Saturday, July 19th - We Need Practice

OK everyone, this is Kathy because Kevin had to go into work almost all day today. I don't know how Kevin stays with Kinley and writes the blog every day because I had to do it once today and it is not easy. I guess that pretty much explains why the post is so late today.

I got to Kinley's bedside pretty early this morning and Delores, Kinley's neonatal nurse practitioner, was already checking in on Kinley and making some changes. Delores increased Kinley's feedings from 20ml/hr to 24ml/hr. The goal is for Kinley to reach 28ml/hr. After Delores left Katie, Kinley's nurse, told me that Kinley had just spit up some food, but her and Delores were thinking it was because Kinley's bed was flat and the head of the bed had been elevated before. Katie elevated the head of Kinley's bed again to see if that would help any.

Once Kinley was re-situated in bed I began working on her range of motion exercises that the OT (occupational therapist) showed us how to do. While I was working with Kinley, Delores came back by with Dr. P. for rounds.

During rounds it was decided to change Ativan from being given every 6 hours to every 8 hours and to stop Kinley's TPN (IV nutrition). Kinley will just receive some extra fluids through her IV line now and all her nutrition will come from the breast milk that she is getting through her NG tube. This change was made since Kinley is so close to full feedings of breast milk from her NG anyway. In addition to her NG feeds, Kinley can also have three extra oral feedings. Before today, Kinley was only allowed one extra feeding which consisted of 10 ml of milk from a bottle. Now for the big news that came out of rounds today...Kinley and I can try to breast feed! Those three extra oral feedings can be either from a bottle or breastfeeding.

After rounds Kinley decided to have yet another blowout diaper. This one was so messy that she needed new clothes, a bedding change and a sponge bath. I think she got herself pretty worked up about it because right after the blowout she spit up again. Poor Kinley. I let Kinley have some tummy time by being held up against me after she was all clean again.

During the day Kinley and I tried the breastfeeding thing twice and what we decided was that we need more practice. After the second attempt with no luck Kinley received a bottle instead. She took all 10 ml in about 5 minutes and only gaged once. I though she did pretty well. I will keep trying to work with Kinley on breast feeding, but the important thing is that Kinley gets some food orally. I don't really care how she does it. Whatever works best for her is what I want to do.

Just before shift change I started to change Kinley's diaper when she decided to spit up again. This time she spit up a little more than the last time and her NG tube came out as well. Katie called Delores and Delores decided to stop Kinley's Zantac and start Prilosec. Delores thinks that the spitting up is a result of reflux that CDH babies are prone to. Prilosec is a medication that blocks some of the acid production by the stomach and usually works a little better than Zantac. Kinley has not had very high residuals during the day and she was not overly agitated, so Delores does not think it is from the increased tube feedings or withdrawal symptoms. Hopefully with the Prilosec now she will spit up less. We will just have to wait and see.

Overall it was a pretty good day. Kinley was awake for most of the day and was fairly good, but she did have her moments of fussiness. Since Kinley was awake so much today that made the blog writing even harder because I like to spend as much time with Kinley when she is awake as possible, especially since I am back to working full-time.