Kyle's Lungs

Kyle's been keeping everyone on their toes the past couple of days. Yesterday I went to visit Kyle at the NICU and met his new neonatologist, Dr. Sharon Brooks.

Monday afternoon, Dr. Brooks put Kyle on a special high frequency ventillator because his lungs were not showing improvement. The high frequency ventillator shakes Kyle slightly allowing his lungs to more easily take in the oxygen. When Chris went to see him Monday night, he mentioned that Kyle kept moving his mouth like he was trying to get the breathing tube out.

According to the neonatologist, late Monday night Kyle had been rejecting the new ventillator so much that they had put him on a medication called Vecuronium to paralyze him. Since this medication may cause pain, they also began him on Fentanyl for the pain. So when I went to see Kyle yesterday he was completely still, not so much as twitching. It was very strange to see him like that but his monitors showed a very even heartbeat and blood pressure which was reassuring to see.

They were concerned that when they put Kyle on the high frequency ventillator it seemed to effect his kidney function and he was not producing as much urine as he should. They put on a foley cathetar to monitor his urine output. They were also concerned that he seemed to be fighting some kind of infection so they began administering an antibiotic just in case and took several cultures to check for infection.

The doctor was most concerned, though, about Kyle's lungs. She showed me his chest X-rays since day one. His more recent X-rays show a "honeycomb" pattern to his lungs which is a sign of http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35017. She explained that the light spots on Kyle's lungs (which were in patches all over) were air pockets of the lungs that were not functioning. She said that the ventillator was meant to help correct this problem and improve his lungs but he was rejecting the ventillator.

I asked Dr. Brooks if there was any medication to treat this lung problem and she said that Coricosteroids have been used in the past for treatment of lung disease in premature infants with great success. However, as of a year and a half ago, they stopped using steroids on infants except as a last resort. They found connections between the steroids treatments and later neurological problems. Though most cases were minor, there was a possible link between the steroids treatments and certain cases of Cerebral Palsy. Dr. Brooks offered me literature on the risks of Corticosteroids and said that if Kyle's lungs did not improve on the ventillator within 48 hours, she would offer the option of using the steroids for treatment.

This afternoon, I visited Kyle again and spoke to the nurse practitioner on duty. Kyle had continued to reject the high frequency ventillator and was having difficulty with his kidneys as a result so they took him off the high frequency ventillator and put him back on the regular ventillator. His saturation levels improved and they were able to bring his ventillator down to 30 breaths per minute (which is much better than he was doing just before they switched him). They also took him off the Vecuronium but he was still not moving when I went to see him because it was draining from his system. His kidney function had already resumed normal activity and he was peeing like a champ. They got his labs back and one culture showed positive for Staph Epidermis but another culture showed negative for the same infection so they were continuing the antibiotics just in case and they took more cultures. If he does have an infection, the antibiotics should be able to treat it. His head ultrasound also showed normal which means that the use of Heparin previously did not cause any bleeding on the brain. So, basically, Kyle was looking really bad yesterday but is looking much better today!

We still may need to resort to the steroid treatments at a later time but at this point Kyle is responding well to the ventillator.