Elise Kathryn Drennan - 8/14

We're proud to announce the arrival of Elise Kathryn at 12:15 AM 4/29/2009. Sorry, we don't have ability to add a picture right now. She weighed in a 8lb 14oz, with a beautiful, full red head of hair, and 20.75 inches long. Kristin did fantastic with labor, pushing for an hour and a half, and requiring only a small episiotomy. She held in there really well and is recovering quickly. She is pumping every 3-4 hours. Unfortunately, Elise ran into some trouble immediately. She had some trouble breathing and so was evaluated by the neonatologist Dr. Stevens. He quickly found that she had bilateral pneumothoraces (collapsed lungs) and there was concern that she aspirated meconium (inhaled baby poop). There was also concern that she may have Group B strep pneumonia, a common bug that 35% of women carry. To reinflate her lungs they inserted chest tubes in both sides of her chest. During labor, Kristin received 4 doses of penicillin, a minimum of 2 is desired for treatment of Group B strep colonization. Elise has been placed on two antibiotics empirically to treat possible Group B strep pneumonia or other infection - claforan (cefotaxime) and ampicillin. In utero, fetuses have high resistance to blood flow to their lungs, as they do not use their lungs for oxygenation. After birth the resistance should decrease so blood can flow to the lungs freely. However, she is maintaining high resistance, or pulmonary hypertension. So Dr. Stevens decided to use inhaled nitric oxide to dilate the pulmonary arteries in a way that Viagra does its job. NO is not commonly used at St. John's and plan B is not available at St. John's. That plan B is to do a cardiopulmonary bypass, ECMO (extracorporeal membrane oxygenation). In that case they decided to transport her to St. Louis Children's Hospital. Elise is requiring addition support. Babies are born with ways to bypass, or shunt, blood away from the lungs, as they are not needed in utero for oxygenation. One shunt is between the atria (PFO) and the other between the aorta and pulmonary artery (PDA). After birth these shunts usually close unless there is pulmonary hypertension, as in Elise's case. Because the pressure in her lungs is so high, the NICU must maintain her systemic pressure high so that blood does not shunt from the lungs. To do this she is currently on three medications to maintain her systemic blood pressure high - epinephrine, dopamine, and dobutamine. She is currently intubated, so she is sedated and treated for pain with versed (midazolam) and fentanyl. Any external stimulation can worsen her pulmonary hypertension, so she is in a low-stimulus environment. She was having frequent hiccups, normal for many babies, that was making ventilation difficult, so she is also paralyzed with vecuronium. Elise was successfully transported to Children's this afternoon by helipcopter and a team of a neonatologist, and NICU nurse, and a respiratory therapist. Our difficultly now is getting her oxygenated. We are following this by measuring frequent arterial blood gases. We are staying in a family room in the NICU tonight and will likely be moving to the Ronald McDonald House tomorrow. We are going to rest and see how she is in the morning. Her condition is critical right now, so send your prayers and good wishes. -Jason