THUNK...OW!!!!

That's right, folks, that's the sound I make when the other shoe hits me square in the noggin. So far the other shoe appears to be something light, a ballet slipper perhaps, as opposed to a steel-toed work boot, but this is still a bit of a disheartening morning for me.

After a lovely afternoon visit yesterday from Grandma and Grandpa Dittrich, Aurelia endured a difficult evening. Her belly swelled substantially, she had trouble peeing, pooping, and she became magnificently gassy. Her pain medications failed to alleviate much discomfort and sleep eluded her for much of the night. With two fever spikes up to 101.8 we guaranteed our stay here in the CICU for at least another day.

The team took a urine analysis, blood analysis, and cultures, looking for infections that might be lurking somewhere unseen. This morning the urine analysis came back clean and Aurelia's white blood cell count is reasonable. Thankfully her fever is down after some ibuprofen and she moved her bowels and peed substantially a little while ago.

Currently, our best guess is that her intestinal track failed to start up to full speed after her surgery yesterday (remember that comment I made about her kidney seeming to have started up?), which meant that she had limited function, but not enough to tolerate full feeds. So all day yesterday, when we ran full feeds, Aurelia's body failed to fully process her food. This resulted in the gas, constipation, lack of urine, and painful belly swelling. To help her the team stopped last night's overnight feed and we will start a Pedialite feed later today to see if things are back up and running. We will keep you all posted.

Oh good news! I forgot to mention that pulmonary no longer believes Aurelia needs her inhalers. Yay!!!!

Bye-Bye Arterial Line....

Hi everyone,
Just a quick mid-day update from CHOP to give you a summary of what we know today.

Aurelia has been seen by general surgery (the folks that did her work on her intestines) and they are pleased with her progress. All seems well with her recovery on that front. Similarly, the kidney folks swung by to look over the latest labs and fluid counts, etc., and they are pleased with the way her one functioning kidney is progressing and working.

They will be making a few changes to Aurelia's medication and ordering an x-ray to look at her lungs today. It's common for newborns in a NICU, and particularly among HLHS children, to experience increased breathing difficulty after a few days of life. As the body begins to grow and produce fluid that needs to be processed and passed through the body it can be hard for an HLHS baby to keep pace with the body's needs.

This is particularly true of fluid that can build up in the lungs. Aurelia has had some trouble breathing, and the increased air flow into her lungs has not really 'lightened the load' she's had to bear when it comes to her respiratory rate. She's working awfully hard to keep the fluid from her lungs and while she's not losing ground to the fluid, they really want to try and ease her struggles to breathe.

To that end they will begin administering a diuretic twice a day to help her get those fluids out. Additionally, they will increase the levels of nutrients she gets daily via her feeding lines to make sure she stays hydrated. All this will be monitored via x-ray to be sure her lungs don't begin to lose ground to the fluids.

Otherwise the only real news is that they are removing her arterial line today. This line is used to constantly monitor her blood pressure. She's been doing so well that they feel no need to keep that line present. They'll take her vitals via little baby blood pressure cuffs and if they need fluids for lab tests they can take it from the venal line.

So, today is a good day so far - as the other consults come and go we'll try to keep you posted. If we don't, it's because we really need a nap!