OpenHealth Q&A

Seeking Guidance: Concerns About Preemie's Kidney Function

I'm reaching out for some advice about my son, who is currently in the Neonatal Intensive Care Unit (NICU). He is nearly three months old, with a two-week adjusted age, and has been battling Bronchopulmonary Dysplasia (BPD) since his early birth at 29 weeks, after my water broke at only 22 weeks. With extremely underdeveloped lungs, he's relied on a conventional ventilator since birth. Now at 41 weeks, he's had consistent oxygen support levels primarily around 95% to 100%, though recently we've seen a reduction to an average of 70% to 80%. Unfortunately, after an unexplained incident last Sunday, he is back to needing about 90% oxygen, accompanied by kidney problems and significant swelling. The swelling in his body has become quite severe, causing his ears to curl and rendering his eyes nearly shut for the past 10 days. Despite being administered diuretics that have previously proven effective, his urine output has dropped significantly this week, leaving the doctors perplexed. They initially tried him on Lasix/Diuril but switched to Bumex via drip. Here are a few critical developments to consider: - The swelling coincided with a positive test for adenovirus after a virus panel was performed. - Just before the onset of swelling, his ventilator settings were adjusted according to a BPD protocol, increasing the pressure control from approximately 35 to 48. - He was nearing a reduction in nitric oxide treatment but began experiencing desaturation, leading to an increased dosage back to 5ppm. I'm eager for any insights that could be shared, so I can discuss them with the medical team. My primary concern is for my son to open his eyes and experience a more comfortable recovery process. While the nurses and doctors have been performing regular checks and adjusting his diuretics as well as monitoring his electrolytes every four hours—and providing necessary supplements like magnesium and potassium—it feels like we haven't truly identified the underlying issue. Thank you in advance for any help you can provide! Current Medications Include: - Amoxicillin (50 mg daily by tube) - Arginine (3.42 mEq every 8 hours by tube) - Betamethasone Dipropionate (topical; twice daily) - Budesonide INH (0.5 mg twice daily) - Bumetanide (0.068 mg/hr IV continuous) - Dexmedetomidine (5.78 mcg/hr IV continuous) - Dopamine (10.2 mcg/min IV continuous) - Dornase Alpha (2.5 mg twice daily) - Heparin (1000 units/mL continuous IV) - Hydrocortisone (2.6 mg by tube every 8 hours) - Hydromorphone (0.068 mg/hr IV) - Ipratropium (250 mcg every 4 hours) - IV Fluids (NO dextrose, continuous) - Levalbuterol (0.63 mg every 2 hours) - Midazolam (0.34 mg/hr IV continuous) - Norepinephrine (0-0.34 mcg/min IV continuous) - Potassium Chloride (3.2 mEq by tube three times daily) - Risperidone (0.1 mg by mouth daily) - Sildenafil (3.4 mg every 8 hours) - Sodium Chloride (2 mL every 12 hours)

Answers (1)

3/28/2025, 7:01:09 AM

OpenHealth AI

I understand your concern for your son, and it's clear that he is undergoing a very complex situation in the NICU. His combination of Bronchopulmonary Dysplasia (BPD), respiratory support needs, kidney function issues, and significant swelling are understandably worrying for you. Here’s a structured approach to understanding and potentially addressing these challenges.

Main Points:

1. Swelling and decreased kidney function with diuretics need careful monitoring and might be linked to respiratory support adjustments or infections.
2. The presence of adenovirus can complicate the clinical picture and may impact kidney and respiratory function.

Explanation:

Swelling (edema) in premature infants can be caused by fluid retention, which may indicate kidney issues, especially when urine output decreases. The use of diuretics like Bumetanide is intended to help with fluid retention, but if the kidneys are not functioning optimally, even these medications can result in limited effectiveness. The recent adenovirus infection could further complicate your son’s condition by affecting both lungs and kidneys, leading to difficulties in breathing and fluid management.

It’s also important to note that adjustments in ventilator settings can temporarily impact your son’s respiratory status, possibly causing fluctuations in oxygen needs and contributing to stress on both the lungs and kidneys.

Next Steps:

1. Ensure Ongoing Monitoring: It's crucial for the medical team to continue closely monitoring your son's urine output, kidney function (through regular blood tests), and overall fluid management strategy.

2. Address Infections: Given the positive adenovirus test, discuss with the medical team about potential interventions that may be needed to manage the viral infection and its effects on his body.

3. Reassess Diuretic Strategy: Since other diuretics have proven less effective, requesting a re-evaluation of the diuretic regimen and considering alternatives or adjusting dosages may be worthwhile.

4. Focus on Supportive Care: Emphasize the importance of keeping your son comfortable through proper sedation, pain management, and ensuring he’s in a stable environment to facilitate recovery.

5. Regular Communication: Continue to maintain open communication with his care team to express any changes in his symptoms and to share your concerns. You might ask them to explain any changes in their management approach clearly, ensuring you are fully informed.

Remember, it’s normal to feel overwhelmed when navigating NICU care; your advocacy for your son is critical. Please continue to seek clarity on his condition and collaborate with his medical team as these circumstances develop.