"He's the boss"

We have learned that the NICU is no picnic. It's not a place just to watch your preemie grow. It's a day by day grind of trying to help your baby survive (since they really should still be in the womb). 

Each day can bring a new set of challenges. The last two days have brought many potential challenges. As Dr. Klein said, "He's the boss." Meaning, Alexander's body will do whatever it wants to do and we have to react to it. 

First off, they did identify a source of infection. Alexander has a urinary tract infection, which is being treated with antibiotics. He has several lines going into his body and that can cause bacteria to grow and settle in lots of different areas. When babies this small have an infection it causes all aspects of his organs to slow down and operate a little less than they otherwise would. We are hoping the antibiotics do the trick.

Secondly, they did identify that the heart duct or vessel that was closed after birth, has reopened. This is called patent ductus arteriosus (PDA) and is a type of congenital heart defect that affects some babies soon after birth and about 50% of preemies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart - the aorta and the pulmonary artery. Before birth, these arteries are connected by a blood vessel called the ductus arteriosus. This blood vessel is a vital part of fetal blood circulation.

Within minutes or up to a few days after birth, the ductus arteriosus closes. In some babies, however, the ductus arteriosus remains open (patent). The opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries.

PDA is first treated with medication, very similar to Ibuprofen. The drug causes the PDA to shrink and close, which is why you don't want to take Ibuprofen while you are pregnant. It also impacts the kidneys and so continued urine output is very important to measure success and ensure the kidney's are not damaged. If the PDA isn't corrected with medication, then open chest surgery is needed to manually close the vessel. We would like to avoid that at all costs as it can be very hard on Alexander's body and take several weeks to recover.

Alexander has had the first of the three doses of the medication (indomethacin). They have not given him the second dose as his urine output isn't what it needs to be. The output of urine helps to measure how his body is tolerating the medication. Basically before tonight we want him to pee as much as his little body can handle so he can take more of the medicine and correct the PDA. 

One good piece of news is he is now over 2 lbs, but unfortunately some of this weight gain is fluid from all the stuff that's going on with his body. You can tell in the photos below that he looks bigger, but a little bloated too. This should go away as he grows and some of these issues are solved. 

Here's our little man, still being so strong through all of this!