What a different a week makes!

What a load off her back. Elise got to lay on her side for the first time.

Elise is starting to check out her world. She has a hard time opening her eyes because she is so swollen.

Much progress today! At 12:15 AM she will conclude the first week of her life, and what a difference has been made. Today she has left behind dobutamine (blood pressure), the chest tube on her left side, both her antibiotics, and is now on 45% O2. Her last blood pressure medication, dopamine, has been weaned from 12.5 to 5. Tonight, that will be brought down to a rate of 2.5, just enough to maintain her renal perfusion. She also was weaned down from 3 to 2 on her fentanyl (pain and sedation). We are hoping that with less sedation she will begin moving more, allowing her edema to resolve through urination, and also get her bowels moving and improving her respiratory effort. She required some lasix (diuretic) to get some fluid off her lungs. This will allow us to decrease the air pressure on her ventilator. If we can begin to decrease her mean airway pressure (PC above PEEP) from the current 22 down towards 14, we will be more successful in extubating. Next we are going to want to remove her inhaled Flolan and dose down her hydrocortisone (steroids). Her bowels aren't moving enough yet to increase the rate that Mom's breast is being delivered. We were successful in getting the PICC placed today after a total of 11 attempts. So she has that in her left saphenous (leg vein). We will be removing the umbilical venous catheter now that the PICC line is in place. Tomorrow we will be removing the Flolan inhalation and begin weaning the nitric oxide. So what else is left? Well not much for medications. Elise has done an excellent job in progressing through this. We still don't know a cause for all this excitement. Currently, we're just calling it persistant pulmonary hypertension of the newborn (PPHN). Simply stated, the blood vessels in her lungs did not switch modes from in utero after delivery. Dr. Downey helped me find some more literature on PPHN in the medical library today, and has been gracious with her time. All the physicians and staff have been excited and joyed by the progress. We are still several days from extubation and that will be the next scary step: seeing how well Elise can breath on her own, and if her pneumothoraces will resolve. Currently she only has a small bit of air above her right lung, however, with all the changes she is still 100% saturated on her oxygen. We are now lowering the PaO2s we want down to more physiologic values of 80-100.

Kristin and I had another beautiful walk through Forest Park, and enjoyed talking about Elise's future that we are now sure to experience. We are thinking about a formal dinner with Kristin's first glass of wine in a year once Elise is extubated. If you have any great ideas of what restaurant in St. Louis we need to check out, send your comments. Love you all, Jason