[Enzo] Day 59 report - Staff meeting.

  • From: "Phillip Koken" <phil@xxxxxxxxx>
  • To: <enzo@xxxxxxxxxxxxx>
  • Date: Mon, 9 Jun 2014 20:41:16 -0700

Day 59

Doctor: Jamie Jones

Nurses: Mary (night), Ruth (day)

RT: Adam (night), Yvonne(day)

Gestational age: 37 2/7 weeks

Weight: 2585 g or 5 lbs. 11 oz.

Length: 47 cm (6/8/14)

FiO2: 100%

Flow: 0.125 LPM on LFNC

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: between 2000 and 0500 finished 2 bottles entirely, took 40 ml from
one and 30 ml from the other, 50 ml + multivitamin @ 0800, 55 ml @ 1100, 50
ml @ 1400, 50 ml @ 1700).

New orders: wean to 1/8 LPM

Other issues: very occasional de-sats, mostly self-resolved. Last apnea with
stim 6/4 11:30pm during nippling.

 

Enzo had another good day.

 

Mary was taking care of Enzo overnight. She managed to get him to consume
two of his nighttime bottles completely, and mostly fed the other two.
During one of his feedings, Mary noticed that Enzo's nasal cannula had
popped out of his nose. Since he was doing so well with his O2 saturation,
Mary consulted with Adam the Respiratory Therapist and left the cannula out.
Enzo managed to go for two hours with NO oxygen and his saturation remained
high! Not wanting to push their luck, Adam and Mary fixed the cannula before
the next feeding.

 

Enzo had a HemoCue test this morning, and his hemoglobin level was up
slightly @ 10.1 (a good thing).

 

During our chat with Mary at the end of her shift, she made a point of
saying how much improvement she's seen in Enzo just over the last three days
that she's had him. She said that she's very encouraged by his progress and
thinks that he's well on his way to graduation. Imagine that-two sons
graduating in the same month!

 

Ruth had Enzo for day shift. She last cared for him when he was in the
middle row, so it's been quite a while. His 8 a.m. (by Kelly) and 11 a.m.
(by Phillip) feedings went very well. Enzo ate all of his bottle without too
much trouble, but was still getting gas that is hard to burp out during
meals. Bonus! He made a giant poopy diaper during his 11 a.m. bottle.

 

Phillip feeds Enzo



 

Per doctor's order, Yvonne weaned Enzo to a quarter of a liter per minute of
oxygen around 12:30 p.m. He continued to tolerate the lower O2 all
afternoon, including during feeding and when he was upset about something.
We believe that he can safely be without supplemental oxygen right now, but
he's being weaned slowly just to be sure. If he continues to do this well
over the next few days, then the oxygen will be discontinued before he comes
home!

 

Phillip attending to Enzo mid-feeding while Lucy checks the amount remaining
in the bottle



 

This afternoon at 2 p.m., we had conference about discharge planning with
select members of the NICU staff: Kelly (dietician), Lucy (Occupational
therapist), Jean (Case manager), Dr. Jones (neonatologist), and Lori (Charge
nurse). They went over all the details of what we can expect leading up to
Enzo's transition home and in the weeks and months after.  We were really
grateful for each of them taking the time to meet with us personally. We
don't know exactly when Enzo is coming home (not tomorrow), but it will be
relatively soon. Part of what will happen over the next few days is centered
around changing his meals to a less-fortified milk to verify that he will
continue to gain weight without the supplementation. (We can't bring home
the Human Milk Fortifier packets. He will be on two NeoSure bottles and one
- 1 ml dose of multivitamin with iron daily.) They also want to see him
starting to breastfeed before taking his bottle.

 

When we talked to Ruth at the end of shift, she mentioned that we might try
nippling before changing him (if the diaper isn't too dirty) so that he
isn't so agitated while trying to suckle. Also, she pointed out that the 24
cal milk is a lot thicker than unfortified milk, and as such, he has to work
a lot harder to get it!

 

All in all, it was a very excellent day. We look forward to discontinuing
our daily trips to Palm Springs before Enzo's due date on June 28th!

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