I went in theis morning and he's doing much better! He was off O2, adn had nippled all of his feeds well and had no bradys...however when I read the chart I noticed that they had noted edema in his legs...he was wrapped up when I got there and didn't unswaddle him b/c I was feeding him....so I look at his legs and the right one is much more swollen than the left and he's painful on it and not movieng it...(I'm kicking myself b/c I thought it hurt him 2 days ago and I thought they were swollen but Russ and the nurses convinced me otherwise...I'm soo sticking to my intuition now). He has more swelling up in the hip/groin area...and it's kinda firm....I wait impatiently for rounds so I can talk with the docs...

The nurse practitioner (NP) and attending (MD) walk over and the first thing the NP says to me is "would you consent to an LP?" WHAT?!?!?!? Then she starts going into about how we should look for a septic focus b/c his 2nd culture was positive...and then the MD piped in that maybe we sould back up and look at the leg first since that could be the source...so the plan was to xray the leg and the chest (why the chest? I don't know)....xrays are clean. So she (NP) comes back and wants to do the lumbar puncture and I declined. She can't give me a good enough reason. She doesn't want to miss a meningitis...but he has no symptoms...he hasn't bradyed in 24h, and hasn't needed O2...and is acting much better....she claimed that he was agitated all night and that can be a sign...I said he didn't seem agitated to me in the time that I was there (about 6-7 hours at that point...he was sleeping in my arms...very out)...then she tells me that staph aureus meningitis is really rare...and that if she gets a neg culture she couldn't completely rule it out....so what the hell is the point of doing it anyway?!!? I asked! And the reason to spinal tap and culture would be to treat with higher doses of abx and for longer...I said no to the LP. I said I would revisit it if he was getting worse or the 3rd blood culture was positive. I'm annoyed she pushed the issue so much....she didn't convince me it was indicated. AND I have no reason for his leg...and she wasn't going to investigate his leg further!! WHAT THE HELL!?!? At that time he has started to move it a little and the color was better and I was able to do passive range of motion and massage and he wasn't complaining so maybe it's getting better... I guess I'll see in the morning. I gave his night nurse strict instructions to call if anything changes. I was nice about it though!

If his leg looks the same or worse in the morning, I'm going to request an ortho consult and additional imaging (ultrasound/MRI). It just sucks now that I feel like I have to be there all the time to make sure he gets the care I want and doesn't get a bunch of extra tests...last night they thought it was a fluid retention problem (it's not symmetrical) and did a renal panel and started weighing his diapers to make sure he was peeing enough... the kid pisses like a racehorse!

Overall though, when I left tonight, I felt comfortable with where he was at.
I'm annoyed about his leg, but he really does seem to be doing better sepsis/brady/apnea wise...and he's off O2 and bottlefeeding!