After taking Juliana off of the oscillator, her nurse Jenny was able to listen to her heart without the noise and shaking. She heard a definite murmur and they went ahead and did a scan on Juliana’s heart. The cardiology report came back last night and Juliana’s PDA has reopened to a moderate-to-large size. This is not an uncommon complication for premature babies. The effects on her stats are clear, her blood pressure which had been steady for many days is low and is being controlled by a dopamine drip set to 10. There are two options for her. The first is to give her a course of indomethacin which can close her ductus medically. Indomethacin is most effective within a few days of birth, but can still work even now. The second option is a simple surgery to close the PDA. The team decided late last night to give her a course of indomethacin. Indomethacin thins out the blood and interferes with kidney function, so they gave her some platelets last night before the first dose to bump her level up and checked that her creatinine levels were normal. I expect that her first dose was given by about 5am this morning. A course takes 3 doses given at 24-hour intervals. If her stats are stable, she should finish by Sunday morning and by that afternoon we will know if it worked. If not, I expect surgery on Monday would be probable. We will be heading over to the hospital later this morning.
Update: Juliana has been doing well with her blood-gas and continues to use conventional ventilation. They have decided to move up her second dose to 5PM today and are administering it now. They will check her platelet levels tonight and plan to give her the final dose at 5AM. She will probably get a follow-up scan on Monday to check the size, if any, of the ductus.
We also got a brief report on a standard head ultrasound that they performed on Juliana. Apparently, she had a Level 2 Intra-ventricular hemmorhage sometime in the past. The blood that they saw was old, so i happened probably a week or more ago. A level 2 is concerning, but probably will not cause any problems in the long term. Her body should reabsorb the blood in time.