The roller coaster ride begins

Mom arrived this morning to find a much happier and healthier looking baby this morning.  Josh was awake and interactive, wanting to have Mom's attention, which Mom was very happy to provide.  According to both the night shift and day shift nurse, Josh had a good night and had little to no drainage from his tummy tube and he had only a few episodes of apnea/bradycardia.

Needless to say, Mom and Dad were anxious to hear how Josh's xrays were and if anything had grown out on his cultures he had sent yesterday.  Around noon, the nurse told Mom that they had added an additional antibiotic, which made Mom suspicious that one of Josh's cultures was positive.  A short time later the nurse practitioner came by to discuss how Josh was doing. 

Josh's xrays were looking better, his intestines had decompressed, so there was less air in them, which means it is less likely that he had a bowel infection.  His blood cultures had no growth so far.  His ET tube culture however had grown gram negative rods, indicating that there is an infection in his ET tube and possibly an early sign of pneumonia.  So they added an additional antibiotic to make sure he is getting the right treatment until the culture can be sent for sensitivity. 

Because Josh was doing better today they decided to try running the ventilator with no assisted breaths (Josh breathing completely on his own).  He did not do very well with this, having multiple A's and B's (apnea & bradicardia).  However, because of the positive cultures from his ET tube, the doctor's decided to extubate him and give his throat a chance to heal and for the antibiotics to work.  So Josh is on CPAP right now.  He may very well go back on the ventilator in 24 hours, depending on how he does, but this will allow his irritated throat time to heal and his antibiotics time to work. 

Josh is very riled up (crying and thrashing around) because of all the things that have done to him, and so we are not sure if he will even make the 24 hours on the CPAP.  If he goes too long with crying and thrashing around, then he may tire out his little body and stop breathing.  If they reintubate him, they will be using a new sterile ET tube, which is also a good thing from having been extubated.  Honestly, at this point, we are not sure what would be better for Josh... to stay on CPAP or to be reintubated.  Both have positives and negatives, and we are concerned that he is just very upset and seems to only breath constantly when he is awake and crying.  Needless to say, we will be calling multiple times tonight to keep track of his status.

So far Mom and Dad haven't been able to touch or console Josh - everything seems to upset him more.  This is pretty upsetting for Mom and Dad - we wish we could just pick him up and hold him. Josh is continuing to have apnea despite being repositioned.  The nurse practitioner increased his CPAP rate to 20 breaths per minute but said if this was not effective he will be reintubated tonight.  We will keep hoping and praying that whatever will be best for Josh will be the outcome.

Prayer Requests:

• Josh's antibiotics be adequate and effective in killing off his infection
• Josh would breath well on the CPAP... not having many A's and B's
• Josh's blood cultures not grow anything (indication of other infections)
• Josh's belly continue to show decreased inflammation
  
• Josh restart his feedings in the next few days
  
• Josh not lose weight, but continue to grow, he is still at 2lbs 9oz - no change from yesterday
  
• Josh not tire himself out by crying and thrashing around
• Mom and Dad get some rest despite feeling more than a bit freaked out and stressed from Josh's condition
• Mom's milk supply continue to grow to support Josh's future nutritional demands

Praise:

• Josh's oxygen saturation and breathing are holding pretty steady
• Josh's blood gases have been good
• Josh's infection was caught early, and so the antibiotics have a very good chance of working quickly
• Josh's tummy is improving, making the chances of renewed feedings better
• Josh is extubated (for better or for worse,)
• Josh can cry audibly (which may sound weird, but we just like to be able to hear him)
• Dad has five days off of work... Yippee!!!

 (Josh sleeping this morning when Mommy arrived)

 

(Josh very focused on going for his ventilator tubing)

 

 (What a sweet boy!)

 

 (Josh trying to control himself to keep his hands off his tubes)

 

 (Unhappy CPAP baby)