Thursday, July 9, 2009

Another Big Day

Day 12: Wednesday, July 8

Today was the next big day that we were waiting for. We got to hold our baby boy for the very first time. Though already 12 days old, he hasn't grown a whole lot from his initial 5 lbs, so he is still as small and precious as could be. As we held him and talked to him he even opened his eyes a little bit. He is still on a lot of medication for pain, so it seemed to be everything he could do to respond to our talking and take a peak at mom and dad. In addition to holding him we also got to do "cares" which includes taking his temperature, changing his diaper, switching his foot pulse monitor, and using a sucker-looking swab to clean the saliva and bubbles from his mouth that collect due to his Anderson tube. It felt so good to finally be involved first hand in his care. I am finally starting to feel like a mom.
Needless to say, this was a very happy day.

When the nurse practitioner came by, I asked her what we were looking for in order to start feedings. She said that two things need to happen. We need to know that his intestines are awake and working, so they will be listening for any bowel sounds and waiting for a bowel movement or gas. In addition to this, they need to see that things aren't still backing up into his stomach. This is indicated by the fluids from his Anderson tube coming out clear and in less volume. She surprised me when she told us that since he wasn't terribly premature, that he would start feedings on the bottle and just skip over the feeding tube. This made me so happy; just one more thing that we can be involved in!

He is continuing to make great progress. They are planning to wean him from his oxygen levels and eventually switch to a cannula that does not force oxygen, but is just there for him to breathe in. They also decided to pace out his morphine to every 4 hours.
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About Gastroschisis

I have posted some links for your information and research, but here's the run down on gastroschisis.

What is it?
Gastroschisis is a birth anomaly in which the baby's abdominal wall does not close all the way during early development. These abdominal defects can result in several problems, the least of which is gastroschisis. This is when some of the intestines escape through the small opening in the abdomen and are now outside the baby's body. During pregnancy these organs are exposed to the amniotic fluid for some time which makes the once maliable and functional bowel stiff and swolen.

How is it treated?
Since gastroschisis is not as serious as other similar defects, it is not dangerous to still deliver the baby vaginally. Upon delivery the baby will go to the NICU and be examined by the pediatric surgeons. At this point of evaluation, there are several courses of action. What needs to happen eventually is that the bowel needs to be surgically put back into the abdomen of the baby.

Option 1: If the bowel has little damage, is quite maliable and healthy, and the baby's belly seems to have the room to accept all of the intestine at once, the surgeons will perform a "primary closure". The surgery is fairly simple. They will make an incision to enlarge the opening enough to push the bowel back inside and sew it up once it is finished.

Option 2: If the bowel is stiff and swolen and or the baby's belly does not have the room to accept it all at once, they will perform a "staged closure". This is more complicated and takes some time. This invloves placing a "silo" over the bowel (this is basically a bag that holds the bowel suspended above the opening). This silo will be somewhat inserted into the baby's belly so as to allow the abdominal fluids to enter and thus healing the bowel by bringing the swelling down and making it malleable again. As the bowel heals and with a little assistance from the doctors the bowel will slowly but surely re-enter the baby's abdomen.

Recovery
A staged closure can take up to a week or two. So you may ask why does he have to be in the hospital for 5 to 6 weeks. Since the baby's system is not used to the pressure introduced by this bowel that is now inside the abdomen, and the bowel has been exposed to the amniotic fluid for so long, it simply takes time for the baby's digestive system to normalize. Aside from the digestive system, other things may be affected such as breathing due to the increased pressure inside the body. The baby's recovery can be broken down into three distinct stages. Pre-Surgery, Post-Surgery/Pre-Feedings, and Post-Feedings.

The first is simply the waiting period before the baby's bowel can be put back inside.

The next period is after surgery, the baby's system is still very fragile and can only be fed interveinously. During this time the amount of nutrients is slowly increased until the baby is ready for the final stage, when his body can accept real food.

Once on breast milk feedings from a bottle, the baby is closely monitored. The process is slow as the baby must phase into these feedings from the IV. Once the baby is up to full feedings and is gaining weight, we can all go home!

Long term effects
Once the baby has fully recovered and is ready to go home, he should be fit as a fiddle and have little or no related complications thereafter. The main thing that he may experience is a case of acid reflux, but this can be treated with medication and it usually will go away as he grows and gets older.