Being a Peds Patient

Last month, we were in the hospital with our sweet baby. It was awful and I'm glad that it's over.  It all started on November 19th. I noticed that Callum was starting to feel a little warm. I wasn't overly concerned about it, since his axillary temperature was only 99, and I normally don't get overly worked up about fevers. Add to this that Rylee was sick the weekend before with a fever, runny nose, and cough, which I then got to experience myself a couple days later. Little guy didn't have any other symptoms besides being a little fussier than usual, and being warm.  

My in-laws came to visit that day, we went to lunch, and Callum was increasingly warmer, but I hadn't checked his temp since 9am. I started vaguely remembering from pediatric courses that newborns shouldn't be running fevers, and it was concerning if they did. I went ahead and called his peds office. They said if he ran a rectal temp of 100.4 or higher, I needed to call them or take him into urgent care if it was after hours. I didn't have a thermometer with me since we were out, so I hung up and mulled over the conversation. 

I felt that something was not quite right with Callum, and knew that his temperature was just going to go up at night, like body temperatures naturally do.  We got home and I checked his rectal temp. 99.9 degrees. I called his peds office back and talked with another nurse. There was nothing they wanted to do since he didn't "technically" have a fever yet. Again, she reiterrated over 100.4 we'd have to take him into urgent care(it was almost 5pm at this point). I asked the nurse what the plan of care would be if we took him into urgent care, because I wanted to know what the concern was with a fever in newborns. She basically said that they would want to do some blood work and rule out sepsis. I heard the word sepsis and immediately started worrying.  

I don't handle anything beyond normal colds very well with my own kids.  I tend to stress and immediately start thinking worse case scenario(thanks Dad, I get that from you!). My in-laws left for the day, and Ryan finally got home for the evening. Callum was getting even fussier and my nerves were raw.  I was convinced he was sick.  At 8pm, Ryan put Rylee to bed, and I checked Callum's rectal temp again, 101.8. I told Ryan I was taking him into Nightlight Pediatric Urgent Care down the road and that he should stay with Rylee for now and I would call if I needed him. I called my mother-in-law and told her we were going into Urgent Care. She asked if we wanted her to turn around(they were about an hour and a half outside of Houston), but I told her I wanted to see what the pediatrician said and we'd go from there).

We were seen promptly, and the pediatrician was great. His temp when we got there was 101.5. His physical exam was normal, which I suspected. He had zero respiratory symptoms, his abdomen was soft, and he had been nursing, peeing, and pooping just fine all day. She wanted a urine sample to check for a UTI, and also wanted to send us to Northeast(where I work) to get a CBC and blood culture done. Since Rylee was sick, she also wanted to do a RSV swab. Callum is not circumcised(we can save that for another post on our decision to leave him intact), and she said they would have to retract the foreskin to in-and-out cath him.  I wasn't sure about that, because everything I had been taught in nursing school was NEVER retract a little boy's foreskin, until it does it naturally on its own, normally around 6-10 years old. But I hadn't ever learned what to do to catheterize an intact infant boy, so I figured the doctor knew what she was talking about. And I figured she wanted a really good specimen which is why she didn't suggest a bagged specimen.  

Let me tell you, what happened next was awful.The medical assistant came in to do the cath. She spent a good ten minutes trying to forcefully retract his little foreskin which had never (and was never meant to at this age) been retracted. Callum screamed and screamed like I had never heard him do. His penis was bloody and every part of me screamed that they were doing this wrong. I was in tears, but I didn't know what to do and I just assumed they had to do this to get a urine culture.  Finally the girl thought she could visualize the meatus enough to go ahead and stick the catheter in. We got a sample, I scooped my little son up and nursed him and cried. Then we got our paperwork to go down the street to get blood work done. We were supposed to be able to go straight into the ER, get the blood work, and go home till the ped got the results, at which point she would call us.

My pathetic boy in outfit #2 since he threw up when the ped used the tongue
depresser to look into his mouth.

