I had another Ultrasound and OB clinic visit today, and then met one of the Neonatologists. At the Clinic they said things are still looking great. Thankfully there is no sign of damage or swelling in the intestines. The Baby's growth is following its percentile curve and looks good. (about 30th percentile meaning Baby is bigger then 30% of babies for gestational age) They estimate Baby's weight to be 2 lbs 4oz. today. These are all blessings, things could be looking much worse at this stage. They also told me they see about 10-14 cases of gastroschisis at McMaster each year.
The Neonatologist is the Dr who will provide day-to-day care in the NICU. They work as a team, so we will see one for two weeks, then a new one for two weeks ect. (Next week I will meet with a pediatric surgeon; Baby will have one primary surgeon from birth through the entire hospital stay, and for follow up care after we go home.)
The Neonatologist explained the normal care for Gastro babies at Mac. He said when Baby is born he will wrap the intestines in gauze or plastic and insert a small sugar-water IV. After this I will be able to hold Baby for a few min before they go to the NICU unless there are urgent concerns. In the NICU the surgeon will examine the bowel and if it looks to be in good condition put it into a silo. (usually it is in the silo within 4 hours of birth) They will put in an IV line that leads to a major vein and start TPN within 24-48 hours, baby will also be on antibiotics until closure surgery at least. He said the bowels will slowly be pushed inside the abdomen from the silo over approximately 2-7 days (usually). Over the next 1-2 weeks they watch to see if the bowels are working. They are looking for no more bile coming out of the mouth/tube, listening for bowel sounds, and waiting for baby to poop. When they are sure the bowels are working and there are no blockages they can start tube feeding. they give 1-2 ml at a time to start, and if baby tolerates well they will slowly increase feeds and decrease TPN (usually this happens during weeks 4-6) When Baby is nearing full feeds they will allow nursing. After Baby is able to nurse or drink from a bottle and is growing We will be ready to go home. (Usually around 6-8 weeks)
He has seen this process go very quickly before, and sent babies home after 3 weeks, but says that is rare. If there are complications at any stage things will take longer. Some of the complications he mentioned include infections, a bowel obstruction or kink, or "Short Gut" These issues happen in about 10% of Gastro cases, and can be very serious. Short Gut comes in two varieties; functional short gut and physical short gut. In the case of functional short gut the entire intestine is there, but it is not absorbing nutrients well. this is from damage in the amniotic fluid and can often be predicted by ultrasound. In physical short gut the bowel is actually short because pieces of it died or were so badly damaged they had to be removed surgically at some point. Both Short Gut syndromes act the same way, leading to malabsorption, poor growth, special medications, longer hospital stays, and long-term TPN use leading to liver dsyfunction/failure.
Please pray that things continue to go well.
We are thankful to have made it to 29 weeks with no sign of labor, please pray that continues- It would be Ideal for Baby to be born at 37 weeks.
We are also thankful for good growth with no signs of damage, please pray this also continues.
Please also pray that everything goes well after Baby's birth, that we do not experience infection, bowel obstructions or either form of Short Gut. Please pray for strength for the rest of our family; it will be a stressful and very busy time for us.
Psalm 33: 20-22
We wait in hope for the Lord;
he is our help and our shield.
21 In him our hearts rejoice,
for we trust in his holy name.
22 May your unfailing love be with us, Lord,
even as we put our hope in you.
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