10/11/06 - NICU Day #9

• Daniel had an echocardiogram this morning. The preliminary finding is that there is a 1.5-2 mm PDA. The increased flow to the lungs because of the PDA is probably the cause of the increased difficulty aerating Daniel's lungs.
• The options for correcting this problem are medical (indomethacin) or surgical (ligation). The medical option was attempted when Daniel was 3 days old and it appeared to work, briefly. However, the experience of our neonatologist is that repeat indomethacin treatments don't usually work and the side effects (gastritis, bowel perforation) are increased due to his now more advanced age. Also, he has some GI findings on his abdominal X-ray since the feedings were started (they are now stopped).
• Our plan at this time, therefore, is to go ahead with PDA ligation. The surgery is done in the NICU by a pediatric cardiothoracic surgeon. The most significant risks are bleeding, infection, and unilateral vocal cord paralysis (the left recurrent laryngeal nerve curls around the ductus arteriosus). We hope to talk to the surgeon today.
• Also, Daniel is back under the UV lights because he had a slight elevation of his bilirubin level on this morning's labs.
  

• In the meanwhile, if you would like to say a mishabeyrach for Daniel, his name during this period of illness is Chaim ben Yosefa Avigayil. We hope that he will take strength from this name both for its call for life and because it is the Jewish name of his Great Grandfather Louis Stein.