January 31st, 2010

Today, Deitre and I drove up to the hospital to see Kierson before I started my 9a-9p shift in the ED. Just as we got to the bedside, we noted her nurse and respiratory therapist at the bedside. I also noted they were having to manually ventilate Kierson. This definitely was NOT what we were expecting to see on arrival. I looked at the monitor to see her O2 sats down in the 20% range (normally 85-95% for her) and her heart rate in the 40s (normally 140-160s). She still had a pinkish hue so we knew that this had just started. Within seconds the 2 people became 6 as other nurses and her NNP came from other parts of the NICU to help out. We stood by, helpless (they don't allow family to get involved in resuscitations). Thankfully, Kierson recovered to normal saturations within several minutes and this time did not become cyanotic. An arterial line was placed for closer monitoring of her blood pressures and for serial arterial blood gasses. Her first blood gas looked totally normal, which was comforting. However, her neonatologist was still not certain as to the cause of the sudden drops.

A short while later, another drop took place. There doesn't seem to be any precipitating factors that we are aware of. Labs from yesterday continue to not support infection as the etiology. She has a negative influenza and respiratory syncytial virus tests. CXR today looks unchanged. Blood cultures and tracheal aspirate are still pending.

Kierson has remained stable for the past 3 hours with only small oxygen saturation drops down into the 70s which she recovers from on her own. Her lungs sound rhoncherous (make a gurgling sound with saliva in the back of your throat and try to make as low a pitch sound as possible....that's rhonchi - due to secretions in the airways as air moves past). My suspicion is she aspirated stomach juices but I don't have any objective support of this right now. She did have approx 1 mL of bilious stomach aspirate from her nasogastric tube early this morning. This is somewhat new. However, ruling out infection is the most important thing currently.

Thank you for your continued prayers and encouragement.