Day 190 - Day 4 of Severe Withdrawal/ Grandpa Don & Dee Visit

Thursday, July 8th, 2021

Update:

• Increased prune juice from 10ml to 20ml to help with bowel movements. 
• Didn't time to weigh or do measurements on day shift or night shift. We will have to get that tomorrow.

Great Nurse on Day Shift and one of our favorite NICU RTs just happend to be floated to the PICU! It was so nice for James to see a familiar face! It was a pretty rough morning and we ended up giving him a glycerin around noon and he had a massive diaper around 2pm. We also gave James a bath and did his trach care using the Nystatin powder.

Grandpa Don and Dee came for a visit in the early evening. Mom held whenever she could to comfort James from his withdrawal episodes. 

In the evening, James ended up having a terrible episode where the pulse ox wasn't reading at all and he turned purple. Unfortunately when the pulse ox is not reading it does not alarm. 🤯 Mom noticed CO2 went up to 100 so she went down the hall to go get someone. His rate also went up to 100. He look like he was having a seizure. And then James threw up because he was so worked up. This could have happened because his clonidine was due at 7p and he didn't get it till 8p. We ended up giving James a PRN Tylenol.

Clarification on the Medication Wean:

James was born 3½ months early, and he has been on opiates since the first day he was born. Morphine was used to manage the distress of undergoing mechanical ventilation in the NICU. Relieving neonatal pain is essential for the management of premature infants. 

After his trach surgery 3 months ago, he was switched to Methadone. James has been weaning off his methadone for the last 3 months, but just this week he has been having severe withdrawal symptoms. Prior to that his symptoms were simply sneezing and yawning a lot. Now he breaks into extreme sweats very fast, rubs his face with his hands and grabs his nose, and his heart rate will go up very fast from like 35 to 100 on top of being inconsolable. If you would like to learn more about weaning please search our blog for the April 5th post on WAT scoring. We are doing WAT scoring in the PICU now after clearing up some miscommunication. Although Mom and Dad are hesitant to over-medicate James we also want him to be comfortable and want to give him whatever he needs. Currently he needs his PRN Tylenol and Morphine.

Factors that influence the severity of withdrawal is the level of dependency and the length of time on the medication. The following are the most common symptoms. Symptoms may be slightly different for each baby. Some of the symptoms of withdrawal in full-term babies may include (James has those checked off):

❎ Trembling
✅ Too much crying or high-pitched crying
✅ Sleep problems
✅ Tight muscle tone
✅ Overactive reflexes
❎ Seizures
✅ Yawning, stuffy nose, and sneezing
✅ Poor feeding and sucking
✅ Vomiting or diarrhea
✅ Sweating
❎ Fever or unstable temperature

P.S. You can email James your love and support as often as you’d like. Mom and Dad read these emails to James as they come in. We all love them! JamesWestonAbramowitz@gmail.com