Ruby Hope McKee Starling

Today was Ruby's 1-week birthday.  Ben and Nicole, children of our friends' here in Philadelphia, made some cards for Ruby.  The cards are now hanging on the wall beside Ruby's bed, where she can see them.  Thanks, Nicole and Ben!

Today was a good day that started off difficult.  When the day-shift nurse came on at 7am, she noticed some equipment had gotten mis-positioned.  This mean it wasn't giving an accurate reading of blood pressure.  So she positioned it correctly at heart-level,  got out the pressure cuff and manually checked her blood pressure on 3 extremities to ensure calibration.  In doing this, she realized Ruby's blood pressure had been a little low for a while and we didn't realize it.  Because it was log, she was also shunting again, which frightened Holly since that was so bad earlier in the week.  But this time, since she's on ECMO, the shunting didn't really matter, because her lungs aren't what's providing her with oxygen -- the ECMO machine is.  So even though there was blood taking a shortcut around her lungs, her oxygen levels in her blood remained normal.  It was like a lightbulb went on in my head and I realized the practical value of her being on ECMO.  This situation, though not dire like earlier in the week, was somewhat of a mystery.  After rounds, the doctors decided to up her dopamine a little, put her back on cortisone, and give her a broad spectrum antibiotic.  The latter was in case she was developing an infection.  Sometimes a drop in blood pressure can be an early warning sign of a blood infection.  They do daily cultures from the ECMO line and they took a culture directly from her and did a urine culture today too.   So we should know tomorrow the results of those, but the initial screening has turned up negative. 

Almost immediately after going back on the cortisone, her blood pressure perked up and we had a great day.  She even starting making more urine and peeing off some of the swelling she has as a side-effect of ECMO.  Tomorrow they'll probably start her on a diuretic to help speed that process along.  They can't take her off ECMO or operate on her until the swelling goes down, so it's a priority. 

I just called the night-shift  nurse and she said Ruby gained about 250g (half a pound) for a grand total of 4.250kg now (9.4lbs).  Most of this weight gain is from water retention, so don't take the weight gain as a good sign, really.  We're actually ready for that to stop and for her to lose a little weight.  But things are going quite well for little Ruby.