Dec 24 – NICU Visit + Rounds

9:30am

• Overall
  • Olivia is on day of life 4! Age is 27 + 4
  • Olivia continues to make small steps of recovery in multiple areas.
  • Right now, the biggest conversation is surrounding what the next steps are for ventilation, considering Olivia’s good progress.
    • The respiratory therapists are working on a plan here for what’s next
• Respiratory
  • Ventilator pressure levels are down to 15.9 (were at ~17)
    • This is indicative that Olivia needs less help keeping her lungs inflated (good).
  • Supplemental Oxygen was at 30% during our visit
    • Level was higher than usual due to it being just after a care time
    • Levels were stable at 25-28% throughout the day
  • Visually, we can see Olivia “breathing over” the ventilator
    • It’s hard to know exactly what this means. 
    • The ventilator she’s on is most effective when Olivia is not breathing much on her own at all.
    • Her breathing could mean that she wants to be breathing on her own
    • It could also be a sign of struggling with the current ventilator and that she needs more sedation.
    • There’s not an easy way to tell the right path forward, but Olivia’s progress is reassuring nonetheless
  • Follow up blood gas tests and x-rays will help determine the next move.
• Digestive
  • Olivia’s high blood sugars are continuing to trend downward, well into normal ranges
    • Dextrose blood reads were at 268 yesterday (under 200 is normal)
    • Progression of reads today went 158, 150, 87, 98
    • This will continue to fluctuate and be managed by fluids
  • Breastmilk feeding rate has doubled again
  • Feeding will increase in frequency to every 3 hours
  • Olivia is also on a caffeine intake ☕
  • Weight decreased by 30g to 630g
    • This is still normal, she should bottom out in weight somewhere between 2 days and a week from now before consistently growing.
    • Daily weight monitoring is mostly used to manage fluid intake
    • Weekly weight monitoring is the better indicator of growth and development
  • Urine output trending down (good)
    • Likely a result of the lowered blood sugars
• Cardiovascular
  • Chest exams showed a slight heart murmur, which is normal.
  • BP was 67/39 (normal)
  • Platelet transfusion was successful and showed a significant increase in platelet levels
• Other
  • Olivia continues to get sedation as needed for comfort with the respirator. She’s a spunky girl who doesn’t like to calm down and let the treatments do their thing
    • She will need to be weaned off once the change in respirators is made
  • Bilirubin levels lowered from 4.8 to 3.8 overnight.
    • She will only need one light bank moving forward
  • Her prophylactic antibiotic treatment course completes at 1PM today
  • Humidity levels in the isolet will be weaned starting tomorrow