Morning Rounds

Our nurse overnight told us early this morning that Ryan had a great night and that the oxygen level in his hood had been turned down from 100% to 30% and he was doing well. Later this morning the respiratory therapist transitioned him from a hood to a nasal cannula, and apparently he was quite upset with this change and wasn't keeping his oxygen stats up, so they had to raise the oxygen level in the cannula to 100% and then weaned it later to 75%. He began to make the "whining" sounds again intermittently, and the nurse practitioner was perplexed as to why Ryan did so well while they weaned down the oxygen level in the hood but was not doing well with the cannula. We had been encouraged because our nurse said that if Ryan maintained his oxygen stats with the nasal cannula, we could maybe give feedings by bottle instead of IV and also that we'd be able to hold him. However, when the primary neonatologist did rounds this morning, he was very concerned about the fact that Ryan had not been doing well with the nasal cannula, so he ordered that he go back to the hood at 100% oxygen and that a chest x-ray and echocardiogram be done. The purpose of the chest x-ray is to rule out recurrence of the pneumothorax (collapsed lung), the echo is to determine if he has any sort of heart defect that might effect gas exchange in his bloodstream, and the 100% oxygen in the hood is in case he is developing pulmonary hypertension (which both he and the previous neonatologist have explained as being a very scary possible explanation for what's going on). At this point the results of the chest x-ray are back and look good (so no recurrence of the pneumothorax). The echocardiogram tech just left our room, and he's going to transmit the echo to Riley to be read this afternoon. The nurse also just gave him his first feeding using the oral-gastric tube, and he seems to be tolerating it well. We are anxiously awaiting the results of the echocardiogram. Please pray that his lungs just need a little more time and a little help from the oxygen hood and that his condition is not the result of a heart defect or pulmonary hypertension. Also, blood cultures were started when he was first admitted to the NICU to determine if he has some sort of pneumonia, and we are still awaiting the 48 hr results of those. If infection turns out to be the reason for his condition, then he will need to undergo a 7-10 day course of antibiotics.