Day 1 of Progress

Things are turning around for Elise today. Yesterday her PaO2s (measure of oxygen concentration in her blood) was in the 40s. Today we awoke to 60s, and by the afternoon we had 121. This is higher than most adults ever achieve. Her blood pressure is remaining high where we want them (MAPs of high 60s-70s), and her pulmonary pressures are remaining low enough to avoid the right-to-left shunting. In other words, the blood is being allowed to flow through the lungs instead of bypassing them. As it stands she is doing well with the great amount of support she is on. We don't want to rock the boat by weaning her off any of it yet. Problems we dealt with today: During this stress, her adrenal glands (glands that sit on top of the kidneys) were not well perfused with blood and showed signs of hemorrhage on ultrasound. This is something that should have adequate perfusion now and should heal and becoming functional again. She has some protection by the functional gland on the other side. What is the significance? The adrenal glands release hormones that regulate our sugar (cortisol), salt (aldosterone), and some sex hormones. So she is having some difficulty regulating her sugar, and so is getting a sugar solution and being supplemented with hydrocortisone, a glucocorticoid. For her sodium she is being maintained with saltier fluids, NS instead of 1/4 or 1/2 NS. Her pneumothoraces seem stable and her lungs well-expanding. They are hesitant to remove chest tubes at this time as they seem to be functional, and it is possible that the lungs could partially collapse in their absence. She is getting routine daily chest X-rays to follow this. Cardiology was consulted today and an echocardiogram was done. She has some dilation of the R heart, to be expected with her high pulmonary pressures. They also wanted to evaluate the amount of shunting, or bypass, of blood from the lungs that is occurring. There is substantial amount through her PFO between the atria and a smaller amount through her PDA. The overall picture is good as her oxygen saturation is remaning 96-100%, as compared to mid 80s to low 90s yesterday. She seems to be tolerating external stimuli much better today. She has also had two brain ultrasounds to evaulate her as a candidate for ECMO, the lung bypass. If she needs ECMO (not likely with her numbers now) they would need to thin her blood with heparin. This puts her at great risk for brain bleeds, so they need to see if she had any existing bleeding. This doesn't appear to be the case. So the big picture is her lungs are not functioning well, but every other organ system appears to be strong. This is a good indicator for her progress. She's even pooping! She's having good urine output, strong cardiac pumping, and beautiful red hair. The neonatologists whats to correct some electrolyte abnormalities, low sodium and calcium and possible start her on nutrition by IV soon (TPN). Giving her breast milk into her nasogastric tube is further down the road, but Kristin is pumping regularly and successfully. They have lactation consultants that are very helpful, 4 lactation rooms, and a milk nurse that handles the milk daily, all inside the NICU! Kristin is still recovering physically very well. She and I feel cautiously optimistic today and want to fast forward a week to see further progress. Today I was able to donate two units of red blood cells for her if she needs it. Right now her hemoglobin is quite adequate at about 18.5, so unless something happens, Elise won't need the blood. Please add comments to the bottom right of this message or questions that we can answer. Thanks for all the support you have sent our way. We love you all. -Jason