Joseph - Day 3 NICU - January 18, 2017

The Daniels have seen improvement during the past few days. Kristine is still recovering at Alta View hospital. Baby James is sleepy but is otherwise doing well (also at Alta View). 

Baby Joseph is still at the NICU in Murray. He has Pneumomediastinum, which is a condition in which there are tiny holes in his lungs that have allowed air to enter into the chest cavity; this air compresses the lungs and prevents them from working properly. Joseph is still on a ventilator and sedated; he has developed a pnuemo thorax (air inside the chest cavity closer to the ribs) that the doctors are monitoring carefully. Joseph seems to be gradually getting better but still has a ways to go. 

The Daniels are very grateful for prayers and support in their behalf. They are also very grateful for the many ward members who have offered to help out with meals and with their other children. More updates to come in the future!

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Kristine - Continues to get better but still tired, able to nurse James a little bit.  

               Her milks is finally in and is pumping.

James - Doesn't latch great, but is getting more and more of mom's pumped milk 

               We are leaving the hospital to go home tomorrow.            

Joseph -

• The Pnuemo Thorax is getting smaller. 
• He no longer needs the dopamine to keep his blood pressure up (GOOD).  
• The echocadiogram (ultrasound of the heart) showed the shunting between the Vein and main artery is decrease significantly. 
• He was switch to a gentler ventilator that lets him breath on his own (GOOD).  
• His oxygen is down to 26% (GOOD) (NOTE: Normal air has 21% so he is almost there).   Next Step: he has to be weaned of the Nitric Oxide which takes a least a day. 
• He still has many steps to take before he gets to come home.  No one will make guesses about when.  I am just glad we have the medical advances that are keeping our baby alive while he heals until he can do what is needed on his own. 

Thanks for you thoughts and prayers. 

Jason and Kristine
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4am: 

Rounds 10 am 

• Weight Down 30 gram 
• D11-
• 1/2 Sodium Acistate
• TFG - 80
• Urin 3.3 6 Stools
• Cayhieror out
• MAPS - 42-60
• BP 62/40 (40)
• Amp 24
• Hz 7
• MAP 13
• FI02 - 32-54% currently 34%
• TCM - 37-59…currency 48
• Blood Gas: 3a: ph 3.7 po02 71. HemGlobin
• Histogram …..
• Medication
  • Atavist - Given as needed 
  • Melenorme
  • Dopamine turned off last night
  • …etc
• Imagine Chest Exra - Desecrate in 
• Has some Edema -> General swelling from liquids
• ??? stinum status: 
• RFP: …Blood - Liver test. . .Renal Function Plan…Sodium, Potassium Chloride, CO2, 
• GIR - Glocus Infusion Rate. . .(adult 4-6 amount of sugar it can handle) ??? in TPN. . increase of the dextrose. . .11.5%
•       TPN - Went up in Protein stead (Amino Acid)
• Respiratory: 
  • X Ray - 8am tomorrow
  • Pneumo Thorax has decreased in size. 
  • Pneumomediastinum still there but small
• Echo Cardiogram Today
• Bili in morning
• Nuero:  MRI when stable … next week
• Endocrine..???
• ???Glucose is up…decrease hydrocortisone? Titrate down...
• RFP -> Tomorrow Morning
• Morphine: instead of manual additions of Morphine, simply increase dosage of morphine
• 
  

6pm - Tyler

• Mean Down 11.5
• Delt P - 21
• 28-35% O2
• TCM: 47
• Melrinone is now off since 3pm
• Echo Came back and looks pretty good
• Maybe: Still has NO PDA (PPHN), but is still shunting
• LESS SHUNTING - improved from the previous echo
• 
  
• Tonight - Monitor for PPHN -
• Next step - Pneuma might be drastically better tomorrow
• Night time: Not likely to make any changes, but will continue to drop FI02, 

11:15 PM - Sarah

• Doing well
• He opened his eyes at about 9pm
• Sucking on his breathing tube and the nurses finger
• 9:30 pm breath a lot on his own, comfortable breaths
• 11:10 pm - Switch to a different ventilation: Draker - Conventional Ventilator
  • More Gentle
  • A step down from what he was on
  • 30 Breath scheduled
  • 15 of his own breaths a minute
• O2 -26%
• Morphine - still increased continuous drip
  • But not as many PRN
• No X Ray Tonight