2 good days - time for a blip

So after 2 good days, we got another late night visit from the NICU staff - this time the NNP (nurse practitioner). My heart just sank when I heard the knock on the door after 10pm. Mary Louise's blood pressure and urine output dropped last night and they weren't sure why. She was started on Dopamine again - a low dose. One of her blood cultures came back positive for a tiny amount of yeast - probably due to the 3 antibiotics she was on. Her infection, although still considered rather minor, is unyeilding in spite of the antibiotic therapy and she has now been started on a daily med for yeast in addition to the prophylactic one she was already receiving biweekly. The doctor thinks her umbilical lines may be harboring bacteria but is waiting until the cultures come back in the morning to decide whether or not to pull them. The problem is that at her size, IV access will be very difficult to maintain. Dopamine is extremely harsh on the veins to compound the issue. Another central line is not reccommended while infections are active. So, that's the circle.

This morning her urine output had increased and her color continues to appear normal. Her blood pressure has stabilized and they are still unsure as to why it dropped to begin with. The doctor thinks it may be due to her body needing to maintain a higher pressure than they would normally think neccessary at her age. They brought her pressure up, and she stabilized, so they adjusted the weaning parameters of her dopamine. She is still considered to be doing well overall and we are praying that her cultures come back negative and her infection clears. They are still slowly weaning her ventilator settings and although we've been assured it will be a long road, she is making progress there as well.

Today, David's blood pressure dropped as well. But in contrast to Mary Louise, his urine output has been really high. The theory is that his body likes a lower blood pressure as he is asymptomatic otherwise. So, they are watching him very closely for any signs of a perfusion problem - such as low urine output which would mean that there is not enough circulation to the kidneys - and adjusting medications accordingly. A rush ECHO was done to make sure his PDA remained closed and it has. His pulmonary hypertension also remains under control. Cultures have been sent off for him as well to ensure he is not getting an infection so we wait for the results from those. His incision still looks good and overall he appears to look good as well.

The problem is that there really isn't a protocol for blood pressure on babies of this gestational age and size. So, they are being treated symptomatically.

The doctor has told us that David cannot be fed for 2 weeks due to his surgery but Mary Louise will hopefully start tiny (trophic) feedings this week.

The nurse practitioner brought us to the NICU last night to show us how we can "hold" our babies. We were so pleased to have some contact as we held hands and cuddled heads and toes. David still gets overstimulated really easily but seemed to tolerate us just touching a hand or his feet quite well.

We did come home today with much support from the NICU doctors and staff. My heart aches for my babies but I feel lucky that we are not to far from them and that they are in good hands with the staff at the hospital.