11/13/09 A Ductus Reductus

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.

9 thoughts on “11/13/09 A Ductus Reductus

  1. Jen and Jason,

    I’m glad that Juliana is still stable but sad for the condition you were describing. We will have special prayers that the medication works and that her condition remains stable. I am praying for both of you that God continues to give you strength for each new day. The previous post describing those organizations was very informative for me. It also opened my eyes to the necessities of donating blood, money, or time.

    May God continue to be with you in the coming weeks!


  2. Our hearts and prayers go out to you. We are almost thirteen years down the road from 25 week 5 day preemies. Our three weighed 1 lb. 5oz,6oz and 7oz. Our Tanner died at day 13 and was doing the best of the three. Kylie was on the oscillating ventilator for five weeks and had the dopamine and dobutamine at the beginning. It such a painful and stressful roller coaster. Kylie and Nathan are amazing preteens with no physical issues. Both are around 5 ft. 6 inches tall. I am sure after the loss of your two precious babies the daily battle is even worse. Dreaming about triplets, than having the devastating loss brings unimaginable pain. God be with you every minute of this difficult time. Renne and Jill Heinrich, Safford, AZ

  3. Praying for you and Miss Juliana. I just took Carter to the cardiologist yesterday for his 2-year PDA checkup. It was still open (pinhole size) last year, but has closed now. This is a very scary time you’re in… I so clearly remember the Dr. saying, “Man, that kid has a galloping murmur!” followed by the Indocin days hoping that it would resolve without kidney complications or heart surgery. So again, praying praying for little J. Much love!

  4. I have been reading about the events that have been taking place in your lives and the short lives of two of your precious ones as well as that of Juliana. What you have been going through most be very painful and as I try to embrace what you most be going through it feel so heavy to me to even begin to understand. We have been praying for you at work and personally. May God continue to be with you and may He cover Juliana with His mantel of healing and cover you all with His mantel of grace is my prayer.

  5. Thanks for the continuous updates, Jason. Glad to hear that Juliana is stable enough for the additional doses and hope the results are positive and that she won’t need the surgery.

    Hope you all have a great weekend!

  6. I keep praying. I loved what one of your friends said, I can’t remember which one, but he/she said that one day in heaven two beautiful angels will come walking up to you, each holding a precious little girl and then handing one to each of you for you to raise there is heaven where everything is perfect. That really hit me. Raising your children in heaven! What a blessing that will be! Much love and prayers to you,
    Cousin Susan

  7. You two and this lovely baby are still constantly on my mind and in my prayers. I can only hope that you’re feeling the love and good wishes surround you.

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