NICU Observations. :-)

Before I talk about my NICU observations, let me update you on Samuel's progress!

He is doing AWESOME with no oxygen support.  Please pray that he continues this way!  We have noticed that Sam tends to drop his oxygen saturation level just before and during a feeding.  I think he does it just before to let us know he's hungry (he also cries a little, wiggles around and thrusts his tongue). The doctor thinks he does it during because he exhibits signs of reflux.  NOT a big deal at this point.  It hasn't caused him to drop his oxygen to really low levels and he seems to be handling his food well.  This seems to be something pretty common with preemies, so it is a matter of him developing more and that should go away.  If it doesn't, well, we'll cross that bridge when it comes.  :-)

He had another head ultrasound on Monday (not because the doctors are worried, just more of a follow up check) and that came back with 2 grade zeros (referring to the intraventricular hemorrhaging that started as grades 2 and 3).  So that was good to hear that it is still nothing to really talk about.

We are looking forward to few upcoming changes.  One is to transition him to a crib.  Currently he is still in the same kind of isolette he started in, but is getting very little support from it.  It started with giving him 80% humidity to help his skin.  Well as of last weekend he has been in room air humidity.  It also was changing the temperature to help him regulate his body temperature.  So for a quite a while he had a temp probe on that would constantly tell the bed his body temperature, then the isolette would adjust its temperature according to how hot or cold Sam was.  They have since taken the probe at and set the bed at a constant temp.  Currently it is at 26.5 C or 79.7 F.  They have slowly been turning that down, which it is already closer to room air than it is average body temp.

Another change is to take him off of his caffeine.  Yes, he's on caffeine.  I'm sure I mentioned it before, but he's a refresher.  The caffeine is meant to help him to keep his heart rate up and keep him from having too many apnea spells.  Well, he's been doing pretty well awesome at both, so now it is a matter of deciding when is good to stop the caffeine (which one doctor told me, that if you increase the amount to match an adult's body weight, he receives the equivalent of 6 cups of coffee every morning).  The doctor also mentioned that it will take about 5 days after he's off the caffeine for it to fully leave his body.  So that will be exciting to see how he handles it when they do that!

Of course we are continuing with upping his milk feedings based on body weight.  He started at 3mL and is already at 30mL and taking the feedings quite well!  Between 33 and 34 weeks gestation (he'll be at 32 weeks on Saturday) is when they start figuring out the suck, swallow, breathe rhythm, which means we'll be started to try some nursing!  YAY!  That means eventually I won't have to pump as much!




Alright some observances about life in the NICU.  Currently there are around 10 babies here, but almost all of these babies are different than the ones that were here when we arrived.  They take on babies because they're early, but also if they were full-term and sick.  So the turn over rate is high.  However there are some that have been here longer than us.  We said goodbye to one on Monday.  She went home!  Which is exciting and sad at the same time.  You form bonds with the other parents of preemies that are here and when they leave it's kind of sad (besides we walk by their now empty room to get to ours, so it is a constant reminder).  Another one of those families will also probably be going home at the end of the week.  So we are starting to look like the old timers in the NICU and hopefully be able to provide the encouragement and like minded conversation that we had with those families.

Something I've also notices is how babies cry.  Samuel is in an isolette, which muffles his cry to the outer world some, and besides he isn't really loud yet either.  So he doesn't get to add to the chorus of cries you hear just outside your room.  However, we have noticed that there is one baby (and I have no idea which one, nor have I tried to figure this out) that cries like a cat meows.  When I first heard this baby, I thought there was an upset cat in the NICU, then I realized that that is silly and it is a baby.  Yet every time that baby cries I keep thinking cat!  We're just glad Sam's cry sounds like a baby and less cat like....

Thursday, February 9 - No More IV!!!

So today was really an extremely uneventful day when it comes to Samuel (praise God for that!), last night however was slightly more eventful (but only in good ways).  As I mentioned yesterday his peripheral IV went bad and they replaced it with a new one.  Well, that happened again last night!  Only this time they decided not to replace it.

