Lucas is born

Hi all,

As you might have found out Lucas Chien Chiang Paulin was born 2:30 am Nov 28, 2011.  His stats are 7 lbs 1.25 oz, estimated 20 inches long and we don't have a head circumference yet.

Just to explain how fast his birth went

• Jessemine woke me at 1:09 am
• I contacted our midwife at 1:14 am
• We got out of the house by 1:30 am
• I got us to the hospital about 1:55 am
• He was delivered at 2:30 am

He was born having severe respiratory problems however he somehow kept himself alive.  His heartbeat was strong and I could see him fighting to breath.  Jessemine was able to hold him for all of 1 minutes until they realized something was wrong and the skill level of doctor started rapidly increasing.  Within 15 minutes they had them in their intensive care ward under pure oxygen.  His blood oxygen level was low but, they were able to keep it around 80 most of the time, even though I saw it drop down to 65 a couple times.  (I don't know the units of measure on the machine).  The doctor said 90 is normal.

Here is my best picture of him before they really got him into more machines.

After that they decided to tranfer him to Children's hospital.  The doctor on call ran two ports through the umbilical cord (one for drawing blood one for adding drugs/chemicals).  The med tech's arrived and loaded him onto a mobile ICU and headed over.  This unit used NO2 not just oxygen.  My sister tells me this is really amazing stuff and fairly recently used.  She likened it to "freezing time".  The doctor on call told me that it will expand his capillaries and allow him to take in more oxygen.  Just to note, he was in low oxygen for a little while.  At that point the doctor on call told us that his pupils were not dilating and he might suffer some damage.  But, after he was move to the oxygen environment he responded much better and when he saw his mom he responded to her very well.  By then his pupils were working fine.  Both eyes were tracking as normal he we was trying to get to her.  So I think he was actually doing really well at this point.

I stayed with Jessemine because she needed some recovery time from such a fast birth.  Soon her Mom joined us with the help of a friend who was transporting her around.  I had headed over to Children's Hospital by then.

Children's hospital is amazing.  Absolutely.  I hope you never have to find this out unless you get the privilege of working there.  Its a teaching hospital and everyone is very excited to tell you everything about what they are doing.  At the same time there are staff, tech, physicians, doctors, pharmacist, you name it working in teams to learn from each other.  Whoever organized this has done an amazing service.  What they decided to do is to put Lucac on ECMO (pronounced ek-a-moe).  Here is the explination http://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation

Basically they use a machine to take the place of his heart and lungs.  This gives his lungs a chance to rest from the respirators that were being used as well as to start cleaning.  Think of ECMO this way.  Its almost magical and ultimately it buys you time.  Which in a case like this is what you really need.  So as long as the surgery to hook him to it went well (so far so good) then suddenly his heart and lungs are not an issue.  The big risk is that he is on a careful balance of  Heparin and other drugs.  The Heparin keeps his blood from clotting while its running through the special Heparin coated plastic that the ECMO is made of.  The clotting is bad but, this also gives him the risk of bleeding in other places.  They have checked his kidney's, blood brain barrier, and other functions and none of them show signs of bleeding.  So this is all good.  He did have a bit of blood in his lungs which can happen from the induced stress of the ventalators + the Heparin.  That seems to have clotted and they will be looking at it in a couple days to see what is really going on.  Most likely it will heal on its own.

Here is what his entire setup looks like.  If you look closely you can see him in the middle of that crazyness.

Also to note, he is totally one-upping his sister who was only on a wimpy biliruben bed when she was born and ended up at Children's (Oh yes, we are repeat customers).

So that's the story so far.  He is stable, and they are only running ECMO at half capacity.  The variable to note is his lung capacity which is right now .2.  (Once again I have no units for you so make some up).  That will be going up and they will ratchet down ECMO proportionately.  At some point it will be high enough and they will do a trial run with him only on his lungs.  We are looking at 4-6 days maybe more.    After that they will be moving him of the ventilators, then drips, then strengthing him.  So maybe even a month there total.

Also to note, they are not positive it was Meconium aspiration that was affecting him.  The x-ray pattern's don't look the standard way where the Meconium will look like little balls moving to the extremities of the lungs.  So hopefully it is something easier for him to work through.  He also has been downgraded to a more conventional respirator which is a good sign.

As for the rest of the family, we are doing fine.  Jessemine is recovering and her family is taking care of Tessa and other things.  Thank you all for your offers of support, I might take you up on this.  

I'm going to maintain this blog for the sake of explaining what is happening and will be putting more information here as soon as I have a chance.

To close out here is a picture of his sister to cheer everyone up.  She is excited to meet him an "not push buttons".