Sunday, September 30, 2007

the long story of how we ended up in the hospital for the second time

Tuesday we thought Daniel's breathing sounded strange - really congested and making some new snorting sounds. We also thought that he looked more yellow (jaundiced) than before. So we called the pediatrician's office and they had us come in for a quick check. She decided that his breathing was just normal newborn congestion, but that maybe he did look a little more yellow than he should. So they took some blood (again! poor little guy) to test his biliruben level. She called later in the evening with the number - it was 13, just fine (she wanted to see it under 20). So - as of tuesday, he's still doing ok.

Then on thursday we had an appointment for both of them to get a weight check. Callie checked out ok, her weight is on the upswing, and the doc is happy with everything she sees. Then on to Daniel, and the doc finds a long list of things she's not happy with....
  1. His jaundice. She thinks maybe he look a little more yellow than before.

  2. His breathing. His congestion maybe is more than normal newborn congestion. He could have a virus.

  3. And he is doing what they call 'retracting' when he breathes. It look like his chest wall is being sucked in as he breathes - a sign that he is struggling to breathe.

  4. His heart - she listens to his heart and hears a very loud heart murmer that she had not heard before.
  5. His weight. He is down 10% from his birth weight. This is the magic number that raises red flags.

The combination of all these things earned us an escort over to the hospital. She felt like it was better to be conservative, and by checking him in to the hospital we could get everything dealt with at once, get seen immediately by the pediatric cardiologist, get his breathing monitored, his congestion cleared up, and also get some more attention from the lactation consultants, to try to get him caught up on the breastfeeding. The clinic is in a building connected to the hospital by a skybridge, so it's an easy walk. The doctor called ahead and told them we were coming, and she personally walked us over and checked us in. She even carried Callie for the walk over.

This time we are checked in to the pediatric unit. It's close to where we were before, except that was the mother baby unit, where we were both patients. And this time it's just Daniel that's a patient.

The doc arranged for us to have a private room where we could all stay together - normally only one parent is allowed to stay with a child in the pediatric unit - but since we had twins and all needed to be together, they made a special accomodation for us.

Once we're all checked in, they start working through his list of issues:

Jaundice: the biliruben level comes back and it is down, so this is moving in the right direction and no longer an issue.

Congestion: the nurse irrigated and then suctioned out his nose. She got out a LOT of crud - a quantity you would not expect to see come out of such a small nose. As soon as this is done - he is like a totally different baby than he has been for the previous 5 days. His breathing is completely quiet. He had been a noisy baby, we just thought that's how he was. But now with his nose cleaned out, he's silent.

Breathing: This sinus clean out also seems to have solved the other respiratory issue - now that he can breathe through his nose, his no longer working so hard to breathe, and the retracting has stopped.

Heart: This is the scariest part. We pretty quickly got a visit from the cardiologist - he listed to Daniel's heart for a long time. And then he drew a picture of the heart, explained what he was hearing: a murmur is just the sound of an extra flow in the heart, but they can't tell what it is just by listening. He explains to us that is could be a number of things - some very serious, others not. He orders an echochardiogram - an ultrasound of the heart - to see exactly where the sound is comg from, and clearly diagnose the problem.

Within just a couple hours, he comes back with a printed picture of the heart, and a diagnosis. The diagnosis is that he has a PDA - Patent Ductus Arteriosis. Basic definition: everyone is born with this - there is an extra valve in the heart that is open in utero - because there is no need for blood to circulate through the lungs while in the womb. Normally at birth this valve closes immediately. But sometimes it doesn't close right away, and sometimes it never closes. This is the best possible diagnosis - this is not uncommon at all, and very treatable and/or manageable. We are very relieved - it was a scary couple of hours. The doc thinks that likely it will close on it's own, and that he's just a little behind schedule. He wants to see him back in 2 months to see if it's still there - but all concur that it likely won't be.

And sure enough - the very next day, the murmur is gone! The docs think that probably they heard it on the day it was starting to close. We'll still go back in two months for another echocardiogram to be sure - but it looks like this little scare is past us.

That leaves us with his weight: The basic conclusion is that even though he was eating enough, he was working so hard to breathe that he was burning more calories than he was taking in. So now that all his other issues have been dealt with, hopefully he will be able to gain weight. The doctor wants to keep him in the hospital until she sees some solid weight gain a day or two at least, possibly through the weekend.

So our mission becomes to fatten the boy up. They weigh him thursday evening so we have a baseline. We have to fill out a log of what he does - how long he nurses, how much supplemental bottle he takes. And they are weighing his diapers to see how much he puts out. We are waking them both up every three hours to feed. It's grueling, but we know it's for a good cause.

We feel a bit like prisoners in the hospital, basically doing nothing in this little room except feeding, changing and trying to get a little sleep. We have been put on semi-quarantine - because of all his nasal congestion they are concerned that he might have a virus. They have sent out a nasal swab, to rule out RSV - apparently a fairly serious virus - and until that comes back, they don't want us wandering the halls and possibly spreading it.

24 hours later - Friday evening - he is weighed again. Our boy has gained 3 ounces in 24 hours! He's a super star weight gainer. Saturday morning the pediatrician comes and proclaims him clear on all other counts - the RSV test was negative - and orders another weight for 4pm. If he has gained more at 4, then we can go home.

At 4:00 - Daniel has gained another 3.5 ounces, and he now weighs just over 7 lbs. So in less than two days we have managed to pack on over 6 ounces on him.

and we get to go home! Leaving the hospital again felt like some kind of wierd do-over. But it's good to be home and back in our own beds.

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