Yesterday, Dr. D left a note with the nurses that he needed to "talk with the parents". Needless to say, I was a bit anxious when this message was relayed to me soon after I arrived. About 30 minutes later Dr. D came in and told me that he'd sent a stool sample to the lab to test for clostridium difficile; it came back "high positive". He gave me the usual medical disclaimer that all tests are known to have false positives and false negatives, etc., etc., however the high positive lab result and clinical presentation made it a fairly sure diagnosis. C. difficile is a severe infection of the colon, often after normal intestinal flora is eradicated by the use of antibiotics. The fact that Max had recently been on antibiotics made it an easy call.
Fortunately, the treatment for c. difficile in neonates is vancomycin. This drug is administered orally and does not pass into the blood stream. As a consequence, it is not a hepatotoxin (liver toxin), and therefore won't exacerbate Max' hepatitis. The primary risk with using vancomycin against c. difficile is that it risks creating vancomycin-resistant bacteria. He's getting 4 doses per day for 10 days (40 doses in total).
For the time being, Max is in "contact isolation". To be able to handle him, especially for diaper changes, it is necessary to wear a disposable pathogen resistant apron and rubber gloves. Furthermore, the alcohol-based anti-microbial foam doesn't kill this particular bug, so all contact is additionally preceded and followed by an anti-microbial hand wash. Although most healthy adults (with healthy gut flora) are mostly resistant, the NICU is full of immuno-compromised newborns who have been taking antibiotics. The risk of a full-blown epidemic in the NICU is non-zero, so they're taking precautions.
So in summary — Max has a serious infection of the colon, but we now know what's causing his GI bleeding, it's treatable, and the treatment won't further aggravate his other existing conditions.
On Saturday, I also signed the consent form to perform an MRI on Max' brain, which is scheduled for Tuesday morning. This will give a high-definition image of the brain injury caused by the periventricular bleed that Max suffered before birth. An ultrasound (low-resolution) last week already revealed that the injury resulting from the bleed was far less than was expected. This MRI will give us a more accurate picture of his long term neurological prognosis.
After spending the weekend in Dallas I can tell you Max has his act together. He knows what he likes and what he dislikes and he has his way of letting you know. He likes touching and so does every one who gets to touch him. He doesn't like a lot of commotion or nurses messing with him for very long. He likes his mommy & daddy being there and soothing him. He has been working very hard to get well and believe me it is working. The nursing staff, doctors, & technology is wonderful but the best part is watching Max fighting to get well, wish I had his will. No doubt this little one has a very bright future and wonderful parents and a big sister anxiously waiting for him to come home. from a Grandma who is very biased.
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