Joshua's first full day - and it was an eventful one!

After Joshua left my hospital room at 2 am, I received a call from a nurse at CHOA around 4 am letting me know he had arrived safely and she needed my verbal consent for him to be evaluated and have surgery.  I quickly agreed and anxiously waited for the next call.  The call came at 5:15 from the pediatric surgeon - Joshua was doing great and she had been able to perform a primary closure!!  There are two options for gastroschisis patients: primary closure which involves tucking the intestines back into the abdominal cavity and surgically closing up the hole, or a silo where the intestines are packed inside a sterile bag and hung above the hole in the baby's abdomen so they can slowly be reintroduced into the abdominal cavity over the course of several days to a week.  Primary closure is preferred, but is often not possible because the abdominal cavity is not large enough to fit everything and it puts pressure on the baby's already strained lungs.  We were hoping for a primary closure, but expected a silo since that is the necessary option more often than not.  I was thrilled to hear the surgeon say that Joshua was an excellent candidate for a primary closure since he did not have too much of the intestines out and his lungs were nice and healthy.  Our little boy was already put back together and whole!!  I am dumbstruck and elated at how fortunate we are with this outcome!  Don't get me wrong, I know there is still an incredibly long journey ahead of us since the real issue with gastroschisis babies is getting the intestines to have healthy activity and absorb nutrients the way they are supposed to.  Joshua will still be intubated for several days since he is on morphine to control the pain and the ventilator is necessary to keep his breathing at a normal level.  He has a PICC line for IV nutrition, a catheter for emptying his bladder, a tube for emptying his stomach contents since his intestines aren't working yet, and a long way to go before he can start on feeds.  The feeding process is the trickiest part of recovering from gastroschisis and can take anywhere from a few weeks to a few months.  In about two weeks, Joshua will be introduced to his first real food - 1 milliliter of my breast milk.  From there the amount of milk will be slowly increased if his body is able to process it.  Often times babies take two steps forward, then one step back.  Since the intestines have never functioned properly, it can be a very arduous process.  But, so far Joshua has exceeded all of our expectations and I cannot doubt our little champ - he will fully recover and I strongly believe it will be more quickly than usual.  I am so proud to be this extraordinary child's mother! 

Joshua after his successful closure surgery

First page of the journal David and our excellent nurse, Nancy, started together