Paige Wonders....

Paige: "Mom, I've been thinking about what kind of doctor I want to be. What kind of doctor deals with the most blood, guts and bodily fluids?"

Me: "A nurse"

Sending love to all my nurse readers out there! lol

A few minutes later Paige comes out and tells me she wants to be a surgeon. This isn't the first time we've heard her say this. We always try to balance our answer with reality (she has very mild CP and shaky hands) while not squashing her drive.

"Well, maybe I'll stick with my original idea and create a preemie doctor field."

You do that sweetie!!

ABDUCTED CHILDREN

****Update March 30, 2009**** First I want to thank everyone who took a moment to look at the pictures of Jack and Duncan. The boys were found but sadly they were not found alive. There are no more details at this time.***


While the majority of the posts on my blog are dedicated to prematurity (with the occasional teasing of my husband), this blog post will be dedicated to 2 children who are missing.

Their family needs your help.

Please take a moment to look at the information and study the pictures. Please do NOT assume that you won't be able to help because of the location of the abduction. Many abducted children are taken far away from the point where they were taken. Also, just because these boys were taken by their father, please do NOT assume it is not as serious as a stranger abduction.

If you would like to help, you can print posters from the following link:
National Center for Exploited and Missing Children

For more information you can visit:
http://www.myspace.com/helpfindduncanandjack

If you are on Facebook you can join the group

"the official bringing jack and duncan connolly home safe group"

If you have any information, no matter how small, please contact

The National Center for Missing and Exploited Children at
1-800-843-5678 (1-800-THE-LOST)

Family Abduction

DUNCAN CONNOLLY DOB: Oct 17, 1999 Missing: Mar 8, 2009 Age Now: 9 Sex: Male Race: Asian Hair: Brown Eyes: Brown Height: 3'6" (107 cm) Weight: 66 lbs (30 kg) Missing From: BLOOMINGTON IL United States

JACK CONNOLLY DOB: Apr 10, 2001 Missing: Mar 8, 2009 Age Now: 7 Sex: Male Race: Asian Hair: Brown Eyes: Brown Height: 3'4" (102 cm) Weight: 62 lbs (28 kg) Missing From: BLOOMINGTON IL United States

MICHAEL CONNOLLY Abductor DOB: May 20, 1968 Sex: Male Race: Asian Hair: Black Eyes: Brown Height: 5'8" (173 cm) Weight: 175 lbs (79 kg)

Duncan and Jack were allegedly abducted by their father, Michael Connolly on March 8, 2009. A felony warrant for Kidnapping was issued for Michael on March 9, 2009. They may still be in the local area or they may travel to Hoffman Estates, Illinois in a grey Dodge Dynasty with license plates A326109. The photos shown above are a representation of what the vehicle may look like. Michael may go by the alias name Gung Yer Lee.

ANYONE HAVING INFORMATION SHOULD CONTACT National Center for Missing & Exploited Children 1-800-843-5678 (1-800-THE-LOST) LeRoy Police Department (Illinois) 1-309-888-5030

Paige's Knowledge of Her Own Medical History

Over the past 2 years we've covered the topic of "how much should you tell your preemie about their medical history" a few times. I believe it's a personal decision but with Paige we have made her a part of her own care since day one. She has heard her medical history countless times and can pretty much repeat it on her own. She knows her current meds including dosage. We never drilled this information into her head. She has just heard it so many times that it is 2nd nature.

If you would like to read the previous blog posts/comments on this topic, you can do so here and here.

Recently we changed doctors from a family practice doc to a pediatrician. I filled out all of the paperwork ahead of time (it's not a simple task when you have a preemie) and was less than thrilled when the doctor proceeded to ask all of the same questions that I had answered on the extensive paperwork. I was answering them as cheerful as possible, as to not start off on a bad note with the new doc, when Paige spoke up...

"Wait Dr. XYZ, I do have an allergy to medicine. Mom, why did you tell her that I'm not allergic to anything?"

I tried to hush Paige with the usual finger to the mouth but it didn't work.

"Mom, duuuuuh! I can't believe you missed something! hehe" (she always thinks it's funny when she realizes that I have made a mistake-loves to rub it in my face too-lol)

I shot her the glaring eyed mom look and then put my finger up to my mouth to hush her again. I figured she was talking about a reaction she had to a seizure medicine where she lost the ability to walk and see colors-after only one dose. "Paige, your reaction to the carbamazepine was due to an overdose on the doctors part. It was not an allergic reaction."

I looked up at the doctor, still trying to smile through the questions that I've already answered.

"Mom, I'm seriously allergic to Omnicef! DUH! Remember my full body hives? Remember those steroid shots I needed? Remember the doctor telling you to make sure I never have any 'cillins'? Remember Mom? " She then breaks out into hysterical laughter, turns to the doctor and says, "Maybe you better ask me the questions from now on."