Yesterday I wrote about how that peripheral IV was really just replaced to keep it open while they made sure that he was taking the feedings well.  Last night when the IV went bad, they decided that since he had been taking his feedings so well there was no real need to replace it, just keep going forward without it.

So today they starting fortifying my milk.  Instead of just giving it as is they added calories.  This means instead of 20 calories per ounce he is getting 24 calories per ounce.  So far he has been taking to his feedings really well.  We continue to be amazed and thankful that everything has been going so well!

This morning Samuel was being slightly fussy.  I kangarooed with him during his noon feeding and he was just so cozy and loving it!  We hardly heard him the rest of the day!

Today I got out and went the the ymca for a little while.  I did a half hour walk using the fancy new gps/activity tracker my brother gave me for my birthday.  It's really cool and I can't wait to get out and take advantage of more of the features, but all in good time I suppose.  For now I just want to get over to the ymca and do some walking several times a week.  Then if that goes well, walk longer and more frequently!

I decided after Samuel was born that it makes no sense for me to stop everything I am doing just because he is in the NICU.  This school year I have been tutoring two students once a week, so after going to the ymca, I came home, did some chores and tutored for an hour.  It was good to concentrate on something else!

This evening I have just been tired, Samuel seemed to be doing quite well, so I called it an early night and went home before 9pm!!  Not that that helped too much as I still need to pump before going to bed and it is already almost 10:20.  Alas, I am a slave to the pump!  At least I am giving Samuel the nutrition he needs and that is all that matters.  :-)

Wednesday, February 8 - Kangaroo Care is AMAZING!!

So today has thankfully been yet another uneventful day.  Last night I guess was a little bit more eventful (though not in the concerning kind of way).  They have been checking and rechecking that peripheral IV with some surprise that it has been holding up.  Well, last night, it finally went bad (as it doesn't work anymore).  So they had to establish a new location, which worked and he's been doing great on the new site.

Which the new site is needed more as back up rather than out of necessity for Samuel's nutrition.  Today they upped the milk intake to 18, which means (based on some elaborate formula that includes body weight and other things) he no longer needs the supplemental nutrition through the IV.  However, they don't want to rely solely on the IV yet until they make sure he is taking the milk consistently well for a little while.  Until then they are running what is basically sugar water through the IV to keep the spot live, until they can take it out.  According to the staff here, hopefully tomorrow they can take out the IV and remove another piece of equipment from the room.  Praise God for giving Sam the strength and health he needs to make all these "baby" steps.  :-)

This morning and early afternoon Sam's been a little bit fussy, but then we kangarooed for his 3pm feeding.  We kangarooed for almost 2 whole hours.  It was amazing.  Every time we kangaroo I just sit there with amazement.  He sleeps real deep during our kangaroo care, but every once in a while he'll shift position and I can feel his little arms, legs, hands and feet move around a little bit.  I sometimes look at him when he does that and just marvel at how he is a complete person despite being born so early.  He has all the body parts we do and he can move them around, he just needs some time to make them stronger.  This is truly amazing.

The other thing that amazes me about kangaroo care is how he immediately calms down and falls asleep as soon as I get him positioned on me.  He was being somewhat fussy just before I picked him up and while I was picking him up.  Then right when I get him positioned on me (before I even sit down, while I am standing by his incubator about to move to sit down) it's like the switch gets flipped and he's asleep.  Now if it stays that easy to calm him from here forward that would probably be a miracle, but I am just loving it right now!

Really nothing else has happened, since kangarooing I've had a very peaceful baby all evening so far and hoping that this evening continues being peaceful.  :-)

Saturday, February 4 - Breathing is Hard Work!

This morning I woke up early to pump and decided to just get ready and head over to the hospital.  I needed more sleep and figured with all the people staying at our house, I would have a better chance of sleeping more in Samuel's room than at home.  So I left the quiet house full of sleepers that were sure to soon wake up.

