Poor Benjamin has been NPO, or nil per os, since Saturday. For those of you not living in a NICU (or not Latin scholars), that means they took him off of food. On Saturday night his sodium levels dropped significantly. Not that he gave any clinical indication of low sodium (His O2 levels were staying steady at 21%, he was satting in the high 90s, his BP was good and he was active), but they decided to give him some sodium through his picc line to bring it up. As luck would have it, his picc line was occluding so they had to take it out and give him a new picc line. Several hours and several x-rays later he was all set for sodium BUT (isn’t there always a “but”?) someone noticed some suspicious looping in his belly from the picc placement x-rays. The low sodium, they explained, could be due to the diuretics they have been giving him, but it could also be a symptom of an infection, especially when combined with a suspicious x-ray.
So NPO. Clinically he was (still) fine. Still active. Still no changes to his O2 needs. Soft belly. Nothing unusual. But if anything looks like an infection, it gets treated like an infection – everyone wants to avoid NEC (necrotizing enterocolitis- it’s bad, trust me). So on Sunday (still NPO) he had a whole battery of x-rays done to see if there were any changes. Everything still looked mostly the same, so they kept him on antibiotics and stayed the course, doing some blood cultures. The first round from Saturday came back clear, but they have to be clear for 72 hours before it’s decided he’s infection free.
Today, Benjamin has stayed NPO, but he’s moving back off the TPN and back onto feeds tonight. His 2nd day of cultures has come back clear. His CRP (C-reactive protein) was a 1 (3+ shows an inflammation). The doctor has ruled out NEC, and after a blood transfusion, our little vampire Benjamin will return to his feeds- probably by 11pm (instead of using a diuretic after blood transfusions here they limit fluid for a bit). However, he’s going to alternate breast milk with formula for a while to help build his bone density (breast milk does not have a lot of Vitamin D, and Benjamin doesn’t get sunlight) and regulate his blood sugar a little better.
Hopefully by this time next week he’ll have been PO (Is that a thing? Probably not.) for a full week and busy gaining some weight. We need to fatten this kid up!