When we left the NICU yesterday, we were fairly convinced Karsie had/has a bowel obstruction. This morning, we spoke with the Nurse Practitioner and she said Dr. Saenz still doesn't think it's a bowel obstruction as she is pooping still and other signs are not pointing to it. However, they are still not ruling it out. After a lot of discussion today among the doctors and nurses (none of which included us) we have yet a new "plan" that we actually like but we are a little nervous as to how it will be run.
Today Karsie has been put on an "ad lib" plan for feeding. She is allowed to take as much as she likes every 2-3 hours as long as she meets a minimum for her weight. The nurses and doctors are convinced (and so are we) that Karsie self-regulates her need for food. In other words, when she stops wanting food, she lets us know and forcing her to eat much more than that could make her throw up. The hope is that she will self regulate and get to a volume that allows her to grow but doesn't overfill her little belly. So they put her on a system where Karsie calls the shots. When she is hungry, within 2-3 hours of her last feed, they will feed her until she doesn't want food anymore. It's very similar to what normal babies do, just keeping very close tabs on it. This doesn't yet solve any problems if it's an obstruction, so we believe they are treating it as if it is not and calling the emesis (throwing up) Karsie not being able to handle full feeds the way we were giving it to her. Thus the switch in plans. So far today, she has done very well with this new plan. Her feeding has gone as follows:
12pm- 38mL
2pm- 32mL
4pm- 31mL
6pm- 55mL
8:30pm- 37mL
She has to get to 180mL every 12 hours. She has met the goal for the first 12 hours already (she is one feeding away from her first 12 hours and already hit the quota). They give her this "minimum" quota to meet as anything less would dehydrate her. We are a little nervous about the night shift as she is a good sleeper, and if she isn't sufficiently awake, she likely will not eat as much. However, the last time she was on 1/2 feeds (35mL) she ate every 3 hours by mouth just fine.
She is not on TPN yet (the nutrition that is good for her but hurts her liver after a while), and as of right now she doesn't have an IV. She had an infiltration on this one (which makes #5 IV that she has lost since last Sunday). This is where basically the small vein can't handle the pressure of the IV and it starts to go elsewhere causing it to puff up the skin. She also doesn't have her NG feeding tube, so she cannot be lazy about eating! We are hopeful the doctors will give her a couple days on this plan so she realizes she has to eat by mouth and cannot rely on the tube. We don't want them to go with this plan and then freak out over a little setback when they have been changing the plan so much lately.
Her belly x-ray was less gassy today than yesterdays, but still semi-gassy. Which basically tells us nil. She always has had some gas but because everything is all jumbled together in her belly, there is no telling how it should be normally.
We are hopeful that this plan will allow Karsie to eat like a normal baby and she will get as much as she needs at a pace that is good for her. And we are hopeful that this will work and she will get to come home without a tube and eating everything by mouth (which would mean more sleep for us)!!
