Still in the NICU

Well, it is Sunday afternoon and Steph and I have spent the morning at the hospital in the NICU with Isaac. He seems to be recovering really well from his surgery. The ENT (ear, nose, and throat) doctors operated on his nose on Friday to remove excess bone that was blocking the nasal passageways and making it difficult for him to breathe. Before the surgery he had an MRI of his brain. The condition he has, called Congenital Pyriform Aperture Stenosis, can sometimes be associated with other developmental problems, especially in the brain. Some of those abnormalities include having only one central incisor instead of two, Holoprosencephaly (which is when the brain doesn’t split properly into the right and left halves but stays one big piece), and problems with parts of the brain called the hypothalamus and the pituitary (which controls release of several hormones, including thyroid hormone, growth hormone, and Cortisol – which helps to control blood pressure – and others). The MRI of the brain came back essentially negative, so the doctors are going to run a few blood tests probably tomorrow, after Isaac has had a few days to recover from the surgery.

Congenital Pyriform Aperture Stenosis is a recently described condition that occurs before birth. It is a pretty rare condition, though there is not an exact number of how often it occurs, since it has only been described since 1988. There is another condition, called Choanal Atresia, which is similar to what Isaac has, but a little worse, since in this condition the entire nasal passage is blocked off and the baby can’t breathe through their nose at all, so they need surgery right away. The doctors think that there may have been many more babies before 1988 that had what Isaac has, but because the CT scanning technology wasn’t as good back then, it was not detected properly and was misdiagnosed as the Choanal Atresia, and treated with the same kind of surgery.

As part of the MRI study and surgery, Isaac had to have a breathing tube put down his throat (intubated), which Steph and I were able to watch Friday morning. I have seen many times when people had to be intubated, but it is a lot different when it is being done on your own child, especially at a teaching hospital, where they let the resident try first, and then the fellow, and then the attending doctor if the others are unsuccessful (which happened in Isaac’s case). According to the doctors, Isaac’s surgery went very well, and he did well overnight on Friday. Steph’s mom had arrived in town Thursday night and spent all day Friday with the other boys, since we had been in the hospital all day for Isaac’s surgery, so we thought it would be good to spend the night with our other children. There was a ward Halloween party, so we took them to that, with Kolby dressed as Tigger, Eli as a dinosaur, and Camden as a lion. They were so cute and had so much fun trick or treating and getting so much candy. It was nice to get them out of the house and spend some time together.

We spent the good part of Saturday morning cleaning up the house and then Steph and her mom went grocery shopping since the cupboards were bare after us being gone for the few days at the hospital. Isaac got the breathing tube out in the morning, so once they got home, we got the boys all cleaned up and took them over to the hospital to meet their new baby brother. We weren’t sure what to expect, and the boys ended up having a hard time, since the NICU is not an ideal place for loud, active little boys who like to touch everything they see and don’t like to sit still for more than 2 seconds (although for the first 10 minutes or so while they were first meeting Isaac, Kolby and Eli at least were good and well behaved and enjoyed seeing him and asking questions about how long it would be until he came home). The nurses had tried to feed Isaac some of Steph’s milk that we have saved for him just before we got there, and they said he seemed to enjoy it, but by the time the boys were done visiting with him, he was struggling quite a bit to breathe. The nurse tried to turn him and suction in his nose and mouth to see if that would help, but his tongue kept sticking to the roof of his mouth, blocking his airway, so they finally had to call the ENT doctors to come take a look. We had to get the other boys some food, so the ENT doctor called us later and said that after looking down Isaac’s throat with a scope, it seems that he had some acid reflux after getting the milk. She said this is common in babies, but with the other stresses of the surgery, having a tube down his throat, swelling in his lip, and tubes in his nose, the combination probably put him over the top and caused the throat to close. They gave him some morphine, put an oral airway in (a piece of plastic that is curved and rests just over the tongue to keep it from falling back into the throat and blocking the airway) and started Isaac on some acid blocking medicines. He seemed to calm down a lot after that, especially with the oral airway, so they have left that in for now to let him continue to wake up from the anesthesia and recover from the surgery. He is getting nutrition through an IV and the doctors said we will wait until tomorrow before trying to feed him again.

