update from yesterday on the ND->NG change). She had residuals (undigested milk in her stomach)) of 22, 17, 15, & 24 MLs, measured on the four-hour mark. She’s currently on 15 ML/hr regiment, so she’s digested over 200 MLs via her stomach already. Note: it dropped from 18 when switching to NG feeding, as 18 MLs was a lot for her little stomach to handle at once from a cold start.

In all the fun transitioning from ND->NG yesterday, she missed a bit of feeding and lost 40 grams overnight. They are increasing her pregestimil to 1 & 1/2 teaspoons per kg (up from 1/2) to give her more calories. She will remain at 15 MLs/hr rate during the day. It will increase 1 ML/hr every 12 hours starting at 1 AM EST.

Although she had one of her best blood gases this morning, there are no changes to her ventilator settings today. Her main goal is progressing on NG feeding, so no distractions necessary.

She’s been in Mom and Dad’s arms since 8 AM.

Daily Rounds

31 Days Old: Feeding Update

May 24, 2016 5 Comments

This morning the enteral feeding system alarmed, indicating that Olivia’s ND (nasoduodenal) tube was occluded (blocked). We had seen this before, just a few days ago. At the time, the team believed the tube had moved and was up against the lining of her intestine. Moving Olivia into a new position fixed things.

Upon hearing the alarm this morning, we tried moving Olivia into mom’s arms to see if the movement and new position fixed the block. That didn’t do it. Next, the nurse switched the feeding system to a Kangaroo ePump, but that didn’t do the trick either. They tried to flush the line next, but it was backed up, and there was a minor spill of breastmilk all over Olivia’s sheets. Suspecting that it was either tube positioning or the tube itself, an x-ray was ordered to examine the position. The position was OK.

Since other options were exhausted, the team believed the occlusion must be a result of the tube itself being blocked by the feeds. Olivia was taken off TPN yesterday so her dosage of ursodiol is now being mixed into her milk, along with multivitamins and pregestimil. This new mixture is thicker and can be a bit sticky, so it is not uncommon for it to back up feeding tubes.

The typical course of action would be to replace the tube, but Dr. P made an executive decision to use this opportunity to try feeding through her stomach again. This meant removing the blocked ND tube and inserting an NG tube. Using an NG tube had failed previously (Olivia was not digesting the feeds in her stomach), but we had planned to give it a try again shortly after she reached full feeds. We were supposed to start a trial run with the NG tube later this week, but instead, we’re now going full force. 100% of her feeds are going into her stomach via the NG tube, and 0% directly to her intestine. If it fails like last time, they will insert another ND tube and give her more time receiving feeds directly to the intestine.

We’re excited. We hope she can tolerate this. They are checking residuals at 8 PM. At 18 MLs/hr, the current feeding rate, less than a 30 MLs residual in her stomach will be considered OK to continue feeding via NG.

In other news, the PICC line was removed at 4:00 PM.

Daily Rounds

31 Days Old: Daily Update

May 24, 2016 6 Comments

Good morning and happy 1-month, Olivia Grace! Mom will share photos from the celebration in a post later today. Olivia ordered up a cake for the royal occasion. She requested to be in the care of one of her favorite nurses today as well.

Tuesday’s medical updates:

Direct bilirubin number is down to 8.6. It’s great to see the continuous decline.
Feeds are at full force of 18 MLs/hr. Her PICC line scheduled to be removed today at around noon. This means no more IVs.
Breathing rate will be pushed down to 15 breaths/min, as they continue to ween her rates.
Hematocrit is up and red blood cells are close to normal ranges. Her Retic was up to 9.4%, so her body responded well and recovered on its own.

In hospital news, we had a Nurture Smart Mobile added to her crib yesterday. This should help with stimulation during her increased awake hours.

Mom got an early morning hold in, kicking off today’s festivities.

Daily Rounds

30 Days Old: Daily Update

May 23, 2016 8 Comments

Good morning and Happy 30th Birthday to Mom!

Olivia had a great night. This morning we walked into her awake, listening to baby Mozart, and with a present for Mom.

No major changes medically.

Feeds continue to increase. She’s at 17 ML/hr with a goal of 18, which we’ll hit today. TPN has stopped.
Respiratory remains the same. They may tweak settings tomorrow.
Lab results for bilirubin, hematocrit, etc. are expected tomorrow.

Some photos from the morning.

Daily Rounds

29 Days Old: Daily Update

May 22, 2016 5 Comments

Good morning and happy Sunday!

Olivia had a perfect night. Her good friend, Sydney, the overnight nurse, upgraded her crib and Olivia is now in new digs. Mom thinks her bedding is a little mismatched today, but that’s nothing that can’t be fixed. The new crib makes the room feel larger, and less medical, and because the sides come fully down we can get in real close for cuddles and hand holding.

No major updates on the medical side. Key items are:

She’ll reach her target of 15 MLs/hour of breastmilk today at noon. They will discontinue her TPN, the food she received via IV, tonight. Her new goal is 18 MLs/hr. A 1/2 tablespoon of Enfamil per kg will be added to her feeds to up her caloric intake, as her weight plateaued slightly over the last three measurements. No cause for concern with this action, as it’s standard protocol and a benefit of constant NICU surveillance. Changes in weight might also be attributed to change in measurement tools (they are using a different scale with the new bed), or extra breathing causing her to burn more calories.
Respiratory remains the same on the support side. They’re going to move her dosage of Albuterol and the saline nebulizer to every 12 hours, from Q4.

The Prior clan departed this morning for Maine, stopping by to tour the newly renovated grounds of Hotel Olivia before their departure.

Reminder: tomorrow is Mom’s 30th birthday!

Daily Rounds

28 Days Old: Daily Update

May 21, 2016 6 Comments

Good morning. Olivia had a great night. She was dressed overnight by her nursing friend, Danielle, in a hospital onesie. While cute as could be, Mom has other plans for her attire.

Dad came in early for another father-daughter session. Olivia bemoaned the idea of weekend schoolwork, so we put the books aside and she slept peacefully in my arms. She has been fantastic these past three days with movement in and out of her bed. Previously such an action would have sent her off in a downward spiral of desat events and the like, leaving her exhausted and frustrated from the attempt. It’s a treat to get so much holding time with her.

Medically, the following updates came in today:

Bilirubin is down to 9.7 from 10.0. She’s single digit now, and Dad is proud.
Respiratory stays the same today. Her progress is great and they’re going to let her rest without making more tweaks.
Feeds are up to 11 ML/hr and growing 1 ML q. 8. She’s still projected to be at her goal of 15 by Sunday.

Arbiters from both sides met again this morning on Hotel Olivia construction topics. An accord was reached to monitor her temperature changes today whilst fully clothed. If all goes well, the crib should be in tomorrow. Olivia had no comment to the resolution.

The Prior clan will drop in again today to play with Olivia. Here’s a picture from their arrival yesterday.

Yesterday a friend of Dad from Oak Hill delivered 2 cases of Olivia monogrammed golf balls. Check ’em out!

Finally, on the administrative side, a few fans reported issues with signing up for email notifications. Dad’s has found and fixed the sign-up page, so it’s working now. If you’ve subscribed and are not getting notifications, please subscribe again or leave a comment here (or text me) and I’ll add you manually.

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