They have decided to keep Elias hospitalized at least another night. We still do not have a definitive answer yet as to what is causing him to be ill. So far the labs, tests, and cultures are coming back negative. There has been a large number of children admitted in the last few weeks for a strong Rotavirus. Someone like Elias, with his issues and compromised immune system due to the trach could be in much worse shape. As we have said before a common cold or flu-like illness to us could turn fatal for Elias. He is obviously not in any danger at this point, but it demonstrates the point that we have to be very vigilant with any illness. However, they are not able to say for certain that is what he has.
Beginning with 20 ml at 11a this morning they began increasing his feed volume by 5 ml per hour every 4 hours leading to the 8p hour where they would have him back at his typical 36ml per hour volume. Through the day Elias still exhibited lethargic behavior, but did seem to want to try and play. He had not had any emecis episodes since about 5p Sunday. Tonight though at about 845p with his normal feed volume running for about 45 minutes, Elias began to go into his routine of coughing and gagging prior to an emecis episode. Again he presented mucus and breast milk content. It was decided that he could have had the episode because he had been fed continuously since 3a (about 18 hours) without a rest at the lower volumes. At the time of this post he is resuming feeds after an hour rest. We will keep our fingers crossed that he does not repeat. Regardless, this presents a perplexing scenario. Why did the episodes begin again at his typical feed volume. What is it about this that triggers it, if it is not a coincidence. Is it reflux? If it is then why is the mucus the prevalent content, with breast milk as a secondary most of the time. Although we have had episodes where the content has been exclusively breast milk. Ahh Elias, you are such a crafty little one and we love you for it!!
We also reminded the doctors today of Elias' pneumonia he had back in July. This is when he had the tracheostomy and gastrostomy and began to crash on the table without any real clinical reason. The day before, Elias began to spit-up and just seemed a little off. The labs showed no real clinical signs of pneumonia that day, but on Friday a routine x-ray revealed he had it in his right lung. There is a lag on x-ray with pneumonia so the fact that he was clear yesterday does not offer us much in terms of relief. I'll feel better after Wednesday and still no signs. When talking with his surgeon today, we also discussed this and the process leading up to coming to the ER Sunday. He made the comment that it did sound like pneumonia and did recall the lack of clinical signs before. While they have not said anything more about it, they do not seem to be ruling it out quite yet. Only time will tell and hopefully we will have some answers. We tend to think that it might not be this because he seems to have peaked in terms of the way he feels. He is showing tiny signs of progress and without any treatment for pneumonia currently being administered, it is difficult to rationalize this being the cause, but history can repeat and that obviously is in the back of our minds. If anything of interest happens in the next few hours then I will update again. Otherwise, we will keep you posted tomorrow on his status, hopefully it will be home.