First an update on the quadruplets: They are all four breathing well on their own with no signs of problems from premature lungs. Their mother is recovered from her c-section and has family helping her to feed and care for the quads. But the babies unfortunately are not tolerating their feeds very well. They all four had necrotizing enterocolitis (gastrointestinal infection that preterm infants are prone to) and are slowly recovering. We are trying to advance their feeds via NG tubes daily. Continue to pray that they will tolerate the feeds and begin to grow soon as they are all still quite small at 2 lbs each.
Now on to some other pediatric patients:
This 16 year old girl has a condition called osteogenesis imperfecta which means she is prone to fracture her bones with minimal trauma. She has been here 6 weeks in traction for a hip fracture but has maintained a good attitude throughout that time. She has been diligent in studying for school and always has a friendly smile for visitors and the medical team. Hopefully she'll be able to go home soon.
The little boy on the back of his big sister was diagnosed last week with congenital hypothyroidism. In the States, this is diagnosed with newborn screening and then patients are put on the appropriate medication as infants to prevent further problems. Unfortunately, this little one wasn't diagnosed till he was a toddler which means that even though we have started thyroid medication now, he will continue to be developmentally delayed and will likely have a low IQ.
We thank God for providing miraculous healing for this baby. At birth he was noted to have significant difficulty breathing and a blue color to his whole body. Normal oxygen saturations are above 90% - his oxygen levels were 30%. Through a couple simple tests, we diagnosed him with PPHN - persistent pulmonary hypertension of the newborn. Basically this means that his lungs did not adapt the way they were supposed to to life outside his mother. The first 24 hours, his oxygen saturations were 30-75% despite maximum oxygen support. The second day, his saturations were 24-54%. Finally, the third day, they increased to 72-92%. He was weaned off oxygen after 2 weeks and discharged home breathing well and feeding well with no obvious problems shortly thereafter. Treatment for PPHN in the States involves things like ventilators, inhaled nitric oxide, ECMO, vasopressors - none of which we can really do here. It's quite remarkable that this baby's oxygen levels were so low for so long and yet he never had a seizure and you can see how alert and active he is (another picture below). Praise the Lord!
The next four pictures are of the same child. Little Chepkirui was admitted to the hospital at 15 months old weighing 3.7kg (8lb - less than my one month old niece Emma weighs). She is the 9th child in the family and her mother delivered child #10 shortly after Chepkirui was admitted. On arrival in the emergency department, Chepkirui was cold, gasping, and critically ill. No one thought she would survive the night. But this first picture is her a few days after admission. You can see she's in a special warmer box to help keep her temperature up.
Picture taken one of the first days she could sit up on her own.
Now able to maintain her temperature out of the box and able to feed from a small cup instead of the nasogastric tube. Pictured with the intern who cared for her that first night in Casualty.
Now weighing 4.7kg (10lb), able to eat rice and beans in addition to milk, and getting close to going home. I have yet to see a smile but Chepkirui is now quite alert and interactive and willingly lets me hold her and play pat-a-cake with her. Please pray for the family, the nutritionist, the social worker, and the community health team as they seek to find a solution to prevent her and the other children from getting into this severely malnourished state again.
A teenage girl with Down syndrome recovering from pneumonia
This plant may appear harmless but in actuality we admit several children each month due to poisoning from ingesting its fruit. Datura (Jimson Weed) poisoning causes severe agitation, dilated pupils, and confused behavior - one of the many things I've learned since coming to Kenya!
This little boy survived bacterial and tuberculous meningitis. Unfortunately, though, he lost his vision as a result of the severe infections. We gave the family the contact info for the Kenya Society for the Blind - hopefully they will pursue that further as that organization would be quite helpful in teaching braille and helping this boy learn how to live with blindness. The typical daily activity for a Masai boy his age, though, is to herd goats or cows, which, sadly he will be unable to do. Pray for his adjustment to a difficult life.
This is one of the few patients to learn my name. Though I like my name, I don't think my parents considered whether it would be easily pronounced in other languages or by small children. But little E greeted me "Dr. Alyssa" each day as she endured several skin grafts and other surgeries to treat her scars and contractures from burns.
I blogged about this little one with severe malnutrition earlier this month - 15 months old and 3.7kg, now quite well and discharged home at 5.2kg. She even smiled for me the day before she went home!
