Wednesday morning the NICU physician stopped by and informed us that Spencer was having more problems with oxygenating his blood. Overnight, they had increased his air flow to 50% oxygenated air. In the morning, the reduced it back to 45%, but his blood gas levels were still inconsistent. So, they switched him from the nasal cannula to a CPAP machine. This is a machine that some adults use for nighttime breathing issues (including snoring and sleep apnea). It was helping, but it was really irritating him and he was restless and fighting the machine. The doctor was worried that he might have some condition like Persistant Pulmonary Hypertension or a couple of other problems. But after several tests, the doctor determined that it wasn't any of the conditions that he was concerned about. In the afternoon, they determined that basically Spencer had Respiratory Distress Syndrome where the lungs were not able to expand fully to inhale oxygen and exhale carbon dioxide without a lot of effort. This was exhausting him. They determined a course of action where they administered a surfactant. Basically, as a premature baby, Spencer's lungs were not completely expanding with air. A surfactant is a substance that will prevent the lungs from collapsing, much like detergent allows soap to retain bubbles instead of collapsing. The surfactant adjusted the surface tension of Spencer's lungs to allow them to stay expanded. We visited him after the surfactant was administered and the change was incredible. He was breathing much easier. He was comfortable and no longer fighting the CPAP machine, his color returned to normal instead of the inflamed red that he had been at since they put him on the CPAP machine. And most importantly, they had reduced him back to 30% oxygenated air and he was comfortable there. The doctor thinks that he may be able to slowly wean him from assisted breathing now. But, it's such good progress.
As for Dexter, his feeding problems continued. When we arrived at half past noon, we were told that he was self-eating less and less and by the 9:30 AM feeding, he hadn't eaten anything himself and had to take all of it by nasal tube. The doctor decided that he was going to increase Dexter's intake by 3ml of formula every other feeding until they got him to 42 ml, which is the amount that he should be taking in per feeding. At the 3:30pm feeding Barbara got him to take about 2 ml of formula in about 30 minutes. By the 6:30pm feeding by playing around with him, I was able to get him to take 6ml of formula. Not much, but progress!
We went back for Dexter's 9:30 feeding and found that Spencer had settled a lot and was actually able to rest. At one point they had dialed him down to 25% oxygenated air, but he started to fuss and they put it back to 30%. However, they thought that some of that might have been due to him still reacting to the irritation from the surfactant going down his throat. For that procedure they gave him a mild amount of anesthesia and pain medication. They thought that some of his fussiness was the pain medication wearing off, the irritation in his throat and the after-effects of the anesthesia. Dexter only took in about 2ml of formula although Barbara worked hard that half hour to try to get him to take more. He was up to 36 ml total and had to take the remaining 34 ml by nasal tube. We stuck around until about 10:35 and by the time we left, they had weaned Spencer back down to 27% oxygenated air. Hopefully he'll continue to progress!
I went back for Dexter's 12:30 feeding and was greeted with the wonderful news that they had been able to wean Spencer down to 25% oxygenated air. And he continues to slowly improve his breathing. After the first 24-36 hours, this was such a welcome change. They continue to wean him lower and are going to delay removing the CPAP until he has stabilized at a much lower level. It is too hard and traumatic for the baby to be removed from the CPAP but have to have it replaced later. But, he is breathing so much easier and getting so much more oxygen in his body. It's marked improvement.
Dexter, was still the same. For a half hour, I encouraged him to drink from the bottle, but he's still playing with the bottle more than feeding and we only got about 2 ml in him. He is up to 39 ml per feeding and took the formula by the nasal tube. But otherwise, he's doing great. I held him for an hour while he slept and sang quietly to him. Doesn't get much better than that.
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