You might remember the runny diaper that Tera had last night when her nurse weighed her. The one that the nurse said we would watch. At 2:30 a.m. I learned the results of that observation. The doctor on-call called to tell me that they had found "specks" of blood in Tera's stool. I'm not sure if she meant the stool from the scale earlier that night or from a diaper that Tera had filled later. Regardless, there was blood. An X-ray was taken, and it was found "questionable." There was an if-y spot on the picture that could be a number of things. Most likely, it was just blocked gas, but there is always the possibility that Tera could develop NEC.
I'm not sure if I mentioned NEC in my earliest posts. NEC stands for Necrotizing Enterocolitis. It is developed in premature infants when their intestines react adversely to feedings. It typically develops within the first few days after the baby starts taking feeds and can lead to anything from a simple round of antibiotics to death, and everything in between. When we first came to the RNICU, the nurses and doctors impressed upon me the importance of giving my preemie breastmilk. One of the Neonatologists has done extensive research on the disease, and his findings show that breastmilk is better medicine than medicine itself in preventing NEC from ever occurring. I haven't thought of NEC since our first days here, but ironically, the disease spontaneously bounced back into my mind on Tuesday, and I asked our nurse if there was still a chance that Tera could develop it. She said that it is still possible, but highly improbable. She's much too old at this point. You can imagine my shock, then, when the doctor mentioned it tonight.
I managed to stay focused long enough to understand that they had stopped her feeds (they call this Resting the Bowels) and were doing three labs to test for infection - a CRP, a CVC (I think that's what it's called), and a blood culture. To compensate for the missed milk, they started an IV in her hand. She would be given 17ml of fluids each hour for next several hours, or until the doctors could re-evaluate and decide what to do next.
This is the good news: Tera's stomach is soft (a good sign that she is digesting properly), and everything about her looks good. Her color is good, she's breathing good, and she hasn't had any bradies, apnea, or de-sats. That's always the first sign that things are better than they seem. Also, the blood in her diaper was bright red which translates into "fresh." This means that she's not bleeding in her stomach because that blood would be an old black/greenish color by the time it made it through her intestines and into her diaper. The fresh blood means that it is in the lower part of her digestive system. This, paired with her good looks, led the doctors to conclude that it's probably just a tear in her intestines, probably from straining too hard to go #2. If that is the case, it will clear up on its own, and Tera will be back to normal in no time.
Don't be too impressed with my understanding of all of this just yet. The doctor told me this once at 2:30 a.m. The nurse had to re-explain it to me when I got to the hospital later this morning. And Tera's pediatrician gave me Round 3 of Bloody Stool 101 when she came around shortly after. At 2:30 this morning, all I heard was "blood," "NEC," "x-ray," "IV," and "labs." Enough to talk myself into believing that we had just taken a major step backwards in our recovery process. I made myself wait until 4:00 a.m., when I had talked myself into believing every worst-case scenario, to call back in to check on any lab results that had come in. The CRP was all that was in, and it looked good. And, of course, so did Tera, so my worries were sustained enough to let me fall back asleep for another couple of hours.
When I got to the hospital, I learned that the CVC had also come back with good results, and the sheer fact that we had heard nothing from the blood culture was a good sign. If it was growing something, we would know about it immediately. The pediatrician came by to check on her before making rounds with the Neonatologist. She was not at all concerned with Tera's episode last night and was certain that we could restart her feeds later in the day.
Instead, she wanted to talk to me about Tera's bottle-feeding. She never said it outright, but I got the distince impression that she was a little concerned that Tera still needs the feeding tube. At 36 weeks - and as big as she is - Tera should be drinking more on her own. She suggested that strategy that might make Tera eat better is if the same person - i.e. her mother - feeds her as many bottles as possible. She said that she might eat better if there is more consistency. Since I'll be the one feeding her at home, she may as well start memorizing my way of doing things now. The pediatrician asked if I had ever spent the night in Tera's room and suggested that I start doing that in order that Tera might get used to my Bottle-Feeding Strategy. I had wondered whether I needed to start staying overnight, so I wasn't too surprised when she suggested it. Of course, I'm not completely ecstatic about sleeping on an extendable sofa, but I'm not completely turned off at the idea of acting more like her mom.
To prepare for my stay (and because Tera won't be drinking a bottle anytime soon) I took the afternoon to get a bag ready for my stay and to take care of some last minute errands. I wasn't sure how often and for what lengths of time I would be able to leave the hospital once I started sleeping there, so I wanted to do as much as possible today. I ate lunch with Jamie before starting my errands and made it back to the hospital by mid-afternoon.
At this point in the day, Tera had not had anything to eat since 8:30 last night. The IV fluids provide her with some sustenance, but they don't give her the satisfaction of being full. In the last couple of days, she has really taken to her pacifier, but it has only been practice for what she needed today. She handled her hunger very well, but it was obvious that Tera was looking for her bottle. Her pacifier proved to be a good alternative.
The doctors decided that they wouldn't start her bottles again until 11:30 tonight, and she would get 15cc for the first several feeds. Lydia called around dinner time to ask about our rescheduled movie date tonight. I decided it was the perfect time to get out. I would be back in plenty of time for her 11:30 bottle and would get a little extra time in the real world before moving in to UAB. We went to see Beastly at the Dollar Theater, then it was back to Tera.
She was crying when I got there - so hungry! I gave her the pacifier again, and I was surprised at how satisfied she seemed to be that no milk came from it. When her nurse came in to prepare her bottle, I warned her that this tiny 1/2 ounce of milk would probably only make Tera angry because of how hungry she seemed. I was completely wrong. She sucked the 15cc down in less than 2 minutes. When I pulled the bottle out, she looked around the room but never cried or even seemed upset. I held her close and rocked her for just a few minutes before she fell back to sleep. What a champ!
Knowing the long night ahead of me, I climbed into my bed as well. It's going to be a long night.
What About Barry and Canon?
Barry and I texted throughout the day about Tera's progress. He called about 9:45 to tell me that he and Canon were about to go to bed. Our neighbors, Jenson and Maggie, had come over to the house to cook tonight, and they had stayed up later than usual hanging out and playing. We got our FaceTime in for the night, and then it was bedtime for them, bottle-time for Tera. They will be coming to Birmingham tomorrow, and it will be interesting to see how (or if) we will manage me staying at the hospital. I already feel like I neglect both Canon and Barry on the weekends, and sleeping at the hospital isn't going to help that one bit. We'll figure it out - we always do.
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