P is in the Hospital

P has been hospitalized - here's a quick rundown...

Th 2/18 - 2mo checkup - 9lbs 14oz; had abdominal ultrasound and swallow study --- no pyloric stenosis, malrotation of intestines, or esophageal stricture.

Sun 2/21 - ER visit for blue episode (usual choking after feeding, turned blue and limp, performed heimlich - RSV negative)

Mon 2/22 - visit with GI doc - videofluroscopic swallow study (w/speech pathologist) showed no aspiration; did show refluxing the entire time he eats; stomach appeared to be full after 1.5-2oz --- Cardiology appt - EKG and ECHO showed a structurally sound heart (no VSD) - II/VI (innocent) murmur --- GI doc upped his Nexium to 20mg BID, 1/2tsp milk of mag and thickened feeds (1tbsp oatmeal per 2oz of EleCare)

Tu 2/23 - follow-up with pedi - 10lbs 4oz - discussed pros/cons of apnea monitor; discussed GI and cardio findings

Wed 2/24 - respiratory therapist delivered apnea monitor

Fri 2/26 - monitor went off at 2:45am because his heart rate was over 220bpm with shallow, rapid breathing --- 10:45am temp of 101.6* --- pedi appt at 1:30pm - 10lbs 2oz - 101.5* - pedi heard wheezing; right ear infection;ordered chest x-ray, bloodwork (CBC, neonatal meningitis screen, blood cultures), RSV test, Influenza A and B tests and urinalysis.

Chest x-ray showed pneumonia in the upper lobe of his right lung. White blood cell (WBC) count is 21,000. RSV, Influenza A and B and meningitis came back negative. Blood culture takes 24-48hrs for a positive or negative and another 48-72hrs to identify the growth. No word on the urinalysis yet.

His highest temp was 102.3* - during this temp, his heart rate was hovering around the 200s and resp rate 80-100; he vomited his entire 9pm feeding. Finally the tylenol kicked in and his temp went back down (as well as his heart rate and resp rate).

Sat 2/27 - WBC 19,800; we'll definitely be here until Monday

If his O2 drops below 94 he'll go under an oxygen tent (at last check he was 94).

He is getting breathing treatments with Xopenex every 6hrs and daily intramuscular rocephin injections.

I spoke with his GI doctor about his pneumonia and the admit. He said if the blue episode was isolated, he would believe the VSS (swallow study with a speech pathologist) when it showed no aspirations. But in light of P having pneumonia in the right upper lobe (which is consistent with aspiration) he is highly suspicious that P is aspirating. On Mar 8, we'll undergo further testing. We'll have another VSS - if that doesn't prove aspiration, there are a few other tests (one including an NJ tube which I'm leaning towards because if we do that and his episodes go away its proof he's aspirating). If we find out he is aspirating P will have a nissen fundoplication (surgical procedure to permanently tighten the lower espohageal sphincter muscle) and a g-tube (feeding tube that enters the stomach from the outside abdomen) for an unspecified amount of time (poss 6-12 months) and his GI doctor will attempt to figure out why he's aspirating (via MRIs, bronchoscopy, etc).