Still trying to grow

I'm starting to feel like a broken record... lack of growth (aka failure to thrive) is still Eliza's #1 problem. After Monday's blood transfusion (only six days since the previous one...) and the associated 12 hours of no food followed by 12 hours of half food, Tuesday night found that Eliza had again lost all of the weight she'd gained recently. Her weight was right back to where it had been two weeks ago - very frustrating!

We had a lengthy discussion during rounds Wednesday morning, and a meeting with the new doctor that afternoon, and came out of it with several plans:

First, increased her feeding amount again - up to 180 mL/kg/day now, which should be enough to provide about one and a half times as many calories as a preemie normally needs to grow. This should really be enough food for her to grow on - so long as she can keep getting it consistently. Which brought us to part two of the plan. Blood transfusions are the main reason she has to go without food, so they started her on injections of erythropoietin, a hormone that stimulates blood cell production. Hopefully that will help her not need transfusions so often. When she does need transfusions, the plan was to put a PICC line back in so that she could switch over to full IV feeds for the day so as to continue getting plenty of calories.

So that was the plan, anyway. And I'm sure you all know by now just how well we and "plans" get along these days... so of course, overnight she started "dumping" - the increased feeds overloaded her digestive system and caused lots of the milk to just pass straight through her more or less undigested - not the effect we wanted! So we went on to "plan B" rather quicker than expected, reducing her feeds by a good bit and adding clear fluids and lipids (delivered by IV for now) to make up the difference.

They tried to put in a PICC line today (because a PICC can stay in a lot longer than an IV, and they can give more concentrated nutrients through it) but were unsuccessful. Apparently her veins are not in the best shape, whether from previous IVs, or something else - I'm not exactly sure. So we still don't have a fallback option for providing all of her nutrients when she next needs another transfusion. They're talking about trying to put in some other kind of central line tomorrow, but that's not definite yet - we'll see.

Waiting now for her 9 PM assessment to find out whether she's gained or lost weight today... here's hoping for some good news for a change!