The Cubby Chronicles XXII

Note: Jacob Raymond Walker was born 12 weeks prematurely at Duke University Hospital the morning of Monday, May 19 2008. The following are updates, notes, & observations on his growth & development.

One of the more common sayings muttered by doctors & nurses around the ICN is 'Never trust a preemie.' Loosely translated, it means that no matter how good or bad things seem you never know what's going to happen next and a baby's condition can change in a second. If we've learned anything over the past 5 weeks, it's a popular aphorism for a reason--it's true.

When we last left our hero he was in the transitional care nursery where he was doing fine except after feeds his belly had started to distend when he was being assessed. Distended abdomens can be a signal for a range of issues, from simple gas to various life threatening conditions. As Jake's belly began to get bigger over the course of 18 hours or so they sent him back down to 'the minor leagues' (the ICN) and started preparing for the worst.

One thing we have to give Duke credit for is they waste no time in jumping into proactive treatment if they have a hint that something isn't right. This kind of thinking is critical when dealing with very little kids who don't have time to recover if something goes wrong. If they have even a tiny suspicion that a baby might be getting sick they stop their feeds, grow blood cultures in the lab that will show an infection, and start them on mandatory antibiotics for 48 hours. Much to our surprise, this is where we found little Jake when we called to check on him at 3AM.

After hearing the news, K & I didn't sleep much the rest of the night and went to the hospital this morning. We spent the day with him and the doctors told us they were looking at two options--he might be having an infection (which while sounding simple can be dangerous in preemies) or he could be having an allergic reaction to his pregestimil milk fortifier (which he has a history of).

The latter would be preferred as it would far less risky for him (and seems logical given that he's been very sensitive to medications & previous fortifiers) but its too early to tell. If there's any good news here, they've eliminated the possibility of NEC, which is one of the most dangerous conditions a preemie can have.

However, we've been with him all day and his condition has improved. The strange thing is that outside the specter of a possible infection hanging over him, he's had a great day. His breathing has been as good as ever and though he seemed a little lethargic this morning he picked it up as the day went on. His belly has also shrunk back down to his normal size with some help from a repogle tube, which vacuums out excess air & bile in the stomach (a medical device that's so obscure there isn't a good link).

Jake's also been getting x-rays of his abdomen every 12 hours and they show it stable & improving. Assuming the next one is consistent, they will start his feeds again at a lowered rate (using pure breast milk without fortifiers) tomorrow. It will take time to see if the blood cultures grow any infection samples (they take 24 - 48 hours) but an encouraging sign is that his blood work yesterday didn't show any increased white cell counts (which are a sign of infection) and all his other vitals are strong. He'll get another round of blood work tomorrow.

We're certainly concerned about the little guy but we're feeling much better than we did last night. We're especially relieved to know he doesn't have NEC (though following a recent pattern I was more stressed than Kristin as the only symptom he had was the distension). Hopefully he won't have an infection or at least just a minor one (the nurse practitioner suggested tonight he might have a urinary tract infection). At the moment, Ben (the stuffed version) is coaching him up for his return to the TCN major league. Whatever happens, we'll keep you posted.....