As, Bs, and a Little Too Much Bilirubin

Greetings to everyone.

As you may have picked up from yesterday, Xavier did not come home today. The reason was he had two Bradies yesterday, one during his car seat challenge and one laying in his crib. He also had an apnea event. As the medical staff say it in rounds, he had one A and two B's on Sunday.

Ordinarily, his "A and 2 Bs" would reset the clock to him needing another five days of observation. This still may be the case. However, the doctors are considering releasing him sooner, perhaps this week still. It is possible his A and Bs were related to his immunization shots he got on Saturday. We'll know more later on, hopefully with a notice not so dramatic as last Saturday.

We will be given a car bed by the NICU. They will hold on to our car seat until we return the bed. It seems Xavier will have his next car seat challenge in a car bed.

Other good news: the doctors have taken Xavier off his "three hour" ad lib schedule and let him return to a true ad lib schedule for eating (not to exceed four hours without eating, however. Apparently, no baby his age and size should be going more than four hours without eating). The "three hour" modification to his ad lib schedule was to try and get Xavier to take an extra feeding during a shift as a way to help him gain weight. He's doing well enough with his feedings, the extra one being "snuck in" is no longer necessary.

Tomorrow, Rebecca and I will meet with the oxygen guys at the NICU and get Xavier's mobile oxygen tank. They will instruct us how to use it. This is exciting because it means Xavier is getting that much closer to being home!

Tonight, Xavier weighed in at 1712 grams, a loss of 4 grams from yesterday. The nurse had not measured his length yet when we called, but will do so during his next set of cares.

Rebecca drove down from Cheyenne late in the afternoon and met me at the NICU. We learned how to mix formula. Xavier will be coming home on 26 calories per ounce, but is expected to be weened down to 24 calories per ounce later on. We have recipes for both, and now the (academic) skills to make it happen. Next on our agenda: rocket science!

I had a chance to speak with this rotation's attending physician. I asked him about Xavier's lungs; they were of great concern through most of the last eleven weeks leading up to his delivery, and for some weeks after. He even participated in a (now de-funded) study involving preemies and lungs.

Dr. Jim did not think there will be any complications or problems with Xavier's lungs (Thank you, Jesus!). He may be a little more sensitive to pet dander and dust for a while. He may also have a slightly more difficult time if he contracts any respiratory issue (like a cold or something). As he grows and continues to develop, even these sensitivities will disappear.

The one lingering issue developmentally that we know about is Xavier's liver. His bilirubin count has consistently been high, around 2.4. Any of the fluctuation we have seen has probably been within the standard error of the lab tests.

What happens frequently with IUGR (in-utero growth-restricted) babies is a major artery feeding the liver (I think this is the hepatic artery) develops differently. The artery actually starts to bypass the liver. This is what Dr. Jim thinks happened with Xavier, he developed a partial bypass. A day or two before his delivery, this very liver artery was checked via ultrasound and Dopplers examined. Everything looked good. However, the ultrasound cannot detect a "splitting" of the artery. Because the artery partially bypasses the liver, the liver cannot clean the blood as efficiently, and hence the high bilirubin count.

Did this artery take a partial bypass in Xavier? That is unknown at this time, but likely based on the history of bilirubins and its common occurrence in IUGR babies. Dr. Jim explained that they (doctors) haven't gotten very good at being able to measure this kind of issue. However, the liver is a strong organ and very good at regenerating itself. The artery, Dr. Jim said, will likely self-correct over time.

Not wanting to leave Xavier's liver health in the hands of the unknowns, maybes and mights, we are asking Father to intervene.

On Saturday, Rebecca and I discussed circumcision with the doctors. Wow, what an education in how that is done! There is a special device called a plastibell which fits up underneath the foreskin, both protecting the head of the penis while creating a tiny operating area where the blood vessels can be clamped off and the foreskin cut away in a very precise and clean manner. Part of the plastibell stays in place to help protect the area while the area heals. The device looks much like its name suggests: a plastic bell.

Xavier is a little small for the procedure (the smallest plastibell was just a little too big). Also, the doctors did not want to do it so soon after his immunizations were given.

Thank you all for your prayers. Awesome is our God!