This morning Stephanie and I each got to hold him for a long time and he was very happy. He even tried to open his eyes a few times for us, though overall he is still very sleepy, and rightly so. And it was really nice to finally actually be able to sit down and hold him like a normal baby. The doctors had originally hoped (very optimistically) that Isaac would be able to go home tomorrow, but given how things have gone a little slower so far, it will probably be a few more days in the NICU, although the doctors still think he is healing nicely and will make a full recovery in the next few days.

Some More Photos of Isaac

Mommy and Isaac after he was born on Tuesday night, 23 October 2007.

He looks more chubby in this photo than in real life, but I

liked the little smile and you can see his dimple here.

He looked so small when he grabbed my ring finger with his little fingers.

Isaac takes a rest in Daddy's arms.

Sweet dreams!

Isaac visits the NICU (Neonatal Intensive Care Unit).

Isaac with an oxygen hood over his head to help him breath easier.

Isaac after his surgery today. They intubated (put the breathing tube down his throat) for an MRI and the surgery they did today. During the surgery, they made an incision under his upper lip to remove some bone from the nasal passage, and then they inserted tubes in his nose. So his lip is pretty swollen, and his nose is a little swollen too. But the surgery was successful and it seems like things are going just as planned. He should have the tube removed from his mouth either tonight or tomorrow morning, and then he can try eating. They said that if all goes as expected, he should be able to come home with us in 2 or 3 more days.

Baby Isaac Has Arrived!

On Tuesday I started having contractions in the morning. I had them irregularly all day, and by that evening I was having them every 7 to 10 minutes. Michael and the boys and I went and ran a couple of errands, and when we got home around 7:00pm I started having the contractions about every 2 or 3 minutes, so Michael put the boys to bed and we called a friend to come stay with them while we went to the hospital. We arrived at the hospital about 8:30pm, and I was dilated to a 7. I got the epidural, which worked just right this time, and then they just had me wait. I was strep B positive, which means that they try to give the mom antibiotics for 4 hours before the baby is born, so they didn’t want to break my water because they were trying to wait the 4 hours. I got the first dose of the antibiotics, but my water broke on its own before they could give me the second dose. After my water broke, he came really quickly. I pushed once and his head came out, and I pushed a second time and he was delivered. That was definitely the quickest delivery yet!

Isaac Steven Bradshaw was born at 11:43pm on October 23rd, seven days before his due date. Michael told me later that he had the chord wrapped around his neck when he came out, but I didn’t even know that. I held him, and then they checked his weight and height and cleaned him up a little bit. He was 8 lbs 13 oz and 21 inches long, so he was our second smallest baby – Camden was 9 lbs 8 oz, Kolby was 9 lbs 1 oz, Isaac was 8 lbs 13 oz, and Eli was 8 lbs 8 oz. (I’m rather glad he wasn’t a 10-pounder).

He got a chance to nurse and we held him and called all the family members, and then we moved to our room. They took him to the nursery for a little bit, and the nurse must have noticed how tired Michael and I looked, because he was all bathed and dressed when they brought him back to us. By then it was quite late, and we got about 4 hours of sleep before morning. Isaac was a noisy breather – kind of making little snorting sounds every once in a while and breathing loudly, but he slept well that entire time. I tried to nurse him a few times the next morning, and he didn’t really latch on well at all. A little while later we let the nurse know that it seemed like he was having a little trouble breathing, and she said that she would take him to the nursery to give him some saline drops and use the bulb to suction his nose. We thought that would be a good thing to do so that he wasn’t so stuffy and he could then nurse without any trouble.

