Resetting the flow chart

Woody's now been through every neonatologist in the unit at least twice, and the guy who's on for the next two weeks is the doctor who was on the night he was born. I can only imagine the difference in his eyes between the tiny one pound four ounce micropreemie and the seven pound plus chubster that Woody is now. Woody's a real live baby now, and he is getting to the point that he only has a couple of obstacles left before he's ok to be sent home: he needs to figure out how to eat, and he needs to get his oxygen needs down. The question that we confronted today was, which one of these needs takes precedence?

If we focus on his feeds right now, the key will be to aggressively wean down the supplemental pressure that the high-flow nasal cannula provides. Currently, it's giving him about 4 liters a minute of air up the nose, and that makes swallowing (especially learning to swallow) difficult, as extra pressure tends to go to the stomach and cause distress. If we focus on his lungs, then we will be going very slow on weaning off the extra pressure support. As long-time followers have probably guessed by now, I'm definitely in the camp for going slow and making sure his lungs are doing all right before pushing the foods. The consensus of the doctors agree with me too, although there was some discussion at rounds about starting to cut down his pressure support to introduce more attempts at bottle feeding. The nurse practitioner that has followed Woody for a long time, however, did her typical* excellent reasoning with the others, concluding with "I have great respect for that chronic lung disease he has" to which I nearly chimed in with an AMEN or something.

So he's on the 4 l/minute cannula for another week, giving him some more time to get extra chubby and build more lungs. Woody also had another eye exam today, at which we got the same boring (but good) word that his eyes are slowly progressing, not out of the woods but skirting the need for surgery, and will need to be examined again.

All in all, he's doing great, and Maggie and I are very proud and impressed.

*This is the same NP who famously labeled his hernias "bodacious".