At that moment I was reminded of why we have always included her in her care. I was proud of her (even her snarky attitude-lol). I watched, in awe, while she answered the rest of the questions on her own (completely accurately I might add). She is such an amazing child!

I beat myself up over the fact that I forgot such an important bit of information. My facial expressions must have made it obvious too because the doctor leaned over, patted my shoulder, and said, "It's ok. You taught her well."

Ok, yes I learned a lesson. Asking those questions, despite the fact that I had answered them already on the intake form, was a good thing. I will never complain about that again!

Hemangiomas and Prematurity

Over the years I've seen discussions on preemie support group sites about hemangiomas. Since this is not a condition that my children have ever dealt with, I never bothered to research it. (I do remember there being a few preemies in the NICU with Paige who also had hemangiomas.)

Recently I noticed that someone found this blog while searching for information on "hemangiomas in preemies". While I found it interesting that there may be a correlation, I never put much thought into it.

Today I was reading a friends blog and there it was again... the topic of hemangiomas (and the use of propranolol). I was surprised to read that they are common in premature infants.

I was even more surprised when I set out to investigate a bit further. There are many journal articles out there on the correlation between prematurity and hemangiomas.

Here's one on the possible association of hemangiomas and ROP...
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2007-0803v1

Here's an article about the possibility of hemangiomas being linked to low birth weight...
http://healthlink.mcw.edu/article/1031002941.html

I know this information probably comes too late for the person who found my blog while searching for info on hemangiomas and prematurity but I thought I would still put it out there in case anyone else needs it.

Impact of Postnatal Corticosteroid Use on Neurodevelopment at 18 to 22 Months' Adjusted Age:...

Impact of Postnatal Corticosteroid Use on Neurodevelopment at 18 to 22 Months' Adjusted Age: Effects of Dose, Timing, and Risk of Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants

Deanne Wilson-Costello, MD^a, Michele C. Walsh, MD^a, John C. Langer, MSc^b, Ronnie Guillet, MD, PhD^c, Abbot R. Laptook, MD^d, Barbara J. Stoll, MD^e, Seetha Shankaran, MD^f, Neil N. Finer, MD^g, Krisa P. Van Meurs, MD^h, William A. Engle, MDⁱ, Abhik Das, PhD^b for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

^a Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
^b Department of Statistics, Research Triangle Institute, Research Triangle Park, North Carolina
^c Department of Pediatrics, University of Rochester, Rochester, New York
^d Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
^e Department of Pediatrics, Emory University, Atlanta, Georgia
^f Department of Pediatrics, Wayne State University, Detroit, Michigan
^g Department of Pediatrics, University of California, San Diego, California
^h Department of Pediatrics, Stanford University, Palo Alto, California
ⁱ Department of Pediatrics, Indiana University, Indianapolis, Indiana

OBJECTIVE. Postnatal steroid use decreases lung inflammation but increases impairment. We hypothesized that increased dose is associated with increased neurodevelopmental impairment, lower postmenstrual age at exposure increases impairment, and risk of bronchopulmonary dysplasia modifies the effect of postnatal corticosteroid.

METHODS. Steroid dose and timing of exposure beyond 7 days was assessed among 2358 extremely low birth weight infants nested in a prospective trial, with 1667 (84%) survivors examined at 18 to 22 months' postmenstrual age. Logistic regression tested the relationship between impairment (Bayley Mental Developmental Index/Psychomotor Developmental Index of <70,> palsy, or sensory impairment), total dose (tertiles: <0.9, 0.9–1.9, and 1.9 mg/kg), and postmenstrual age at first dose. Separate logistic regression tested effect modification according to bronchopulmonary dysplasia severity (Romagnoli risk > 0.5 as high risk, n = 2336 (99%) for days of life 4–7).

RESULTS. Three hundred sixty-six (16%) neonates were steroid-treated (94% dexamethasone). Treated neonates were smaller and less mature; 72% of those treated were at high risk for bronchopulmonary dysplasia. Exposure was associated with neurodevelopmental impairment/death. Impairment increased with higher dose; 71% dead or impaired at highest dose tertile. Each 1 mg/kg dose was associated with a 2.0-point reduction on the Mental Developmental Index and a 40% risk increase for disabling cerebral palsy. Older age did not mitigate the harm. Treatment after 33 weeks' postmenstrual age was associated with greatest harm despite not receiving the highest dose. The relationship between steroid exposure and impairment was modified by the bronchopulmonary dysplasia risk, with those at highest risk experiencing less harm.

CONCLUSIONS. Higher steroid dose was associated with increased neurodevelopmental impairment. There is no "safe" window for steroid use in extremely low birth weight infants. Neonates with low bronchopulmonary dysplasia risk should not be exposed. A randomized trial of steroid use in infants at highest risk is warranted.

**As published in the March 3, 2009 Journal of the American Academy of Pediatrics***