My goodness, you'd think by now I'd learn not to relax and let my guard down thinking we're on the home stretch! Poor Joshua had a rough morning.
The Short Story: He has severe anemia requiring a blood transfusion and pneumonia (possible sepsis) requiring high flow oxygen supplementation. He's doing much better now, back on vanc and gent antibiotics, and once again the doctors are trying to figure out exactly what is going on.
The Long Story:
I went in at 6:00 to get a couple of hours of kangaroo care before church today. Joshua was tachypneic (breathing quickly, a sign of various bad things such as anemia, infection, and more), but this has been gradually worsening over several days, so nothing new. After an hour or two sleeping on my chest, he started crying inconsolably. I called the nurse, and we put him back in his incubator. He started having difficulty breathing, working really hard to breath, using muscles in his chest and abdomen (retractions) to try to get more air in, and he seemed panicky to me, the way I would feel if I couldn't breathe. He was also very pale and had cyanosis (blue) around his lips, which is new for him, and he was tachycardic (fast heart rate). The nurse practitioner came in and started him on high flow oxygen (to force the air into his lungs to allow him to breathe more easily), and he became a little more comfortable. The doctor came soon after, and they both thought he had RSV (a respiratory virus that can be very serious in a preemie). The stat chest x-ray showed infiltrates, which signifies pneumonia, which fits with RSV. I sat on pins and needles for most of the next hour until the RSV and influenza tests came back negative, thank goodness.
The CBC results showed anemia (hematocrit of 25%, which is pretty low), which would explain the pale color and cyanosis as well as tachypnea and tachycardia. He fit criteria to require a blood transfusion, no biggie since transfusions are so safe these days. James orders them all the time in surgery, so he wasn't worked up about the rare but potential side effects. I signed the consent form, and it said the chances of HIV, hepatitis, or another infection from a transfusion is about one in a million. Ordinarily I wouldn't have batted an eyelash at that statistic, and logically I know it's completely safe, but this is the kiddo who repeatedly proves he will be in the "one in a something" rare minority. I got nervous for a second and asked if James and I could be tested to donate our blood directly to him, but that would delay his transfusion for three days, and we didn't have that time. He's is getting the transfusion over several hours now.
Just when he was starting to make great strides in his feedings (up to 13 mL q 3 hours and tolerating it very well), now he has to be NPO (nothing by mouth) for 24 hours due to the transfusion. There is an increased risk of NEC with transfusions, not a risk Joshua needs right now. I thought we were past that, but NEC won't stop haunting us.
They started him on antibiotics, vanc and gent again, because they aren't sure exactly what's causing the infection. If it's not viral, it could be a bacterial pneumonia or PICC line infection. Once again we'll have to wait 48 hours for the blood and urine culture results. They needed another line for the transfusion, so they started a peripheral IV in his scalp. When I take care of babies, I counsel the parents not to worry about an IV in their head. It looks freaky, but it's harmless, less painful, less likely to be pulled out by the baby, etc. Well, forget that when it's my own child! I do NOT like seeing an IV sticking out of his beautiful forehead! This whole experience is giving me a greater empathy for my patients, but I think my empathy was just fine without having to learn these lessons the hard way, thank you very much. Whah whah, I know I'm whining.
In the middle of all this chaos, what does Joshua do? He goes and yanks out his NG tube (yes it was taped down pretty securely). He's a feisty one, that guy. As if IV starts, blood draws and a urinary catheter isn't enough, let's make it so they have to shove the tube up his nose again. Gee whiz. I wonder if he was thinking, "That's all ya got for me? Well, BRING IT ON!" At least he didn't have that lethargy he had last time. He has been alert and active throughout all of this.
Oh, one more thing...if everything comes back negative, they will do an echocardiogram to rule out problems with his heart (it was enlarged on x-ray). I'd rather not even think about that right now, so I'm not going to elaborate on it until we cross that bridge.
Well, that's the gist of it. My summary doesn't adequately portray the unknown, scary aspect that we were feeling over several hours while waiting for test results. Joshua was looking much better when I left the NICU a couple hours ago, so that's what really matters. I think I'll invest in Clairol stock since I'm going to need a truckload of hair dye to cover up all my new gray hairs!
Thank you for keeping us in your prayers!
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