Sunday, July 13, 2008

Oxygen? I Don't Need No Stinking Oxy...Wait, I Guess I'll Take Some

Kayley had a semi-rough day today (it's not often that I write that). She was taken off the prongs at 9 am this morning. She was doing great with the low settings she was on so it was almost an obvious decision. She did very well most of the day. Normally, her oxidation hangs out in the high 80's to low 90's (83 to 93 is acceptable at her age) with the occasional trip down to the low 80's. Today, she took a lot of trips to the 70's. That wasn't really a problem early on because she would always recover on her own very quickly. It was expected that she would maybe have some slight issues. However, when I got to the hospital for Kayley's 3 pm feeding (Megan and Marla were there all morning), things got a little worse. Normally, Kayley's feedings tend to make her oxidation level go down a bit because her stomach becomes so full. At the 3 pm feeding, it was much of the same except Kayley didn't really recover as quickly as she normally does. She stayed in the upper 70's...not an acceptable state. Our nurse had a feeling, and I agreed with her, that Kayley just had some reflux that was causing her discomfort which caused her low oxidation. So, we tried a little experiment. We put the prongs in her nose for a little bit to see if it would help. The nurse had no intention on leaving them there so she didn't even tape them to Kayley's face. I had been holding Kayley the whole time so I decided to put her back in her bed to see if that helped also. With the little extra oxygen, Kayley slowly climbed into the upper 80's. That backed our theory a little bit that Kayley may have some reflux with the new feeding amount and need a little extra help when she has a full belly. Then, Kayley desat'd (oxidation went below 75). The nurse wasn't in the room so I immediately got up to check on her. Kayley had spit up. Again, this backed up our theory that Kayley's low oxidation was caused by reflux. I found the nurse and told her and she helped me change Kayley. While we were doing so, Kayley let out a lot of gas. More reason to believe she was uncomfortable. So, we got her all cleaned up and swaddled and life was good. Her stats looked great so the nurse gave her to me to hold.

Kayley was going strong. Our new plan to help Kayley with her reflux was to increase the time she was being fed. She was receiving 35 cc's over 45 minutes. Our new plan was to give her the same amount over 1 hour to give it time to settle and digest. It was a good plan except that Kayley didn't allow us to make it that far. She began desat-ing rather regularly. And during these times, she wasn't recovering very fast if at all. Her oxidation lowered to the upper 60's a couple of times. The nurse whisked her away from me and gave her oxygen from the bag. Even then Kayley was very slow to recover. However, she did recover so we were going to give her one last chance.

It wasn't long until Kayley was desat-ing again. And this time, she even threw in a brady (slowing of the heart). So, the nurse had to report it to the Neonatal Nurse Practitioner. The decision was made that Kayley just wasn't ready and she needed to be back on the prongs. The respiratory therapist was called and Kayley and I prepared. It was very scary at the time because her oxidation was dipping into the low 60's. The lowest I've ever seen it. At that point, Kayley becomes very limp and doesn't move a whole lot. Thank God the respiratory therapist was in within a couple minutes to put the prongs on Kayley. By the time it was done, Kayley was pooped. It took her a while to recover fully even with her oxygen at 40%. Normally, her oxidation is shooting through the roof at 30%. So, Kayley was back on the prongs and resting comfortably. Her 6 pm feeding was given to her over the planned hour instead of 45 minutes. She did great. It looks like we just didn't have the correct combination this time but we learned from it.

So, we'll try another day. This was just a small bump on the roller coaster ride...which we really can't complain about. It's been a very calm ride thus far. But, no one wants even the slightest bump when it's your little girl at stake.

Other than the real big news today, Kayley did gain a little bit of weight. She's now up to 1905 grams which is still 4 lbs 3 oz. A gain's a gain...

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