Still stable!

Today was a good day! Averi's blood gases continue to be good, and at this point, they are no longer talking about putting her on ECMO. This is fantastic news! Her bilirubin level went up instead of down, so she is still under her very special tanning bed.

The doctors have begun talking about scheduling surgery for sometime next week. I thought I'd talk a little bit about what this surgery entails. There are a couple of different ways they can do this surgery, depending on the size of the defect:

1) Primary repair: If the hole in the diaphragm is small enough, it can be repaired by either simply stitching it together or by cutting some of the baby's inner abdominal muscle, flipping it over, and using it to sort of patch the hole. It is called a primary repair because the surgeon is using the baby's own tissue to repair the hernia.

2) Patch repair: If the hole is too large for a primary repair, a synthetic material such as Gore-tex will be used to patch it. In some cases, pig skin will be used, but that seems to be pretty rare.

The advantage to a primary repair is that it is using the baby's own tissue, which obviously will grow and stretch with the baby. Synthetic patches, while a good and acceptable option, do not grow with the baby, and many times need to be replaced as the child grows. The decision on what type of repair to do is usually done in the operating room, once the surgeon has a good visual on how big the hole is.

Sometimes this repair is done laparoscopically (where they do a few small incisions and are guided by camera), and sometimes by making a midline incision and completely opening the baby up. This decision is based on where the hernia is, how big it is, and the surgeon's preference based on the baby's condition.

The other thing to note is that the surgeon will not take the time to perfectly lay out every bit of intestine. The idea is to get in, get everything out of the thoracic cavity, and close up as soon as possible. A CDH child's anatomy will never be exactly like the typical model. The stomach is usually rotated a bit, and the intestines just sort of "fall where they may." This can create reflux issues for the baby as well as complications, and possibly the need for future surgeries later on.

I say all this in order to give you very specific things to start praying about!

• Timing... pray that the doctors are fully aware of everything going on in Averi's body, and that they make a decision on the "when" based on all of the information available. Pray that this will be the optimal time.
• Surgery... best case scenario is a primary repair. Pray that the surgeons will have wisdom as they are making decisions about the repair. Pray for those little intestines to fall in a good location... that the stomach will be positioned well.
• Healing... pray that Averi's body will heal quickly, that there will be no infection, and that her smaller lung will begin to expand rapidly!
• Feeding... though a few weeks off, be praying for Averi's digestive system. Pray that she won't have issues with reflux. Pray that she will eventually be receptive to breastfeeding and not have any oral aversions.

That's probably a lot of information to digest for one post, so I'll just leave it at that! Praise God for giving Averi a couple of really good days! This is a great sign!