Saturday, October 07, 2006

10/7/06 - NICU Day #5

Nurses: Rachel, Maureen



I figured out how to white balance the camera under the blue lights in order to take natural looking pictures. This is a great long shot.

  • Stable weight of 890 grams.
  • Oxygen saturation and blood gases are good.
  • Chest X-ray today with no PTX, vacuum turned off and the chest tube was placed on water seal. He'll be followed for a while on water seal with no plan for pulling the tube on any particular day.
  • He was particularly active today. His nurse gave him a pacifier to calm him.

10/7/06

 

10/6/06 - NICU Day #4

Nurses: Rachel, Relany
  • Uneventful. A welcome respite after yesterday's pneumothorax.
  • Just laying around calmly all day with good numbers on the monitor and the labs.
  • The neuro ultrasound from 10/5/06 was officially read as negative - no sign of an intra-ventricular hemorrhage. There is a choroid plexus cyst but this is a common finding in preemies.

Friday, October 06, 2006

10/5/06 - NICU Day #3

Nurses: Jincy, Carolyn

  • Mild-moderate (20-30% lung volume loss) right pneumothorax (PTX). The 6 AM X-ray was interpreted as PTX versus pneumomediastinum. The 9 AM follow-up showed a slightly larger PTX. A right-sided chest tube was placed at around 10 AM and a chest x-ray (CXR) showed improvement.
  • After the tube was placed we held him in his isolette for a little while. His blood type is O+. Jenny and I must both be AO.
  • The PTX failed to completely resolve on a repeat CXR so the chest tube was adjusted. This still didn’t fully succeed so the chest tube was replaced (after confirming that the PleuraVac was working correctly).
  • Final CXR of the day shows the tube in the appropriate location and no residual PTX.
  • Last dose of indomethacin given. Pulse pressure down to 15-20 mm Hg
  • Blood pressure remains strong.

10/4/06 - NICU Day #2

Nurses: Jincy, Carolyn




  • Weaned from the dopamine overnight.
  • PDA not seen on echo. However, pulse pressure is wide (~25) so PDA is presumed and plan for 3 doses of indomethacin (has received 2 so far).
  • Lungs clear on X-ray. Minimal residual RDS with a question of hyperinflation.
  • The official report identified PIE (pulmonary interstitial emphysema). Started on high frequency oscillatory ventilation with great success.
  • Spontaneously diuresing. They expect to see this day 3 or 4, so he’s early. Early diuresis appears to be good for the lungs.

10/3/06 - NICU Day #1

Dr. Williams, Dr. Kasat
Nurses: Melissa



  • Mr. Stein's exam (Ballard Score) is more like that of a 27-28 week-old than 25-26 weeks.
  • Hypotensive with MAP 15-20. Needs dopamine to support blood pressure.
  • Intubated but spontaneously breathing. Moderate to severe respiratory distress syndromes (RDS) on X-Ray. Group B Strep (GBS) pneumonia not excluded. Receives 3 doses of surfactant with improved aeration.
  • Under lights for hyperbilirubinemia (Bili ~4-5). Evolving post birth ecchymoses are a likely source.
  • Echocardiogram pending to evaluate PDA.
  • Hematocrit 36. Will transfure to keep above 40 until extubated (anemia induces increased cardiac output and stresses the lungs) Will keep above 35 thereafter. Most of the anemia is probably iatrogenic, the consequence of necessary medical care (due to blood drawn for tests and cultures). His entire blood volume is about 80 mL.

Thursday, October 05, 2006

10/2 Yom Kippur

  • Midnight – On the monitor at NYU contractions are one minute long, one minute apart. Exam by Jackie shows 1 cm dilated. Preterm labor is official. One SQ shot of tertbutaline stopped the contractions for 15 minutes. Then a 2 mg load of magnesium and 2 mg/hr drip with the expectation of minimum 48 hours. Contractions space out to q3-4min. Plan for indomethacin.
  • 2 AM – Received PCN G (q4) for potential GBS.
  • 4 AM – Mg increased to 2.5 mg/hr and 1 extra dose of tertbutaline given.
  • 5 AM – Jenny gets IM injection of betamethasone to mature the baby’s lungs
  • 8 AM – Dr.Schweizer arrives and changes the plan. The terb has been more effective than the Mag so magnesium is stopped and a terb drip starts. Contractions start to spread out to 2-4 painful (6-8/10) contractions an hour. UA is positive with leukesterase and bacteria. Macrobid planned for but changed to keflex. Azithromycin added for coverage of mycoplasma or ureaplasma.
  • 9 AM – Ultrasound normal for dates (estimated weight 887 g)
  • 2 PM – Temperature 100.4
  • 4 PM – Temperature 101, BP on cuff 88/55. Coverage increased to Gentamicin.
  • 5 PM – SCD boots to the thighs are placed.
  • 6 PM – Painful contractions start to come more frequently. Contractions are associated with bleeding.
  • 8 PM – Dr. Schweizer does a manual exam and finds the cervix is 8-9 cm dilated. The baby has to be delivered. Caesarean section had been discussed earlier as the plan if the pregnancy had progressed but since delivery would be at 25 weeks, a vaginal option was still considered viable. The baby’s heart rate was strong and the delivery of such a small baby would be fast.
  • 9 PM – Jenny is moved to a Labor and Delvery room (805) and starts pushing. Contractions are coming only every 5 minutes so pushes are far apart.
  • 10:06 PM – Baby Boy Stein is born crying. His nurse (Belle) insists on a name. When none comes she declares him "Mr. Stein." Apgar 8/8. 1035 grams. 35 cm. He is whisked to the NICU. He is intubated electively about 2 hours later.

10/1 Erev Yom Kippur

  • Noon – Brunch with Amy, Ken, Stanley, Sol, Gustine, Judy, Marc, Joseph, and Orly at Lundy’s in Brooklyn
  • 4:45 PM – Dinner at Joseph and Orly’s
  • 5:30 PM – Walk from stuy town to shul for Kol Nidre
  • 9 PM – Walk home from shul. Jenny is uncomfortable. Couldn't get comfortable on the seats in the shul balcony. Feels “full.”
  • 11 PM – Jenny wakes from sleep with abdominal pains every 6-8 minutes and GI upset. Over the next hour the pain doesn’t change and, in fact, starts happening more rapidly.
  • 11:45 PM – Dr. Nath is covering Dr. Markoff. She suspects gas pain but to find out for sure we go into NYU to be monitored