Today was the day we were to hear about the results from Zane's head ultrasound, along with his echo. No surprise regarding the echo: his PDA is still open with a L-R shunt present. A PDA is a patent ductus arteriosus. The ductus is a vessel about the width of a plastic coffee stirrer that connects the pulmonary artery with the descending aorta. When Zane was in utero the DA takes the blood and shunts it away from the lung since the infant does not need to use his lungs for oxygenation while in utero. If Zane had gone to term his DA should have closed 12- 24 hours after birth.
Why did Zane's DA not close at birth? First he is premature. Infants who weight less than 1000 grams have a >80% change of having a PDA
Next he received 3 doses of surfactant to treat his respiratory distress; surfactant helped to increase lung compliance and increases the alveolar expansion (which helps with oxygenation) but surfactant can increase symptomatic PDA
Some of the signs Zane showed was a murmur, increase need for respiratory support (higher oxygen and higher settings) he will be treated with another 3 rounds of ibuprofen (this closes the PDA) and he will have another echo on Thursday if the PDA remains open then the only option left is surgical ligation.
His xray also showed atelectasis on his right side and a increase in pulmonary edema (wet looking lungs) and PIE. PIE is pulmonary air leaks that happens from over distention of the air ways, this is something that occurs with frequent vent changes when trying to balance the need for minimum ventilator support but enough support to maintain good oxygenation and blood gases. Placing the infant on the JET helps to minimize this trauma.
The other notable lab values was a 2x increase in Zane's white blood count (which indicates infection) he was started on vancomycin and gentamicin.
Zane's hemoglobin also dropped (due to the frequent blood sampling) and he required a 5ml/kg blood transfusion.
The head ultrasound showed a grade II bleed on the right side only, this occurs because the blood vessels are very thin and highly vascular and fluctuations with the cerebral blood flow can cause a bleed. What causes fluctuations, increase/decrease of blood pressure, changing the baby's diaper and lifting him too high, turning him and not keeping him in a midline position -- and just being so premature, he will have additional head ultrasounds to monitor this bleed during his stay at the hospital
--
No comments:
Post a Comment