I had done a little crash course google research on fevers in neonates and was increasingly worried about the possibility of sepsis, since sometimes the only indicator is a fever. It rapidly progresses in newborns and is the number one cause of neonate death. It seemed like the course of action for a newborn with a fever was to first figure out what was causing the infection, and then start a broad spectrum IV antibiotic if there was a suspected infection until cultures could narrow down what antibiotic needed to be continued. 

Northeast's ER is sketchy sketch at 11pm, let me tell you. It took awhile to get registered, but they we went back to a triage room for the blood draw. Our nurse was a pretty callous young guy, who could have cared less why we were there or that Momma might be a little panicky about having to have a blood culture drawn on her 7 week old to rule out SEPSIS. I crawled up in the bed with Callum and held his little arm while they tied a tourniquet on and tried to locate a vein. He did not like being held down or the tight feeling on his arm so he screamed and screamed. The nurse finally located what he thought might work, and of course it did not. He left to get an EMT, and we repeated the same process two more times. After 20 minutes of holding him down and making him scream in terror, I finally got to pick him up and immediately nursed him. The only compassionate person that entire room was the tech girl who helped me get Callum in a position to nurse and led us to a chair so I could sit down. The chair was the nasty lab draw arm chair in the triage area, but whatever, I was touched by her compassion, and angry at the other staff members who had been totally indifferent and didn't communicate anything about what they planned to do. So I nursed my baby in a disgusting chair, behind a curtain in a dark little corner of my hospital's triage area and shook with silent tears, wishing I had Ryan with me. Why in the world did I think I could handle all of this on my own?  I had called Ryan on our way to Northeast to tell him about the plan, and told him to get some sleep while he could and we would be home after we were done till the ped could call us back.

After I was done nursing Callum, I tracked down a nurse and asked for a NICU nurse to draw little guy's blood. Thirty minutes later, two very competent NICU nurses showed up, both concerned for my little guy and the symptoms he was exhibiting.  Callum responded so much better to these two ladies! The cooed and "ahhed" at him, asked what his name was, and patted his head and stroked his arms.  He very quietly watched them and hardly cried. They got just enough blood and we were finally done.

The Nightlight ped called me just after we got home around 12:30am. She said his urine dip stick in their office showed moderate leuokocytes, which is indicative of a UTI. She said depending on his CBC, we might have to be admitted to the hospital and placed on IV antibiotics until the cultures were back. I felt the floor shift underneath me and knew that we were probably going to end up going to Kingwood Medical Center(my hospital is not in network with our healthcare exchange insurance).  Thirty minutes later, she called back. His CBC was a little off, showing that he had an infection developing. She said we'd have to go through the ER to get admitted. I started throwing basic things in a bag, called my aunt to tell her we were bringing over Rylee, texted my mother-in-law, and then told Ryan to meet me at the hospital after he dropped Rylee off. By the time I was getting ready to go to the car, the ped called me back and told me she was going to try to get us a direct admit to the peds floor, which she was able to do, so we didn't have to sit at the ER waiting for a room! 

After all was said and done, even with a direct admit, it was about 3:30am by the time we got to our room. I hadn't slept at all, and was beyond exhausted. I had had no intentions of playing the "I'm a nurse card" because I'm not a peds nurse, and it's annoying when patient family members do that to intimidate or show-off. But I was sitting talking with the night nurse about everything that had gone on with Callum, and she said she needed to call Nightlight to get report from the nurse. I was explaining to her that Nightlight was closed for the night since they weren't a 24 hour facility, and there hadn't really been a nurse taking care of us. Jokingly, I told her I could give her report. She asked "Are you a nurse?" Reluctantly, I said yes, I was. She laughed, and I gave her report on my baby.

She was a little quirky, but didn't interrupt our sleep too much that night once we got settled in.  For instance, when I told her Rylee and I had been sick, she asked if I was breastfeeding. I said yes, and she nodded knowingly and said "well he could've gotten what you had since you are in such close contact with him." Um, bottle feeding moms are just as physically close to their babies. Not to mention, he's little enough that he's still getting antibodies from my milk. I digress though, she was nice and competent.

