Jacob & Jordan Update 3-31-10

Family, Friends, Prayer Warriors,

For our long standing followers of this blog, and to our recent visitors (welcome), our daughter Jordan has undergone increasing difficulties since her birth with her PDA and bottle feedings. Even though the two items are related (one inadvertently affects the other), as Jordan has had a successful progressive history for weight and tube feeding CC's despite her rapid breathing, the condition has now caused enough of a hindrance to the point that it is impacting her increasing her bottle feeds and transition off of the nasal cannula. This poses a hiccup on going home with little to no assistance as we would like to happen and would be better for her; as long as Jordan is not able to take the hospital's requirements for adequate and sustaining feeds, and cannot go for seven days without brady cardia or desat episodes, she will not be able to be released from the hospital. The doctor's, cardiologist, and Sheri and I have agreed that we must now allow for more internal means of closing this PDA, i.e. surgery. I had a chance to finally speak with the Cardiologist who is on rotation this month for March, Dr. Denktaf, today.

Dr. Denktaf explained that the issues that Jordan is having with faster breathing, which is now impacting how many CC's of mother's milk and/or formula, and how many bottles she can consume in a day, is directly affected by her PDA. The mild stenosis on Jordan's Aortic Valve does not impact her breathing and feeding difficulties and will not be be addressed at this point (it will continue to be watched, even into Jordan's later years. For a detailed description of Jordan's stenosis and PDA, see the March 19, 2010 update on the blog).

As Jordan's condition is right now, the PDA still has not closed. When the PDA issue was first brought to our attention, the doctors had these courses of action to correct it (preferably before Jordan reached the 6 month marker):

* medicine given intravenously to close the PDA (usually given within the first few weeks of life on babies with more severe breathing issues, not the case with Jordan); Jordan has continued to do well with increased feeds and weight gain in spite of the PDA issue, and has outgrown the medicine option.

* duretics and conservative restriction of fluids (Jordan has been on this for a while now, and has flushed out excess fluids in her body thereby promoting healthy weight gain [no fluids on her lungs or heart thankfully] since receiving), but her PDA still remains open.

* coil procedure (catheter is inserted in Jordan's groin area, and winding through other blood vessels to plug up the PDA vessel and close it from the inside out); Jordan is not old enough, nor large enough weight-wise to have this done. She would have to be released from the hospital, at least 6 mos. of age and have stronger blood vessels (preemies tend to have weaker blood vessels because of their size) before this would be an option. I had previously reported this procedure to all of you before as a clip would be inserted to close off the PDA vessel, and this was clarified for me by the twins' doctor today that it is actually closed off internally by putting a small surgical knot inside the vessel.

* surgery (performed by a cardiovascular surgeon, not the cardiologist). Jordan would be put under anesthetic and inebated, a moderate incision would be made in the left side of her chest in between her ribs (not open heart surgery where they would have to open her chest), and the cardiovascular surgeon would go in and surgically disconnect the PDA vessel by putting a surgical clip on or tying off the vessel to permanently close it. The cardiologist recommends that the vessel be clipped and sealed, if it was tied off, it could possibly re-open. It is estimated that the surgery would take about twenty to thirty minutes once Jordan was properly prepared.

Jordan's recovery rate would be entirely up to her, and when her breathing normalized (again, up to her) and her feeds resumed and met the hospital requirements for her breathing, milk and/or formula consumption and weight, Jordan could go home.

As today was her last day on this month before a new cardiologist came on for April, Dr. Denktaf would have to brief the new cardiologist, Dr. Arnold, and the cardiovascular surgeon coming on shift for April on her recommendation, and then Dr. Arnold would have another consult with Sheri and I prior to any decisions and surgery times scheduled. Dr. Denktaf also let me know that this surgery which she is recommending (and is also recommended by Dr. Arnold), would be a safe and very routine procedure with a high success rate, and is usually suggested when premature babies with PDA issues come along, after other non-evasive or much less evasive methods are attempted.



Jordan's Aortic Valve
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I also received a further detailed explanation on Jordan's Aortic Valve stenosis (I mention this only for your information; keep in mind, Jordan has a mild case of stenosis and this does not impact her PDA issue, or her feeding issue, and will be watched for now. There is a very good chance that she could go through life with this and still be able to do everything a normal kid/adult can do (we will continue to pray for that)).

Normally, an Aortic Valve has three leaflets (envision in your mind a Fleur-De-Li, or a three leaf clover). In Jordan's case, she has two leaflets that have grown together, and one of them is somewhat smaller, which is causing the stenosis. As I mentioned before in the blog entry dated March 19, 2010, Jordan could have a balloon procedure performed on her later (where a catheter would be inserted in her groin area, and routed up to her valve to expand it [like a stint procedure on an adult], or if blood flow from her heart was severely restricted enough in later years, Jordan would have to have the valve replaced. There have been many cases though where people have mild stenosis and are still able to fully perform all sorts of tasks (running, jumping, playing, etc.)

For the twins' official report for the day:

Jacob's official report for the day:
3 lbs. 14 oz.
3 brady episodes
1 desats
21-30% FIO2 on the nasal cannula, with .5 liter flow
35 CC's of 24 calorie fortified milk, with 4 bottles a day
3 dirty diaper
5 wet diapers
0 CC's residuals


Jordan's official report for the day:
4 lbs. 7 oz
21-30% FIO2, with .5 Liter flow nasal cannula
35 CC's of 27 calorie fortified milk, with 2 bottles a day
2 dirty diaper
6 wet diapers
3 brady episodes
3 desats
1.6 CC residuals
daily dose Lasix diuretics
Potassium 4 times a day

Sheri and I have also made inquires to the nurse's manager tonight, as well as individually talking to some regular night shift nurses in efforts to have more consistent coverage in the evenings with the twins. While we have met a lot of very accommodating, knowledgeable, and friendly nurses and staff along the way since the twins arrived at Children's Memorial Hermann, it is our feeling (which is also supported by the staff there as well, and are very thankful and appreciative of that), to have a steady presence of nurses who can really get to know the In's and outs of both our babies and us. This reinforces a comfort and thriving level for the babies by giving them a few additional familiar faces to work with, and allows us to rest a little easier and gives us some flexibility to do we what we need to do for a short while and get back up there to be there for them as quickly as possible. We are pretty close to getting that squared away, and will let you know who the new additions will be very soon!

Both babies have done extremely well, even with all the issues presented to them thus far thanks to your continued prayers and wishes. Please continue to pray for both of the twins, and we are sure Jordan will come through this bump in the road with flying colors a healthy and happy little girl!


More as it develops! Thank you for all of your love, prayers and thoughts! More progress reports soon!


Kind regards,


The Cordova Family (Andy, Sheri, Jacob & Jordan)
cell - 281-300-6212
email - maverick2601@hotmail.com