We've been really very lucky. No major problems thus far, everything moving quite smoothly along. So it really was just a matter of time before something was going to happen...
Which was 3am last night. The night nurse noticed that Meorah was stressing and having some problems. She seemed unresponsive at times. A host of tests were done: blood tests, lung scans, abdominal scans...you don't want to mess around with a preemie. Lungs came back fine, blood tests came back fine. Abdominal scan came back with maybe something. Repeat scan done 6 hours later, along with more blood work. Again....possibly something, but hard to tell. But, since radiology likes to be safe, they called it possible necrotizing enterocolits (NEC).
NEC is primarily seen in preemies, and is when parts of the intestinal tissue dies. The direct cause is unknown, although there are many hypotheses. All that is known is that it does hit preemies, comes on very suddenly, and often occurs about two weeks into life. It seems to be less common in those being fed breastmilk compared to formula. Complications include sepsis, perforation of the intestine, peritonitis, and intestinal obstruction. There is a 25% mortality rate. When a preemie is diagnosed, they are immediately taken off any feedings and are administered nutrients via IV. Antibiotics are also given. Sometimes it resolves and other times surgery can be done to remove the dead tissue and eventually re-attach. Lifelong disability can also be a consequence, depending on the severity.
Since NEC can progress quickly, they immediately took Meorah off the NG tube and put in an IV for nutrition. She also has an IV for antibiotics and was given scans and blood tests every 6 hours to check for progress. When I saw her, the poor thing had her hands wrapped up with the IVs, was laying on her back, and was sleeping. Her color was very mottled and 'off'. When she did wake up, she was obviously stressed and kept trying to bring her hands to her face to self-soothe, but couldn't because of the IVs. She also kept 'air-sitting', which is a preemie stress sign: lifting the legs in the air so it looks like she is sitting. Yawing as well, which is another stress sign. It was really painful to see. I used a flannel blanket and held her down to provide some support and also held a pacifier for her, which seemed to calm her down a little bit. Still not ideal.
The only comforting thing was that her doc was actually not that concerned: Meorah's blood work and vitals were completely normal. It was his opinion that she was ok: he had seen the scans and thought that radiology was just being overly cautious (what is a radiologist's favorite plant: a hedge). When I left, he had Meorah put back on feedings and off the IV nutrition. He explained to me that having her off the nutrition for too long would actually hurt her as it would cause the intestinal villi (cells which absorb the nutrients) to diminish, causing future malabsorption issues. So...we left knowing that things were 'stable' and probably ok, but that she would be getting another scan in the evening.
On our way home, Heidi (the day nurse) called and said radiology took another look at her scans and decided she was fine: what they saw was stool. She was really surprised that they acquiesced, given their track record of over-analyzing everything. So, if they think she's fine, she must be.
Crisis somewhat averted. We are still very nervous though, and probably will be for at least a few days. It was the first 'set back' that was substantial. They say that the NICU is a roller-coaster. I guess we just took our first ride on it.
I think I'd prefer the kid's play area and a more sedating ride, personally. Not a fan of the roller-coaster.