They took Callum out to the "treatment room" for his IV and I had Ryan accompany him, since I couldn't take any more screaming.  For ped patients, they try to do procedures outside of the child's room so the kiddo doesn't associate pain with their room. Unfortunately, the unit was quiet and I could hear him from down the hallway, so I paced nervously until he came back.

Poor little guy with his IV!

In the morning our day nurse took over. She was quiet, nice, and again, competent.  Callum's fever was gone after the first dose of antibiotics, so I was a lot less worried about him becoming septic.  The peds hospitalist didn't round till after noon. He basically told us what we already knew, that we were waiting on Callum's urine and blood cultures and would have to be on daily IV rocephin until they came back. At that point, depending on what was growing, we could go home on oral antibiotics if it was a general E. Coli. If it was something more drug resistant or weird, we would have to stay in the hospital, continue IV antibiotics, possibly for another week, and do further testing. 

And so we waited.

And waited.

And waited. 

Wandering around the unit to get out of the room.

My poor baby! 

His IV was so sad!

His 24 hour blood culture came back negative, and I breathed a huge sigh of relief. The urine culture done at Nightlight seemed to have gotten lost, so the hospitalist ordered another one. They in and out cathed him, and I made Ryan go with him for that one.  The urine anaylsis came back with really high levels of bacteria and WBC's, all indicative that a UTI was brewing. Before that point, I was still just hoping the results of the urine dip stick at Nightlight was a fluke and the result of contamination of the specimen. I was hoping Callum just had whatever Rylee and I had had, but it was looking like he definitely had a UTI going on. I went home to prepare for the long haul and bring more stuff up to the hospital.

We seriously moved into the hospital. I had no idea
how long we were going to be there, so we brought all
kinds of crap, including his swing.

Look at that sad face.

Fortunatley, none of the nurses had any problems with us co-sleeping part
of the night in bed, thank goodness, because he was nursing a lot.

Hooked up to my pump so I could have some milk for him
in case I needed to leave. He never did end up needing a bottle
while we were there.

We tried to see Rylee for a little bit each day, so she didn't feel forgotten. Ryan's parents had come back up and were staying with her for the weekend, but would have to go home Sunday night.  She was so good and patient through the whole upheaval.

Our second night we had the same night nurse, and things were pretty low key. The unit did get really busy and they had a huge influx of patients. They went from 2 to 12 literally overnight.  There was another baby down the hall that screamed a lot. My white noise machine and sleep mask were life savers for me and I was able to sleep relatively well. It felt weird to be sleeping in a hospital bed and not be the patient though. My mother-in-law stayed with me that night so Ryan could go home and get sleep, since he had a licensing exam to take in the morning! Poor guy! It was too late to cancel so he had to go take it.

Day two was much the same, waiting and waiting. I spent the morning by myself with Callum and it was actually really nice. I hadn't really had any just me and him time before, and I had absolutely nothing else to do besides feed and snuggle with him. Ryan got back later in the afternoon. I went back to the house again and played with Rylee.

Spending some quality time with Daddy.

Finally awake! He slept most of the time we were there,
fitfully, but still sleepy.

The metal crib was so sad! It's made for toddlers too,
but it looked like a little prison. So institutionalized.

