Sunday, November 07, 2004

We were warned that being the parents of a premature baby was like riding a rollercoaster, but we really had no idea. Perhaps Will sensed this, and gave us a few quiet days to get used to the idea. Those quiet days are over for now. As anyone who has been reading this space regularly knows, Will has been dealing with significant breathing problems for the past few days. The source of much of this -- we hope -- is a patent ductus arteriosus, or PDA. The ductus arteriosus is a duct that connects the lungs to the aorta. In the womb, this duct serves a purpose. Outside the womb, however, it can be debilitating for the baby because it circulates blood that has already picked up oxygen in the lungs back through the lungs. This is inefficient and, as Will has shown, makes it much more work to breathe. It normally shuts after a day or two in a full-term baby. In premature babies it sometimes fails to close on its own. This is a fairly common problem.

The doctors prescribe indomethacin for this. It is a drug that constricts blood vessels, much like aspirin, actually, and it is given in the hope that it will constrict this duct. If it doesn't work, the next step is to surgically close the duct. It is small enough that a single stitch often will do it, but it obviously is quite invasive for such a little patient.

When we left the hospital today after our morning visit, we were told that Will's condition was deteriorating too rapidly to allow for further indomethacin treatment. Babies typically get three doses of this in each course, each subsequent dose given 12 hours after the one prior. They usually get two or three courses. After Will received one course, the doctors were afraid it would be too dangerous to wait to do further courses, and got us ready for the idea of surgery. An echocardiogram taken to determine the state of the duct, however, showed that the medicine was working; better than expected, in fact. As we leave it now, Will began a second course of the medicine tonight in the hope that the duct will close on its own. If it does, it will make his heart more efficient, and by extension help his lungs and breathing. He is far from being out of the woods on this -- Saturday night and into Sunday morning was his most difficult period yet -- but it is good news on a day where surgery once seemed the only option. Surgery may still be the ultimate solution; the doctors say the duct doesn't always stay closed after this treatment. But even if it stays closed for a short time, that may be enough to allow him to eat some and to let his lungs get a bit stronger, things that would make surgery less risky in the long run.

When we left tonight, he seemed his old self (if that's possible for a 12-day-old baby), sleeping with his hands thrown back and his purple goggles on (the jaundice light returned tonight), oblivious to the bustle around him. His oxygen needs again were low and his ventilator settings were lower after both were startlingly high just a few hours before. We take this one day at a time, and after a less-than-promising start, we ended this one guardedly optimistic about tomorrow.


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