For the past few days, I'd been pushing the staff about how Wyatt seemed to be a little pale to me. He was slightly anemic but not dangerously low. They've been waiting for his bone marrow to kick in to make blood cells. If they give him a transfusion, then his body realizes he has plenty of blood and doesn't make his own blood cells.
That was a perfectly good explanation to me, for a few days. Then I noticed his belly was a little bigger. Then I noticed his vital signs were a little more up and down than his normal.
I pushed again about it and again they wanted his body to make red blood cells.
And then he had a lot of left over food in his belly. That wasn't normal Wyatt. He's always been great about digesting his food. He loves his food. I drew a line.
One of the great things about this NICU is they do pay attention to parents' intuition. I was up at an obscene hour last night to pump and called to check on Wyatt. The nurse and I talked and I mentioned that perhaps his GI tract had slowed down because he was anemic.
The next morning, I got a call from the nurse practitioner.
They got an x-ray of his belly. There's a nonspecific bowel gas pattern but there was an area of concern. One of the big concerns with preemies is Necrotizing Enterocolitis, aka "NEC". On an x-ray, they'll see air within the walls of the bowels. But the radiologists only called it "suspicious". His blood counts came back low. So they stopped Wyatt's feeds, started him on antibiotics just in case and, since they were holding his feeds, they went ahead and gave him some blood.
He looks much better. He's a nice pink baby again. And he doesn't act sick which makes them think what is on his x-ray is air around some stool he needs to pass. And she agreed with me that his anemia may have caused poor perfusion to his GI tract, slowing it down.
We talked a bit about it and I hammered her with questions. But it did get her wheels turning some more and they're going to take a stool sample that can check for inflammation in his bowels.
Honestly, I think he's okay and the blood transfusion will fix it. His repeat x-ray showed that the suspicious area had moved so it sounds like that's just stool. Still, they're doing what they call a "48-hour rule-out". They start him on antibiotics as though he has it and wait for labs to prove he does or doesn't. If his labs are negative, then they'll stop the antibiotics. If they're positive, they'll continue the antibiotics.
Now onto his other issue, his PDA.
His PDA may be the source of all his problems so they would call it a "symptomatic PDA". There are people walking around with a PDA, don't know about it, and are just fine. Sometimes they cause problems and it's looking like it is. It could be why his tummy is being so sensitive. It can also be why we're having trouble weaning him off of the high flow oxygen.
Among his many tests today, he had another heart echo. His pulmonary hypertension is still gone, but his heart is showing some changes consistent with being a little strained. It's mild and reversible, but it's pointing towards his "moderate to large" PDA causing problems for him.
He's having a BNP drawn in the morning which will give them an answer. If elevated, they'll consider a few treatment options. One is to restrict fluids and possibly give him a diuretic and hope that closes the PDA. Another is to give him medication similar to Ibuprofen and Tylenol. The medication works better when they're smaller, but because he had pulmonary hypertension, he couldn't have his PDA treated. The third option is to surgically close it.
All treatment options carry risks, but for the surgery, since they work so very close to a nerve for the vocal cords, they can injure that nerve. This could ruin his voice, but more importantly, make it difficult for him to protect his own airway when he eats or swallows.
So Wyatt could use some prayers--that his tummy is okay and that his PDA can close with fluid restriction and/or medication.
He had a rough day today with all the tests and not being able to eat. All I could do was hold his hand and talk to him. He seemed to enjoy that and eventually drifted off to sleep. I wish I could do more for him, my sweet boy.
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