After a little while, we were informed that the bulb had not helped, and they had talked to the pediatrician who had ordered a few tests to check on why he was having trouble breathing. A chest x-ray didn’t show anything abnormal and they put a tube down his throat, but it went down fine, so they didn’t suspect any problems with his throat. They said that they tried to pass a tube through his nose, but couldn’t – so they suspected some kind of blockage. Some NICU doctors came and said they were taking him to the NICU and they were going to see if they could figure out what the problem was.

So, when we went down to the NICU a little while later to see him, they told us that they thought it might be a dermoid cyst (a blockage of dead skin that would have to be removed in surgery, but which was not any type of cancer) in the nasal area which was making it hard for him to breath through his nose, but that they would have to wait until they got a CT scan to see if their hypothesis was correct. Later that night we returned to the NICU and a resident showed us the CT scan. It did not show a cyst, but just that the nasal passages looked more narrow than they should be. We had to wait until this morning until we talked to the ENT (ear, nose, throat) doctor to find out his diagnosis and plans for treatment.

So, today the ENT told us that Isaac has a pretty uncommon condition called Congenital Perform Aperture Stenosis, which just means that the nasal passage is really narrow. They said there is no real reason that this happened, it is not genetic – it just happens to be the way that his bones formed, and they didn’t separate as much as they should have. I guess this is a pretty uncommon condition. But they made it sound like it isn’t going to be a serious problem, and he shouldn’t have any long-term effects from it.

Isaac’s scan showed that the bones in this area were a little closer together, and on one side the soft tissue looked like it was really close together. This is a pretty rare condition, and there is not much information about it online. We did find a few articles that mentioned that babies with this condition could also have one large tooth in the middle, instead of two top teeth in front – but Isaac’s scan showed normal teeth. Other articles mentioned a triangular palette associated with this condition, but we haven’t noticed anything like this in Isaac. In fact, except for the breathing problems, he seems to be doing just great, and he looks like everything else about him is just how it should be. The doctors told us that other articles say sometimes this condition is associated with problems with the hypothalamus and pituitary, two organs in the brain that control many of the hormones needed for growth and development, like thyroid and growth hormone. They want to do an MRI tomorrow while he is already sedated for the surgery, just to make sure that everything looks ok. The doctors seem to be doing everything possible to help us out here.

They are going to do surgery to correct this tomorrow morning. They will remove some of the bone and put in two tubes to make the passages stay open, and then the tubes will be surgically removed in about 3 weeks. They will do this all through an incision under his upper lip, so it won’t leave any scars. I am pumping now, and they hope that he will be able to start nursing normally after his surgery. And they said that as long as everything goes well, he will be able to go home from the NICU two or three days after his surgery. We are not allowed to sleep in the NICU and I got discharged from the hospital today, so we will be home tonight, and then I will probably return to be with him in the morning. My mom is arriving tonight, so that will be helpful to have her here. (By the way, my parents were able to return and see their house last night since the evacuation for the wildfires down in San Diego, and their house was not damaged by the fires at all. A couple of the houses up the hill from them were burned, and the fire burned down the hill to within 50 yards of my parents’ property, but their house and yard were not touched). So, thank you to all of you who have helped out with watching the boys for us this week. And thanks to everyone for your prayers and support. We really appreciate it! I’d better head back down to Isaac’s room now to be with him.

I will post photos of Isaac once I’ve had a chance to get them off of our camera on our home computer. But he’s really cute – he has light brown hair that looks kind of golden in the light, just the same color as Camden’s was when he was born, little round ears, dark eyes, and it looks like he’ll probably have a dimple on the left side. Michael thinks he has the Bradshaw nose. And Tyce Kearl said that he definitely looks like a Bradshaw boy. He is long – he looks tall and he has cute long feet and long toes. And he is strong – when they rolled him on his tummy yesterday, he was lifting his head up over and over. I can’t wait to take him home with us!