[Enzo] Day 57 report - Oxygen down & Poop up

From: "Phillip Koken" <phil@xxxxxxxxx>
To: <enzo@xxxxxxxxxxxxx>
Date: Sat, 7 Jun 2014 21:12:36 -0700
Day 57

Doctor: Jamie Jones

Nurses: Mary (night), Penny (day)

RT: Adam (night), Yvonne/Shannon (day)

Gestational age: 37 weeks

Weight: 2547 g or 5 lbs. 9.8 oz.

Length: 46 cm (6/5/14)

FiO2: 21% (room air)

Flow: 0.75 LPM on NC

Feeding: 50 ml Q 3 hr. (24 cal breast milk) through NG tube. PO multivitamin
with iron (0.25 mg q 12 hr). Bottle every feeding, gavage QS (amount
nippled: 30 ml @ 2000, 20 ml @ 2300, 25 ml @ 0200, 15 ml @ 0500, 35 ml @
0800, 20 ml @ 1100, 40 ml @ 1400, 50 ml @ 1700).

New orders: 0.4 ml glycerin suppository at 2240, wean from nasal cannula as
tolerated. 

Other issues: ongoing A/B/D, mostly self-resolved. Last apnea with stim 6/4
11:30pm during nippling.

 

Enzo had another good day.

 

Overnight, Mary had our Enzo. She took care of replacing his crib at the
beginning of her shift. The old crib was looking kind of dirty. 

 

Mary noticed that Enzo was continuing to have problems producing stool, so
he was given a glycerin suppository and promptly filled up three diapers for
her! All of that pushing must have taken a toll on Enzo's energy, as he kept
falling asleep during his bottle feedings. Mary ended up partially gavaging
each of his feeds. For his last meal on her shift, he didn't even really
wake up at all. Poor guy!

 

Enzo's FiO2 was held steady at 21%, 1 LPM throughout the night without any
issues. There were very, very few desats, and all were quickly
self-resolved.

 

This morning, after a long hiatus, Jocelyn was back as Enzo's nurse. Enzo
was continuing to be sleepy and was definitely of two minds about nippling
while we were there. He would eagerly suckle for a few minutes and then
become very upset about it. Jocelyn said he was back in business by 5 p.m.
and finished that bottle in less than half an hour. Kelly gave Enzo a shot
at breastfeeding to see if that would produce any better results, but Enzo
still isn't sure what to do once he latches on. 

 

Angry Enzo



 

Peaceful Enzo



 

Yvonne installed a "low flow" metering valve on Enzo's oxygen today. When we
got there his blood oxygen saturation was pegged at 100% on .75 LPM of room
air (down from 1 LPM last night). Amazing! We were so surprised by Enzo's
high saturation that we called over Yvonne just make sure that everything
was reading correctly. (It was.) Don't tell, but Phillip even took out
Enzo's cannula entirely while he was holding him, and Enzo's O2 saturation
stayed in the high 90's and never dropped below the high 80's even when Enzo
was moving around. What a huge and dramatic change from a couple of days
ago!

 

100% Blood Oxygen Saturation (also showing 7 minute historical trace of
100%)



 

If Enzo keeps this up, he will be off of supplemental oxygen altogether!
[Enzo] Day 57 report - Oxygen down & Poop up

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