I can describe night three in one word "STUPID." We had a different night nurse, and within 60 seconds of interacting with her, I knew exactly what kind of nurse she was. 100% by the book, a little scatter brained, and obnoxious. It's fine to be a "by the book" nurse, I know we have to protect our licenses. Sometimes, it's more important to let your healthy patients sleep though.  In her twelve hour shift, she came in at least ten times, and every time shook me awake with a "Mom" and tap on my shoulder.  At midnight, she wanted to do a full assessment on Callum, woke him up, etc. At 1am, she came in, shook me awake to scan my wristband for a saline flush, a SALINE FLUSH people! I totally almost lost it, but I took a deep breath and tried to have some patience. She was, after all, trying to do her job. At 2am, she came in to do a nasal swab for a MRSA culture.  I was totally livid.  MRSA cultures take at least 2 days to get back, and we were hoping to be home the next day.  Callum of course woke up after she stuck the qtip up his nose. I know that it was ordered, because that's hospital protocol, but Callum was seven weeks old and had never been in a hospital before! It was not a priority at 2am.

In the morning I went on a slight rampage about the night nurse and stalked about the room complaining about all the annoying things she had done in the night. It was so awful it was almost funny, so I wasn't actually super mad, just annoyed and relieved that hopefully we would be home that night in our own beds.

Good news came to us Sunday morning. His urine culture done after the first dose of antibiotics was negative, meaning the Rocephin did it's job!  The hospitalist wanted to wait for the results of the first culture before sending us home so he knew what antibiotic to send us home on. I convinced him to let us go home if we followed up with our normal pedi and that I would answer the phone when he called with culture results. He would also call in a prescription for us when he got those results.  As far as the oddity of Callum having a UTI so young and being a boy, the hospitalist told us it would be up to our doctor on if we did further testing.  Some doctors would do a VCUG and renal ultrasound with the first UTI, and others would want to wait for a pattern of recurrent UTIs.

As we were packing up all our stuff to go, Nightlight FINALLY got back to us with results. Normal E. Coli with a sensitivity to cephlasporins.  We got sent home on a seven day course of oral Amoxil.  The discharge process was incredibly fast and next thing I knew, we had all of our junk filling up a huge plastic wagon and were headed home.

The first thing  I did upon getting home was throw everything in the washer, made us each take showers, and gave Callum a bath.  Rylee was so happy to have us home!  We all slept very well in our own bed that night.

On Tuesday, we went to his normal peds office, but saw a different doctor because his normal one was out of town for Thanksgiving.  She was very nice, said he looked great, and we would wait to see if he had a second UTI before we did further testing.  She said that him being intact should not have contributed to him getting a UTI, which was different than what the hospitalist said. He had told me that there was a slight increased risk in intact male newborns during the first three months, and then the risk was the same as circumcised boys.

The week after Thanksgiving, we were back at the peds office for his two month check-up. His normal ped wanted to do another cath for a urine test to make sure the UTI was gone and send him in for a VCUG(to test for relux) and a renal ultrasound to rule out any structural issues causing a UTI. We replayed the same scenario with the medical assistant trying to retract his foreskin, being unable to visualize the meatus, and trying to tell me he had adhesions.  Our peditrician came back in, gently said that it wasn't adhesions, he was just a brand new baby with an intact penis, and you couldn't always visualize the meatus, nor did you need to. She cathed him without a problem and Callum hardly fussed, mainly because she wasn't forcing his foreskin back.

The next day we were back at Kingwood Medical in the outpatient radiology. He had to be cathed again for the VCUG, and the nurse retracted his foreskin and tried to tell me that I should be doing that at every diaper change to clean him.  That is of course false, and is not what is suggested by the American Academy of Pediatrics. But I didn't see any use in correcting her. Poor Callum's little penis was swollen and bleeding from all the retracting. I'm hoping there is no permanent damage. If your little boy is intact, don't let anyone tell you they have to retract the foreskin. I'll write another post later about that and our decision to not circumcise.

Everything came back normal! So hopefully we don't have to deal with this ever again.  It was horribly scary for that first twelve hours when he had a fever and we couldn't rule out sepsis. Callum is back to his happy chill self.  I'm still trying to process the whole experience. I'm not sure how parents with sick kids do it! I can't begin to describe the feeling of my entire world crashing around me, or feeling like my heart was being sucked out of my body.  It was awful. I am so glad he is healthy and doesn't need surgery or further procedures. Thanks for reading!