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4/6/92 — Preemies at Home, Day 10

April 6, 2011

Molly — 5 pounds 3 ounces 

Ike (l) and Molly together in the bouncy seat. Ike weighed 4 lbs. 4 oz. here, and Molly weighed exactly one pound more. Both obviously still bald. My friend Carole decorated those teeny t-shirts for them. Though we had another visit with Dr. Lum this day, and it was becoming obvious that Molly's heart was still causing her problems, I just don't remember being that scared. We had come so far and I was so happy to have them home. We were also in a whirlwind of preparing for family to descend for Ian's bar mitzvah just four days away. Maybe we were just too busy to be scared.

We took Molly back to see Dr. Lum today. Her chest was retracting when she breathed and he heard mild crackles in her lungs. He increased her Lasix dose and referred us to see Dr. Cole in the next day or two for a cardiac consult.

Discharge notes for Isaac from Dr. Gardner to Dr. Lum:

As you know, Isaac Bearman was hospitalized in our Infant Special Care Unit for November 17, 1991 – March 10, 1992 because of preterm birth at 24 3/7 weeks gestation. Her hospital course was complicated by respiratory failure and the development of chronic lung disease in addition to candida [yeast infection] and enterobacter sepsis [hospital-aquired infection].

This infant was a first twin born at Evanston Hospital to a 31 years old primiparous [woman pregnant for the first time] mother whose pregnancy was accomplished by GIFT and was complicated by chronic bleeding throughout pregnancy. The mother was hospitalized one week before delivery because of increased vaginal bleeding and uterine contractions and was treated with bed rest and tocolysis [delaying of labor, in this case with drugs]. On the day of delivery increased uterine contractions [resulted in early delivery]. The infant was intubated promptly after delivery and was treated with exogenous surfactant [surfactant not produced internally, but introduced from an external source] once her condition was stable. Apgar scores were 4 and 7 and one and five minutes.

At the time of admission, the infants weight was 685 gm, length 31 cm, and head circumference 22 cm. His color was pink [that’s highly debatable by anyone who actually remembers seeing him in those early days; more like dark brown/red/black and blue] while he was ventilated with 27% oxygen and there was fairly good air exchange throughout the lung fields. No anomalies or dysmorphic features were noted and the infant’s size and physical findings were consistent with a gestational age of 24 to 25 weeks. A brief summary of his complicated [this is an important differentiating word between Molly’s discharge notes and Ike’s — his course was “complicated”] hospital course follows.

Cardiorespiratory

The infant initially maintained satisfactory blood gas values while being ventilated with relatively low inspired oxygen concentrations. His respiratory status worsened on the fifth day in association with a pulmonary hemorrhage. Signs of pulmonary hemorrhage resolved within approximately 24 hours and the infant then maintained satisfactory oxygenation while being ventilated with oxygen concentrations ranging from 27% to 42%.

Decadron [corticosteroid] therapy was begun on the 18th day and was followed by significant decrease in oxygen requirement and ventilation requirement. He was extubated on the 41st day and then maintained satisfactory blood gas values while breathing low levels of supplemental oxygen by head hood.

His respiratory status deteriorated on the 51st day in association with enterobacter sepsis and he again required assisted ventilation for an additional 24 days. Through the remainder of his hospital stay he require 25% – 35% oxygen by nasal cannula in order to maintain satisfactory oxygenation. His chest x-rays initially showed moderate granular opacity of the lung fields with air bronchograms and his x-ray findings progressed to complete opacity of the lung fields. There was gradual improvement in the appearance of the chest x-rays over the last two months of hospitalization and the film obtained on the day of discharge shows moderate increase in densities bilaterally, more prominent in the mid- and upper lung fields.

Theophylline was initiated at the end of the second week to assist in weaning and was continued through the hospital stay. Apnea and bradycardia were not a significant problem during the latter weeks of hospital stay.

Serial echocardiograms showed no evidence of a ductus, normal cardia anatomy, and no evidence of cor pulmonale [right-sided heart failure].

Infectious Disease

Treatment with Ampicillin and Gentamicin on admission and continued through the first week, although blood cultures were negative.  Treatment with Vancomycin and Ceftriaxone was begun on December 7 because of suspected sepsis. Blood cultures were subsequently negative for bacterial growth, but repeated cultures were positive for candida. Treatment with Amphotericin was begun on Decmeber 19 with 5-FC on December 13 and both drugs were discontinued February 1. On January 5 the infant had acute respiratory deterioration in association with sepsis due to enterobacter and was treated with Ceftriaxone for 14 days.

Hematology

At the time of delivery, the infant was noted to have significant blood loss at the site of a scalp electrode insertion and transfusion with packed cells was performed shortly after admission. Phototherapy was initiated on the second day because of mild hyperbilirubinemia. On the fifth day bilirubin rose significantly to 13.4/1.5 and exchange transfusion was performed. Mother’s blood type is A+ and the infant is A+ with negative Coombs. The infant received a total of 20 days of phototherapy. He required multiple transfusions during the first three months to maintain adequate hemoglobin level and the last blood transfusion occurred on February 17. Treatment with Fer-in-Sol was begun approximately one month before discharge and was continued through the remainder of the hospital stay. At the time of discharge, hematocrit [proportion of red blood cells] was 27% and reticulocyte [young red blood cells] count 4.1%.

Nutrition

Nutrition was maintained with intravenous alimentation from the fifth day through the 70th days. Small volumes of nasogastric feedings were begun at age four weeks and continued with periodic interruption. The infant’s lowest weight wasw 523 gm on December 12. His weight gain was consistent [read consistently slow] from mid-January to the time of discharge. Isaac made rather slow progress [huge understatement] to taking nipple feedings but had taken all feedings well by nipple during the 12 days prior to discharge [debatable according to my journals].

Screening Examinations

The initial cranial ultrasound examination on the second day was interpreted as a possible left germinal matrix hemorrhage. Subsequent examinations were normal. Serial opthalmology examinations showed progression of retinopathy to Stage II-III on February 25. Subsequent examinations showed resolution of the changes and his retinal examination on March 20 was normal. Neonatal metabolic screen was normal on February 18, 1992. Auditory Evoked Brainstem Response on March 18, 1992, was mildly abnormal on the left and moderately abnormal on the right [these were hearing tests]. Follow up study in 2 to 3 months is recommended if there is any clinical indication.

Immunizations

DTP and hepatitis-B vaccine were given on February 4, 1992.

At the time of discharge, Isaac’s weight was 1751 gm, length 43 cm and head circumference 31.5 cm. His color was pink while he was received minimal oxygen supplementation and there was fairly good air exchange throughout the lung fields. He was receiving theophylline (2.3 mg q six hours) and Fer-in-Sol (3 mg 3 times daily) in additional to supplemental oxygen by nasal cannula.

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3 Comments leave one →
  1. Lori Prang permalink
    April 6, 2011 8:59 am

    What a sweet sweet picture!

  2. April 8, 2011 12:11 am

    I love this photo of your little ones. Very, very sweet 😉

  3. April 8, 2011 7:41 am

    Thank you Anna and Lori. It’s one of our favorites, too. They are starting to look like “real” babies now, even though they were only four and five pounds — still very small for being almost 5 months old.

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