The Cubby Chronicles XXIV

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.

We're pleased to announce that little Jake is still doing well. He's still hanging out in the transitional care nursery & it looks like he's in it for the long haul. A couple of days ago he was officially transferred over to the TCN doctor staff (they have their own nurses & doctors that are 'core' to the nursery) which just about sealed the deal.

We've enjoyed meeting the new nurses and practitioners but we've also missed our old favorites. As mentioned above, the 'core' nursing staff means that its rare that Jake will get to see his old nurses. The TCN has a standard stable of 12 or so nurses that specifically handle their own babies (there are only ~ 9 babies in the TCN at any given time while the ICN has ~ 40). The ICN works on a primary care philosophy that assigns most nurses a single specific baby that they will care for on each of their shifts (12 hours long, 3 - 4 days a week).

In addition to Annette (his current primary), Jake also has 4 other members on his care team (not to mention an 'unofficial' favorite) and we've been lucky enough that they were all hand-picked from the best. The rumor goes that a few of the higher-up nurses playfully jockeyed over who would get to be the primary nurse for the little guy & they settled it by putting most of themselves on his care team.

While this is great in theory, since the nurses were some of the most experienced ones in the ward they would often have other duties assigned to them (such as being the 'charge nurse' or leading research teams). This led to Jake not always being attended to by his team & his previous primary volunteered to step down (while she was great, because she has so many other responsibilities she almost never actually got to care for Jake) and a few weeks ago she & the team recommended Annette to fill the role.

Though she's relatively young & less experienced than the rest of the team (who average over 15 years each) she's great-- we couldn't be happier. The problem now is it's hard for Annette or anyone else to be assigned to him now that he's in the TCN. If there's ever a TCN 'core' nurse available that's who he'll get. She can only sneak in if there's an opening for the day (either by vacation or illness).

Regardless of the nurse assigned, the little boy is doing wonderful. He's still breathing very well and is literally on the least amount of assistance available (they turned his Nasal Cannula down to its lowest airflow setting). He also passed his initial ROP screen with flying colors which bodes very well for him having normal vision.

They are steadily increasing his feeds; he's currently at 140ml/kilo (the previous high last week was 180ml/kilo). His weight last night was 1197 (his previous high was 1185 last Friday) so he's up a little but has essentially plateaued for about a week which means the whole allergy scare cost him about a week's of growth.

However, a former nemesis has returned--for some reason unknown to the doctors his blood pressure has increased to the high levels of a month ago. He's been put back on the Propanerol (the same med that caused his resting heart rate to slip to 95 awhile ago ) but at a much lower dosage. Though his rates are still elevated & there have been some dosage adjustments, the medicine is working all right & the doctors seem satisfied so far. Other than that, we're very pleased that he's doing great.