Moving On

Yesterday afternoon Lincoln showed signs of leveling off from the stumble he had Monday. His oxygenation saturation started to return. His cultures have come back negative for infection, except for his nasal swab which showed MRSA present. As long as it is not in Linc's blood, it is not super serious. His antibiotics they started him on Monday will treat it and he gets a nasal swab of bacitracin twice a day. We now have to wear gowns when around Lincoln to prevent spreading the bacteria to other patients in the NICU. His heart rate is still somewhat elevated, but it is in the normal range for an infant. Since the doctors have looked into infection, checked for fever and checked for dehydration, they are going to not worry about his heart rate. He is more alert now and being asked to do more work on his own than at any point in his life this far, so a slightly higher heart rate is understandable. They just wanted to be sure it wasn't a symptom of something else going on.

They have begun to turn down his oxygen percentage on the ventilator again, but are not going to turn down the rate of breaths per minute or the nitric oxide just yet. They don't want to change things too quickly and have a repeat of Monday's drop in saturation. Lincoln's blood work is still showing a slightly lower oxygen number, but all of the other signs show us he is being saturated well enough, like his good eye coordination, skin color, and urine out put. His body is adjusting to life with less oxygen and healing from major surgery on top of that! So the doctors are going to accept the lower number for now.

Lincoln had a repeat echocardiogram this morning to continue monitoring his heart function now that he is post surgery, is not on medication to help his heart pump and squeeze, and to check on his pulmonary hypertension. The results showed that there is improvement in his hypertension and his heart is still functioning properly, although some of his chambers are slightly enlarged due to the increased work they are doing now that Lincoln is off of ECMO. The doctor was happy with the results. Since his heart got the all clear and he has been pooping, the doctor put the order in for Lincoln to start feeding today! Until now, Lincoln has been getting his nutrition through his IV. He gets a special mix of amino acids and minerals called TPN and lipids, or fat. They will start him on oral feeds of small amounts of breast milk through a feeding tube (1ml every 3hours) to see how he responds. If he does well, they can increase the oral feeds and decrease the TPN. They can also switch his Sildenifil (med to help his hypertension) to oral too.

The doctors are pleased with Lincoln's morning x-rays still. His left lung is T8, meaning it extends to the bottom of his 8th rib, and his right lung has expanded to T7! It is really incredible the amount of lung tissue our little man has! The x-rays do show some mucus build up and some stress from being on the vent for so long (another reason the docs are accepting his lower blood gas numbers and continuing to wean off the vent). The docs started chest physiotherapy every 4 hours to help break up some of the mucus in Linc's lungs. The nurse uses a small vibrator to gently shake his chest and lungs to loosen the mucus and then suctions them out. This, along with more diuretics to reduce body edema, will hopefully help Lincoln to breath easier, and oxygenate himself better too.

Since Lincoln is waking up more (and will be even more awake in the coming days as his sedation medicines are reduced) the staff is trying a few things to help keep Lincoln calm as he becomes more fussy and needs to do more breathing for himself. He now has soft music playing in his room. He was swaddled for the first time today and he loves it. He also now has his first pacifier to help him self sooth. Lincoln's doctor said she wants to be more aggressive with moving forward in the coming days, so they are giving him every tool they can to help him succeed. We know he can do it!