I will try to share as much information as quickly as I can but we are headed back to the hospital to spend the night so forgive me if I am not clear.
Natalie had one of her best days respiratory wise. Her O2 requirements were as low as 28% (room air is 21%). Her chest X-Ray is one of the best I have seen. I told Steve I wanted to take a picture of it and hang it on the fridge I was so impressed.
So, on the day she seemed to make much headway with her lungs, things fell apart from the diaphragm down.
When I arrived at the hospital she had areas of redness on her abdomen. This indicated an inflammatory process was certainly going on. Her CRP that had been all the way down to 15 recently shot up to 196. Her body was clearly reacting to something. On the upside her white cell and platelet counts remained stable and normally it severe NEC those numbers tend to plummet. Her blood pressure also remained stable, another positive.
I was told her 12 o'clock belly film looked no worse and that her other clinical signs were good with the exception of the redness on her abdomen. Their best guess was she would sort it out on her own within a day or two.
Enter Dr. Lee, the pediatric surgeon who stopped by in the early evening. He was not happy with her films and was very concerned about the redness. I called Steve to meet me at the hospital and we were presented our options.
1. Full exploratory surgery to look for areas of bowel that have died. This is what they would normally do but all doctors involved felt it would be too much for Natalie to tolerate the recovery from the surgery. It involves an incision all the way across the abdomen and is a major ordeal.
2. Surgically place drains to allow bacteria to exit her peritoneal space. This reduces the bacterial load and makes it easier for the antibiotics and her immune system to control the infection.
3. Do nothing and see what happens.
We opted for the surgical drains. It was a much lower risk from a surgical stand point, but we are taking a risk that large portions of her bowel need to be removed and we will not know.
She had the surgery right in her room and tolerated it very well. The surgeon removed some cloudy fluid that indicates there is an infection present. The good news is that there was no evidence of blood or stool, so her bowel has not perforated.
She is on major antibiotics to kill all of her intestinal flora. They are culturing the drainage fluid from the surgery so possibly they will be able to better target the antibiotics.
I will do my best to keep everyone updated. The next 24-48 hours are very crucial in letting us know if the surgery will be of help to her.
Thank you in advance for your good thoughts and prayers.