[Enzo] Day 61 report - Parole has been denied.

From: "Phillip Koken" <phil@xxxxxxxxx>
To: <enzo@xxxxxxxxxxxxx>
Date: Wed, 11 Jun 2014 20:21:07 -0700
Day 61

Doctor: Jamie Jones

Nurses: Leah (night), Sherry (day)

RT: n/a (off-oxygen)

Gestational age: 37 4/7 weeks

Weight: 2677 g or 5 lbs. 14.3 oz.

Length: 47 cm (6/8/14)

FiO2: none!

Flow: none!

Feeding: 50 ml Q 3 hr. (24 cal breast milk) through NG tube. PO multivitamin
with iron (1 mg q 24 hr). Bottle every feeding, gavage QS (amount nippled:
50 ml @ 2000, 50 ml @ 2300, 50 ml @ 0200, 50 ml @ 0500,  50 ml @ 0800, 50 ml
@ 1100, 50 ml @ 1400, 45 ml @ 1700).

New orders: give second dose of immunizations

Other issues: occasional de-sats during feeding, mostly self-resolved but
sometimes used "blow-by" oxygen. Last apnea with stim 6/11 8 a.m. during
nippling. Difficulty burping during nippling.

 

Enzo had another good day today.

 

Last night with Leah, Enzo was on good behavior, even though he was
completely exhausted from his exertions during the previous shift. 

 

Enzo ate each of his bottles but had much more difficulty burping than
normal (which is difficult already!). In the past, when things got really
difficult and Enzo was tired, it was quite simple to "Bump his Os"
(temporarily increase his supplemental oxygen). Now, that he is off the
supplemental O2, it is up to him to fix his oxygen saturation when it drops.
This can be a lot work and leads to him becoming tired much sooner. Once he
was completely exhausted, he needed "blow-by" oxygen on a couple of
occasions to maintain his saturation. (This just means that they placed an
oxygen source near his face, no mask or cannula). 

 

Dr. Johnny stopped by several times to check on him after his RetCam exam
and immunization. Enzo did VERY well on a difficult night - we are very
proud of him!

 

Enzo in his crib 



 

Today, Sherry was back as Enzo's nurse. He was stoked to see her!
Unfortunately, he wasn't feeling quite right for his 8 a.m. bottle and had
some serious desaturation action again, meaning that he's deferred his
graduation for another 5 days at least. We agree with the NICU on this one.
Enzo is working very hard to keep his oxygen saturation up, and it shows! We
would prefer to wait until he is feeling more relaxed and he is not as close
to "the edge" of losing saturation as he is today. All of that being said,
Enzo is still without supplemental oxygen, and seems to getting better with
time. His 11 a.m. and 2 p.m. feedings were back to his normal self, except
for a little extra difficulty burping. 

 

Before his 11 a.m. bottle, Lucy came by to go over several PT exercises for
us to work on with Enzo each time we change him. They are very simple
exercises that target stretching and range of motion. Kelly and Phillip each
took turns helping Enzo through his PT. He was fairly cooperative and seemed
to enjoy most of them. The ones he didn't enjoy he did anyway. what a
trooper!

 

Stretching out Enzo - No pain, no gain!



 

Post-workout debrief



 

At 3 p.m. today, Enzo received the last of his two month immunization shots.
He was upset for about five minutes but then settled down (with Nurse
Sherry's cuddling) and slept straight through until his bottle at 5 p.m. He
was awake and eager during the first half, but slowed down at the end,
outright refusing the last 5 ml. Still, not so bad for having a second day
in a row of serious sticks. A lot of babies refuse to eat at all after a
traumatic event (even something like a shot or an IV), so we weren't
surprised when he didn't want to drink the last drop.  No feeding tube means
that if Enzo doesn't eat it from the bottle he isn't getting it. however,
this seems to work well for 99.999999% of babies!
[Enzo] Day 61 report - Parole has been denied.

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