PPHN

Eli is still in critical condition. They've given him more medicines to paralyze him and sedate him because he's been moving around a lot lately. They think he was probably in pain and are hoping paralyzing him will help him get more oxygen in his blood. The PPHN (Persistent Pulmonary Hypertension of the Newborn) still continues in full force. I don't know if I explained it earlier and so I will quickly explain again what his problem is. Eli has developed PPHN as a complication of a surgery he had last Friday for his TE Fistula. The PPHN is more serious and dangerous than the Fistula and so in most respects no one has been worrying about his birth defect at the present moment even though the pediatric surgeons see Eli several times a day. My simplified explanation of PPHN is as follows (please google PPHN if you want a better explanation than I can provide): Due to the stress of the surgery (they had to push aside one of his lungs to access his trachea and esophogus) Eli's blood circulation has reverted to a fetal (pre-birth) mode. While in the womb, babies don't need their lungs and so most blood bypasses the lungs through several specialized connections between the Aorta and Pulmonary Artery. These connections normally close shortly after birth as a change in pressure in the lungs at birth causes blood to switch directions and start flowing into the lungs in order to get oxygenated. PPHN is caused by extremely high pressure in the lungs that prevents the blood from changing directions. So the blood that is sent from the heart to the lungs actually travels over to the Aorta without getting oxygenated and mixes with the already oxygenated blood. This "shunting" also happens the other way where oxygenated blood travels back over to the Pulminary Artery to get oxygenated even though it has already been oxygenated therefore causing extra stress on the lungs and heart with no gain. The only solution to this problem is to lower the pressure in the lungs and to raise the blood pressure in the rest of the body in order to help the blood flow into the lungs. Closing the fetal connections is not a viable option because the heart could not handle the stress of working against the high pressure in the lungs without a release - the heart would fail under the stress. So Eli gets Nitric Oxcide and Viagra to try to relax his lungs and he gets Dopamine, Dobutamine and other meds to try to raise the blood pressure in the rest of his body. So far this has helped keep him alive, but the shunting is still strong and he is still not getting enough oxygen even though he is on 100% oxygen (we normally breathe only 21% oxygen). There are many ways that the doctors test how he is doing. They take blood every two hours (aterial blood gasses or ABGs) and measure the pH, the partial pressure of CO2 (pCO2) and the partial pressure of oxygen (pO2). The first day or so with PPHN, Eli's blood was extremely accidic and this was the primary concern of the doctors. They have since fixed the pH by adding base (sodium bicarbonate) into his blood, but unfortanely his pO2 levels have dropped drastically in the last two and half days. pO2 levels are not a percentage like spO2 (another measure of oxygen in the blood) and can range into the hundreds. In fact the doctors want Eli to be in the hundreds and he was until a few days ago. Normal is probably somewhere in the 80s. The doctor said that if you or I were on 100 percent oxygen we would be in the 400s. Eli is right around 50. We have been told that if he stays prolonged (4-6 hours) under 50 that he will need to be hooked up to the ECMO (the heart and lung bypass machine) - which thing is to be avoided because the survival rates are not great. Amanda and I live from blood gas test to blood gas test. We visit or at least call every two hours to get the latest test results. The last one was 49. He has been all over the place, ranging from several hours in the 40s and 50s to as high as the upper 80s. When its in the 40s its all we can do not to cry (though often we fail) and when it is in the 80s we stop holding our breath for a minute to smile and hope Eli has finally started improving. So far his numbers has mostly been low and the times when his oxygen has been high have been the exception and not the rule. There's so much more I could write, but it's so hard to write and so I think I will end this long post shortly. Noah has had another lazy day in which he has refused to eat or even wake up. The nurses think he is conspiring to stay in the NICU with his brother. Amanda needs to rest, but it's hard to get her to. I've spent the last two nights at the hospital - my days are starting to blur together; even when I am asleep I dream about Eli and Noah in the NICU.