Day 28 - Tomorrow's Neurosurgery

Monday, August 14, 2017

AGE: 3 weeks, 6 days old (28 weeks, 5 days gestation)
Lochlan: Weight is 1110 grams/ 2 lb. 7 oz. (Birth weight: 760 grams/1 lb 10.8 oz.)
Lex: Weight is 1100 / 2 lb. 7 oz. (Birth weight: 760 grams/1 lb 10.8 oz.)

Lochlan will have surgery tomorrow (08/15/17) to have a subgaleal shunt (a temporary shunt) put in his head to help drain excess fluid. Since his brain bleed (grade 4 in left and grade 2 in right) shortly after birth, his body has not been able to get rid of the blood in his brain. Though the cranial ultrasounds show he has not had further bleeding, the existing blood makes it difficult for his brain to absorb spinal fluid which is continuously made by the body. The excess fluid is causing inflammation in his brain ventricles and needs to be removed so it does not cause damage.  His head has been closely watched and has continued to increase in size which is why the decision was made to intervene. He has also been becoming more agitated and uncomfortable; he required morphine this morning for care likely because his little head hurts.

This morning, we met with the neurosurgeon to learn about the procedure and risks and to ask questions. Lochlan will be moved to an operating room for the procedure unlike Lex’s surgery which was done in his room. The surgeon goes in through the soft spot to insert a catheter which will drain the excess fluid into a pocket under the scalp. This will allow his body to reabsorb the fluid without inflaming the ventricles in the brain. This is the best option for him right now. We anticipate a smooth surgery and, most importantly, we look forward to seeing a comfortable baby boy again without a headache. Once this is done, Lochlan can start to refocus on improving his respiratory system. If we can get his breathing to improve, we will avoid the PDA ligation surgery.

There is a 80-90 percent chance Lochlan will require a permanent shunt once he is big enough (about 4 lbs), but we will cross that bridge when we get to it.

Lex is doing very well. He continues to make respiratory progress thanks to his PDA ligation surgery. Today, he is at a respiratory rate of 35 and oxygen percentage is in the low 40s. He is up on his feeds and may even get his PICC line out tonight. His goals are to increase feeds, reduce IVs and lower oxygen requirements. Once the IV and PICC line are out, all of his focus can be on reducing respiratory support.