Friday, December 28, 2012

RSV Update

We're in a nice little routine right now...Dave and I are taking turns spending the night with Dani/Ryan.  I'm home with Dani tonight, so I finally have a chance to update.  On Wednesday we were worried about his crazy high heart rates.  Yesterday early on, he had some high heart rates, but they were starting to look more like normal.  The doctors were saying that he was stable and they were pleased that he wasn't showing signs of needing any more support, so that was a really good thing.  He lost his 2nd IV yesterday, but it was after they had given the OK to start up his breastmilk feeds again, so when the nurse mentioned doing a PICC line I asked if we could avoid it.  Placing a PICC line would mean sedation and a slight risk of infection, and his veins are so hard to poke, I just really didn't want to put him through that if it wasn't absolutely necessary.  She said she would talk to the docs, and they were ok with waiting.  He started his feeds and tolerated them fine, so they switched the antibiotic to an oral version (rather than IV) so he could get that through his g-tube instead.  So no more IV!!  He was acting feverish, going from hot to cold with lots of sweating, so they gave him a dose of Tylenol in the evening and he really settled down. 

He slept great last night minus the times when they had to suction out the mucous.  The one thing I started to notice before he went to bed was that his heart rate was looking a little low.  He was hanging out in the 90s and even made the alarm go off for a hot second when he dipped below 70.  I had a minor NICU flashback to the days when he would have random bradys, but this was so quick and his sats were fine, so I chalked it up to a bad lead connection.  Then in the early morning, even after he woke and his heart rate would normally rise to the 150s, he was still hanging out in the 90s-100s.   He was also cold to the touch, which is strange for him.  I was holding him, which usually heats us both up, and I still had to cover him in warm blankets to get him to warm up. Then he had one more of those random dips into the 70s, so I had to be a squeaky wheel (thanks to some great advice from some mommy friends of mine).  I asked everyone who would listen if his heart rate and cool temps were a reason for concern.  The pulmonologist said he was ok with it, the PICU attending said he was fine with it, they did a blood gas to check for anything off, and it looked just ok.  His CO2 was 61, which to them seemed high at first, until they found out he was discharged from the NICU in October with a CO2 of 62.  He's got chronic high CO2 because of his lungs.  So, they all assured me that it wasn't sepsis or any other sign of infection, and that they were actually pleased with his progress fighting this virus.

Here's what I learned today about RSV, or actually, viruses in general.  So, the virus attacks the body and to fight back, the body becomes inflamed so that more blood can get through the body to fight the virus off.  Thankfully, since Ryan has had two rounds of the synagis shot, he already had some antibodies in him that help fight off RSV.  That's why he's been able to fight this off so much better than most babies with bad lungs, and he hasn't had to be intubated.  But, his body still gets inflamed to help fight, and that's what causes his lungs to have problems.  So they give him steroids to help with the inflammation so that his lungs can breathe easier, but they don't want to overdo it because some inflammation is good to help fight the good fight.  There was a lot more to it than that, and they explained something about the antibiotics and how that plays into it, but I'm too tired to remember right now.

So overall, he's still stable, and he's getting slightly better each day.  The doctors explained that RSV typically reaches its worst point at 3-5 days after the first symptoms, so if that's true, he should be on the downhill road to recovery starting tomorrow.  Once he gets over the worst part of the virus, then it will just be a matter of seeing how his lungs recover before we can figure out when we will be able to bring him home again.  The whole virus usually runs its course over 7-10 days, and then he'll have a lingering cough for a few weeks, so we'll see how it goes and take it day by day.  All the love and prayers you guys are sending every day are so very appreciated.  Ryan has been enjoying visits from all his old NICU nurses, too!  All 4 of his primary nurses have already been able to stop by and see him.  If he has to be stuck at a hospital, I'm glad we're at CHOC where everything is familiar and people remember him as soon as they read his name.  Off to bed...

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urban flowerpot said...

I'm glad you've been able to avoid the PICC and hope he continues to improve quickly! I wish you didn't know so much about RSV now but I think you could write a pretty solid mom-plaination after this! <-I just made that word up so hope you get it! LOL

Jen Aprea said...

Totally get it ;) LOL