June 16, 2007 - Day 2

The day after Andrew's birth, D was able to check out of the hospital on a 'day pass' so she could come visit Andrew at Children's. They had moved him from a standard ventilator to a high frequency vent, which pumps continual oxygen into the lungs and often provides a better result. The high frequency ventilator sounds like a huge air compressor and shakes his whole body a bit (especially his chest), so it's a bit scarier to look at him on this mechanism. He also had an extra IV or two, including a PICC line and an additional umbilical line. There were at least eight different fluids dripping into him from various bags/bottles.

We spoke to the doctor and saw some X-rays from before the pneumothorax, after the collapsed lung, and after the chest tube. His right lung looked a lot better after the chest tube, and appeared to fill the entire right side of his chest cavity...a good sign. His 'numbers,' a LONG list of statistics gathered from various electronic monitors and blood tests, were pretty stable, and recovering somewhat from the trauma of his first day of life. We headed back to the hospital so D could continue to recover. She's saving up 'food' for Andrew to eat when he recovers, so we're somewhat limited to three/four hours out in public at a time.

I headed back that evening to check up on the baby. I sat there and talked to him for a while....he can hear us, even though his muscles are being 'paralyzed' and he's sedated to remove any pain. I also took some more pictures. While I sat there, the doctor came by several times and varied the oxygen input to test out better treatments. They also tried moving his head to the other side (on the vent, his head either has to be directly left or directly right). When his blood oxygen saturation started dropping significantly, they even tried rolling him over onto his stomach for a bit.

Eventually, the doctor decided that nothing was working, even on 100% oxygen, a nitric oxide addition, a surfactant treatment, and multiple body positions. [I apologize for the medical jargon...feel free to ignore it, or look these terms up on your own.] The next step after standard ventilator treatments is to put a child on an ECMO machine. ECMO stands for Extra Corporeal Membrane Oxygenation....it's another term for a heart/lung bypass machine for pediatric patients. Children's is the only facility in San Diego County that has these machines, and we were very lucky to be so near for the delivery.

In the NICU, surgeries are done in-place. The surgeon came over from the ER, the surgical team brings in sterile gear, and everybody gowns up and scrubs in for the surgery. I was kicked out of the ward at that point, and had to sit in the waiting room while the surgery was performed. I left the room at 1am and the surgery didn't end until 3:30am. The surgeon came out and described how the procedure went...it took a long time, but Andrew came through well. Putting a child on the bypass means that their heart and lungs don't have to work as hard, so a successful surgery takes a lot of effort off his traumatized lungs. His numbers were almost immediately stabilized.

The positive is that the ECMO machine stabilizes his oxygen levels and allows Andrew's lungs to recover from the pneumothorax, ventilator, and other traumas. The downside is the list of possible complications. First, and most importantly, all the blood traveling through the machine is heparinized, which means it won't clot well. That makes any bleed, especially in the brain, very dangerous for the patient. The surgical and IV sites are also susceptible to these clots. Second, the open wounds can lead to infection, which would deal a distinct setback to his medical progress. There are several other minor complications, but bleeding and infection are the most pressing issues.

Once on ECMO, the desired sequence of events would be a stabilization of lung and heart function followed by the hernia surgery and removal from ECMO. It should give Andrew's lungs a chance to heal, so that he will be strong enough to survive on his own after the surgery.