An interesting week

Wednesday started early with a not atypical session of reflux, only this time it included brown stuff I took to be dried blood. One panicked mother called the doctor thinking the steroids had done something horrible. The doctors, however, are not nearly as excited about it as I was.

Reflux is a common problem for preemies. There is a muscular valve between the esophagus and the stomach which normally closes when we eat. When it is immature, it may not close properly and can allow the stomach contents to wash back up into the esophagus. This is particularly true for babies with BPD (breathing problems) since they use stomach muscles when they breathe, placing additional stress on the stomach. The result is something like heartburn which causes pain, gagging, and spitting up. The acid from the stomach can damage the tissue in the esophagus. It sounds like that is probably the source of the blood; the doctors simply say his reflux must be worse than they realised. They consulted with a gastroenterologist. Toby was already taking 2 "antacid" medications. Those have both been increased.

When he saw the pulmonologist Thursday, his weight was up a few more ounces to a new high of 10 lbs 7 ounces. His O2 level improved while he was on the steroids. His breathing rate remains high. The supposition at this time is that the cause is extra fluids; his diuretics have again been increased. To conserve energy and help compensate for the extra work he is doing breathing, Toby is allowed 2 bottles a day and tube fed the other 5 feedings. We need to wait a couple weeks now to be able to evaluate the effects of these changes.

He also had a flu shot and RSV shot this week to help ward off trouble from those directions.

Toby met with an occupational therapist who evaluated his oral skills. He did very well taking his bottle despite the challenge of also breathing 80 - 100 times a minute. So the plan is to try him with solids next time. She also made suggestions for working with him to keep the oral associations alive while he is tube fed and to keep feedings a pleasurable experience. If an infant with reflux problems begins to associate eating with pain, he may refuse to eat. At this point, we're not too worried about Toby- he loves to eat.

He also loves to smile and "talk" and play with his toys. He even surprised us last night with a few sit-ups while reclining in his car seat. He's getting quite strong- though not yet to the point of maintaining the effort. Overall, he's even more enjoyable than ever and the little bit of weight gain makes him even more squeezable. Hugs to all.