Closer to out

Woody's stint on the high-flow nasal cannula ended today, as he was placed on the LOW-flow cannula, which is basically a little tube that connects straight into the oxygen nozzle at his cribside. This is another milestone in a big month of milestones for him. The decision was made when he got turned down to 1 (liter) on the high-flow, and a quick series of calculations determined that he was actually getting about the same oxygen on that setting that he would be on the low-flow. Now we're dealing with different stats on the oxygen percentages, too. Even on the high-flow, we were still dealing with the same oxygen percentage figure that we were comfortable with from the ventilator; that is, speaking of oxygen given to him as a mixture with room air. Woody's needs were in the 30-40% realm before going to the low-flow (remember that 21% is room air); now we speak only of the liters per minute of the oxygen, because since it's so low of a flow, the oxygen is basically mixed with room air by the baby (and forgive the oversimplification). Woody's sitting right now at .12 l/m (liter per minute), and is satting just fine. I am so impressed.

How impressed? I was talking with Nurse J, and she told me that the most oxygen she's ever seen a baby go home on is .3 l/m, which is almost three times what Woody's on right now. Which is another shocking sign that Woody's getting close to coming out. Now the big obstacle is the feeding, and when the speech therapist was in earlier she noted that Woody was having a little bit of trouble with the swallowing, and because the worry was that milk was getting to his lungs, we can't take any chances with that. So Woody gets a 'swallow study' on Monday, which will involve him drinking some milk laced with barium, and then swallowing in front of an x-ray. It should be great fun.

The swallow study is one of four of the big tests that he needs to pass before getting out of here-- that I know of. The others* are:

• The 24-hour readout, where his monitors are all tied to a computer that records every beat of his heart, every breath, and his blood oxygen saturation. If he displays apnea or bradycardia spells, or otherwise shows too much volatility, he won't be sent home


• The kidney backflow test, where they catheterize him, inject a little dye into his bladder, and make sure he's not getting any backflow of urine into his kidneys.


• The breathing study, where he gets hooked up for a period of a few hours to a sophisticated monitor that tracks his breathing and looks for 'immature breathing patterns'. If he has them, he needs to be kept longer.

Somehow I suspect that these will not be the only tests, but these are the ones I know about. It's fun, but scary, to be thinking about what it's going to take to get him home.

*I forget the actual medical names for these tests. I'll be more precise as they get closer.