Nicholas' brain ultrasound showed a blood clot in the fourth ventricle. This could have been caused by the initial IVH or from the shunt surgery- basically any bleeding in the brain could have been the source of the blood that formed the clot. It is at the base of the brain near the brain stem. The fourth ventricle is enlarged right now so the clot is blocking CSF from draining to the spinal cord. It didn't look enlarged last week but it could have been. The lateral ventricle has decreased in size because of the shunt and when that was enlarged it could have made the enlarged fourth ventricle look normal. So they really can't tell when it happened. The neurosurgeon is out of town but they called him and his assistant and NP are going to look at the ultrasound. It is not an emergency right now because it doesn't appear to be bothering him. The brain stem controls breathing, heart rate and circulation. All of that is fine on Nicholas right now. So they are going to watch him closely and see what the neurosurgeon says when he gets back. He could do nothing and hope it goes away on its own or it could require another surgery to compress it and get rid of the blockage. Just another day on the NICU roller coaster.
Other than that, he is doing well. They decreased his Vapotherm down to 2.5 liters. He took his whole bottle at 2pm and will get his other two tonight.