Plateau

Hannah seems to have reached a plateu in her recovery. She has improved to the stage she was 2 weeks ago & is not going any further. This is concerning the drs & why they are focusing now on the leaking heart valve, as they believe this may be what is holding her back.

I will try to explain the problem so you can understand. Firstly, there was nothing wrong with her valve when she was born, but due to the extra work the right side of the heart has to do since the operation it has grown a bit. This means that the valve between the 2 right chambers of the heart no longer snugly fits the gap and causes a small back flow into the top chamber of the heart when the bottom one contracts to pump blood out to the body & lungs. This results in a reduced flow out into the body and to the lungs, & as the body naturally will ensure the flow to the vital parts of our organs, less flow is going to the kidneys and lower part of the body, hence the reason for her kidneys not kicking back in (that's the theory anyway).

A second consequence is that the flow coming back from the lungs to the heart are meeting a higher resistance due to the higher preessure in top champer of the heart. This means that the flow is backed up in the lungs which could be the reason for the continued fluid in the drains.

Two alternatives are sugested to fix the problem. One: lower the blood pressure by medication; two: do heart surgery to try and fix the leaking valve. At the moment we are trying to reduce her blood pressure with medication. This hadn't been working so far, so today they increased the dose of the drug, plus started a second drug. So far it seems to be having some effect, but not sure if it's enough.

Keeping her feeds down continued to be a problem, so they talked of again inserted the NG tube so that it goes directly into her intestines. They had previously tried this last time she had trouble with vomiting & it was sucessful, but apparently when they replaced the tube last week they just put it in her stomach. HOWEVER, while waiting for them to do this, she started keeping her feeds down. So we are just continuing as it is & see how it goes.

There continues to be a small amount of urine producion, but not much. The dialysis is still working well. There was however a small amount of bacteria in the fluid that has come out the last 2 days, so they have started putting vancomyacin (an antibioic) in the dialysis fluid. This is something they are famiæiar with in treating adults, however is not something they normally do for infants, so they are a little unsure of the dosage & it's a little trial & error.