Wednesday, May 20, 2009

Too much caffeine?

It was my turn at the hospital last night with Adam. I undressed him to take his temperature and change his diaper. He seemed quite irritated, much more than usual. The nurse came over, concerned, to help calm him. His heart rate was above 230 and she decided to let the neonatal nurse practitioner (NNP) on duty know what was going on. While she pulled up his monitor at her desk, the nurse at his bedside and I decided to pass on his bottle feeding. Instead, I opted to kangaroo him to provide comfort and try to get his heart rate to settle back down. To look at him, he appeared extremely relaxed. But his heart rate remained in the high 190s or low 200s. Very unusual for him - it is typically in the 150s or 160s while we kangaroo.

On my way out for the evening, I spoke with the NNP to let her know my input regarding Adam's caffeine lately. Last week they were administering a level of 18 to stimulate his brain and keep his bradycardias at bay. On that level, he was already having periods of high heart rate while he was awake. Dr. Clark was considering reducing his caffeine or possibly administering it twice a day. Unfortunately, she took a well deserved weekend off and the on call doc did not read the notes in the chart. Instead, he followed typical body weight protocol and increased Adam's caffeine to 20. He had now had 3 doses at the higher level before she came back and reduced the level to 15 yesterday. I told the NNP I didn't understand why the rate would be increased when he was already showing signs that his body didn't like the current level.

Shannon relayed our concern and irritation to Dr. Clark over the situation this morning. Professionally and respectfully, she can't slander another doctor to agree with us. Irritation is putting it lightly.

Dr. Clark ordered Adam's caffeine to be stopped completely this morning, as well as an EKG administered to make sure there is, in fact, nothing going on with his heart. We are waiting for the results to be analyzed. She also ordered a blood test to check his hematocrit levels to rule out another episode of anemia. At this point, Dr. Clark is making sure there are no negative issues going on. If it is due to an intolerance of the higher level of caffeine, we will have to wait a few days for his body to wean itself off.

Adam currently has his crib set up as a fort - receiving blankets draped over it to cut down on noise and light to keep him as calm as possible. Sorry, buddy.

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