Lungs, Lungs, Lungs

As you learned from our earlier posts, both Milo and Madeline are back on ventilators to help them breathe. They were initially weaned off the ventilators in their first week or two of life to see if they could support themselves breathing with a little assistance from a CPAP. Unfortunately, both their lungs were too immature to last long on the CPAP, and, to avoid completely exhausting both of them, they went back on vents. It was pretty apparent by the time the doctors shifted them back to a ventilator that they were ready. They had lots of desaturations (when levels of oxygen in their blood stream are too low), combined with large drops in their heart rates.

Milo's lungs are looking pretty good for a baby his age, and he is responding well medically to his oscillating ventilator (an oscillating ventilator keeps a baby's lungs continuously inflated by providing tiny quantities of air at extremely rapid rates), but doesn't like it much and flails around a lot when he's awake. On the plus side, the doctors are able to keep his oxygen levels are pretty low, generally between 26 and 34%. (Room air is 21%.)

Madeline is also on a high frequency ventilator. She is still recovering from her surgery and is plugging along. On her third day after surgery, she is much more hearty and her blood pressure and heart rate are doing much better. Unfortunately, she has some lung complications unrelated to her surgery that the doctors are trying to correct. Her left lung is distended, meaning that air is entering the lung and not going anywhere. Her lung tissue is too thick to absorb the air due to immaturity, and the lung is expanded and pushing down on her diaphragm. In order to collapse the lung (meaning to get the trapped air out, not total collapse), the doctors are changing her position to lay her on her left side to allow gravity to help close her lung. Complicating matters is that her incision from her PDA surgery is on her left side, so they are carefully monitoring and managing her pain levels. Basically, the ultimate cure for the condition is for her to grow and for her lungs to mature more, so this situation will be with us for several weeks.

Long term, because both babies were not able to breathe well off ventilators within their first week or two of life, they are at higher risk for what the doctors call bronchopulmonary dysplasia (BPD), or chronic lung disease. When babies are still on ventilators several weeks after their birth, the supplemental oxygen and mechanical ventilation can damage lung tissue and impair their ability to heal. Typically BPD is diagnosed for babies Milo and Madeline's age when they are still on oxygen 36 weeks after conception. The condition is treated by slowly weaning them off their vents and off oxygen, combined with good nutrition, medications, and attention to getting their lungs to grow and heal. Most babies with BPD get well quickly enough to go home by their due date, breathing on their own. Babies with more severe BPD are more vulnerable to respiratory infections in their first year of life, as well as asthma, and occasionally smaller than average lung capacity. However, in all but the most extreme cases, the difference is not enough to inhibit their normal activities or play. The babies' current doctor, David Durand, is a respiratory specialist, and believes that Milo & Madeline have a good shot to be in the moderate category, and will eventually recover from this condition as they grow. What it ultimately boils down to long-term for them if all goes as expected is that they should never smoke, and careers in firefighting, mining, and asbestos manufacturing are right out.

I haven't linked many internet articles or information on BPD to this post because much of the information available is worst case scenario and pretty scary sounding. Certainly read it if you like, but keep in mind many children go on to live normal healthy lives after having this condition, and Milo and Madeline have not been diagnosed with this condition yet. The information on BPD above was taken from the Preemies book we mentioned previously.