Lincoln has been doing great with increasing his feedings over the past few days. Two of his three sedation/narcotic medications were weaned also. He was up to 1/2 an ounce of breast milk every three hours yesterday when he started showing signs of withdrawal. His heart rate was high, even at rest, and his breathing rate was elevated, too. He started running a fever of 100.9 and was sweaty and moaning a lot in the afternoon. Withdrawal symptoms can appear similar to infection symptoms, so the doctors wanted to be sure Lincoln was just having a hard time with the weans, and not sick again.
The nurse drew some blood to send to the lab for culture and blood counts. She also gave him a spot dose of withdrawal medicine to see if that helped him. She also gave him a suppository to help him move his food through since he had not digested his last feeding. (Before each feeding they pull his stomach contents out through his feeding tube to be sure he is digesting the milk and they don't overfeed him if he is not.) Then around 5pm, he puked. The medicine for withdrawals didn't seem to help much, although his fever did come down some. So, they decided to increase one of the sedation meds that had been weaned yesterday. They also gave him a bolus of the same med to help him feel better. His blood they drew for labs clotted before they could be tested, so they had to be re-drawn. (Poor baby! More heel sticks!)
Lincoln didn't look much better by the time Dan and I left the hospital around 7:30pm, although he was able to fall asleep. He was working really hard to breath (chest heaving and flairing his nostrils) so they decided to get a chest x-ray around 10pm. It showed that some of his right lung had closed again due to secretion build up. It could be from an infection (possibly the same infection as before, just a new flare up) or from having his diuretic discontinued yesterday. They stopped Lincoln's feeds to rule out feeding intolerance and he was put back on antibiotics. They also increased his oxygen percentage on his flow to give him a boost. His second blood draw was able to be tested but came back showing some funny numbers, so they are ran the tests for a third time this morning and they showed no increase in white blood cells (meaning infection is unlikely) and not as good of a blood gas (probably due to the secretion build up).
At this point they cannot be sure whether he has an infection, is having withdrawals from weaning his narcotics, or both, but it looks like the signs are pointing more towards withdrawal. It didn't help the decisions made last night that Lincoln ended up having three different nurses over the night shift, two of which were not familiar with him. Another baby in the NICU had to be put on ECMO in an emergent situation around shift change, so they had to switch some nurses around to accommodate that little guy. (Specially trained nurses are required for ECMO and dialysis.) I was concerned about Lincoln being ill again. This is now possibly the third infection he has had, but the doctor said it is common for babies with CDH to get sick a lot and not to worry. Lincoln's lungs are very fragile, so just a small bug can have a large impact for him. If Linc does have an infection, they are treating it with antibiotics and will watch for growth in his cultures over the next 48 hours to be sure. Regardless of what's going on, he does seem to feel a bit better this morning, as compared to last night, which is reassuring. He is still struggling a bit to breath, and his heart rate is still high. He does not have a fever anymore though and was able to stool last night. We will have to wait to see what the doctors decide for a game plan for the next few days, since Lincoln has decided he's not going to follow the sedation wean they had mapped out for him.
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