This is Rylie. He slept most of the day.
This is Randall after he got through feeding Rylie.
The whole time that Randall was feeding Rylie, he kept trying to open his eyes, but the lights were too bright. Once we shaded his eyes from the light, he decided to have a look around.
This is Ryan, he was awake and wide eyed quite a bit today. The black thing in the picture is not a defect in the picture; it is a piece of plastic on Ryan
This is Reese. This is early this morning before the surgery.
She kept trying to open her eyes, but the light was just too bright.
Once we shielded her eyes from the light, we got to see those pretty blue eyes.
This is Reese after Surgery.
We have some great news today.
Reese did exceptionally well with her surgery today. The team from Cook Children's was delayed in coming to get her this morning; and there was an additional delay before the surgery was actually started. She was scheduled to go from Harris to Cook Children's at 7:30 and have surgery that was scheduled at 8:00. However, she was not taken over to Cook Children's until nearly 9:00; and the surgery was not started until nearly 11:45. She was in surgery for just over an hour. The surgeon told us that she did well in surgery. He said that Reese did have a very large PDA, and that it did need to be closed surgically. Then they brought Reese out of the surgery suite and headed to the recovery room; the team stopped and let Shelley touch her; when Shelley spoke to her, she opened her eyes and looked at Shelley. She spent almost an hour in the recovery room, before she was brought back over to the Harris NICU.
Remember, from yesterday, when I told you that the best chance for a good outcome depended upon having a well experienced surgical team? Today we found out just how good of a team we had. We did not just have a good team, we had an excellent team. Her surgery went so well, she did not have any air, fluid, or blood leaking from her left lung, so she did not need a chest tube. While she was in the recovery room, she did so well, that she was able to be taken off of the ventilator and had her breathing tube removed. When she came back to Harris Methodist NICU, she was breathing unassisted, and only needed supplemental oxygen.The anesthesiologist did a caudal spinal block in order to help her with the pain. This allows good pain control without the need for a large amount of narcotics. Fewer narcotics means less depression of her respiratory drive, so she should breath better.
This morning, before surgery, Reese's blood pressure was 60/27, with a Mean Arterial Pressure (MAP) of 36 (Mean Arterial Pressure is an indicator of the average pressure and correlates well with the amount of blood that reaches peripheral tissues). Yesterday I told you about how Reese's blood pressure was low because it was being shunted to the low pressure system of the Pulmonary Artery; this is evident by the low bottom number, the low MAP, and the wide pulse pressure (pulse pressure is the difference between the top number and the bottom number; a wide pulse pressure always indicates some type of problem). With that blood pressure, she had a respiratory rate between 80-100 breaths per minute, and a heart rate of 190-200 beats per minute.
After the surgery, her blood pressure was 81/51, with a MAP of 60; that is almost exactly what is normal for a newborn infant. After surgery, her heart rate was 150-160 beats per minute, and she was breathing at a rate of 60-70 breaths a minute. Her blood oxygen saturation was 95% or better.
Before surgery, her blood gas analysis showed a partial pressure of oxygen of 33.9 mm of Hg, and an oxygen saturation of 92%. After surgery, her blood gas analysis showed a partial pressure of oxygen of 41.2 mm of Hg, and an oxygen saturation of 96% (higher numbers are better).
The staff has been very accommodating of me being a doctor. They have let me look through the chart, showed me X-rays, let me see lab reports, as well as several other things. Today they let me look over the paperwork that was kept during the surgery. One of the items that is kept during surgery is a log of heart rate and blood pressure; and, it is recorded in such a fashion that it is almost like reading a chart; this allows trends to be seen and recognized easily. It might, for example, be easy to overlook the fact that several blood pressure readings were a little lower than usual, but when you can see the graphical trend, it helps you to be able to provide better care (again, this was just and example; there was no evidence that Reese had a pattern of falling blood pressure during the surgery). A quick look at this data revealed the exact time that the PDA was closed, because the blood pressure jumped up to normal levels, and the heart rate began to decline to more normal levels.
She started to have a few problems later in the afternoon. Apparently, she got a little bit too much narcotics for pain; narcotics depress the area of the brain that regulates breathing, and she was not breathing well; she was breathing shallowly and slowly. She was given a dose of Narcan to help reduce the effects of the narcotics, and her breathing improved immediately.
Randall got to give Rylie a bottle today. He took about 2/3 of the bottle. He continues to do well, and he is gaining weight.
Shelley got to hold Ryan today, and attempted to breast feed him again, but he did not respond very well to that. He continues to have problems with his blood oxygen saturation dropping whenever he gets a feeding. He continues to gain weight.
Shelley went back and checked on Reese again, after the nurses changed shifts, and her breathing was back to normal and her oxygen saturation was okay.