I got to the hospital and grabbed some more breakfast, pumped and laid down.  Sleep overtook me quickly.  I woke up to talk to the doctor and hear more about the results of the head ultrasound.  Yesterday they gave us some preliminary results and what the doctor told me was also not an official reading, but I think we can go with it pretty well.  What he told us is that this ultrasound looked like there really wasn't much for bleeding.  In fact the grade 3 now looks like a grade 1 and the grade 2 looks like a 0.  The doctor said they might have been simply over zealous in the diagnosis the first time or they might have misread it too.  He found it hard to believe that it would have gone down that much in so short a time.  They will do another head ultrasound in another week and we are hopeful that it will match or be better than the one they did today!

The doctor also said that we would probably start giving Sam more of my milk at each feeding starting today.  He has been getting 3 milliliters every 3 hours and now he should get 6 every 3 hours.  They then starting doing this too with the 12:30 feeding I believe.  He has been tolerating the upped amount great too!

This morning Samuel must have decided that breathing is just hard work!  He would stop breathing enough, which would set off an alarm that would call a nurse over to check and help him.  After doing this several times and not getting his oxygen level back up the nurse decided to give him a little bit more oxygen.  He is doing great on the amount of oxygen he is given and actually only receives a little more than what we get breathing regular air.

Ben, AJ, Dale (Ben's Dad) and Anna all started showing up a bit before noon.  A few of them were surprised that I was at the hospital they had thought I was at home sleeping until it was commented on while eating breakfast.

During the afternoon everyone decided they were finally ready for lunch (I had eaten the food at the hospital already) so we took a break and went to Jimmy John's.  Then after finding out that Ben's Dad had never been to Cold Stone, we stopped there too.

This evening has been really uneventful.  I got to kangaroo with him again, which I just always find absolutely wonderful.  They have me pick him up and put him back and I am getting much more graceful at it, which means Sam gets less fussy during transition.

Now we are just kind of relaxing and getting ready to go home.  Samuel's still doing great!  He is gaining weight back now too, he is practically back to his birth weight!

Tuesday, January 31 - Mother's Milk

As of Tuesday our little Samuel had only been receiving nutrition through IV fluids.  He had dropped some weight (pretty much every baby drops some weight, regardless if they are term or premature), but the doctor said when he starts getting my milk he will start gaining it back.  The other "fun" thing he will get to start doing is pooping!

So Tuesday, because things seemed to be going well, they decided to start Sam on my milk.  I had produced a bit of supply by now, so I was excited that all this time I have been spending pumping and kicking people out of Sam's room so I could pump was finally going to be put to use.  Besides that, by him taking my milk, I feel like I am contributing more!

Some clarification on what it means for Sam to take my milk...  He has a line that is run through his mouth into his stomach.  The milk he receives will go into this line and directly to his stomach.  That means he doesn't actually drink it and he does not need to be on the breast to get it, he simply receives it passively in his stomach.

Also by starting him on milk that does not mean he will no longer get IV fluids.  They start these premies on such a small amount and only slightly reduce the fluids.  Most of his nutrition will still come from the fluids until they up his amount of milk.  Tuesday they started out by giving him 3mL of milk a feeding (which happens every 3 hours).  Eventually 3mL will go up, but they have to make sure he is taking to the feedings well.  They do that by checking and seeing how much of the last feeding is left over before giving him a fresh one.  As long as less than half of it is in there, then he is taking them just fine.

So I got to excitedly watch an unexciting event of him taking my milk (kind of anticlimactic, because all he did was lay there while they ran the milk through a line).  Yet it still made me happy nonetheless.

Tuesday I also got to kangaroo with him again and yet again I just stared at him in amazement that he is my son and he is already here!

All the families in the NICU do something called family rounds once a week.  Our day is Tuesday for family rounds.  What this means is the whole team of people that are working together to get Samuel strong meet and discuss his progress over the previous week and the goals for the next week.  The parents are invited and encouraged to join in on the rounds as much as possible.  So Ben and I were there and ready for our first set of family rounds.

The team that is working on Samuel is quite large actually, it includes the following people: doctor, nurse, dietician, lactation consultant, family liaison, social worker, physical therapist and I think I got everyone???  Basically the outcome of the first set of rounds was pretty much what we expected.

Goals:  keep an eye on the ventricular hemorrhage, slowly up his dosage of milk.  And I am sure they were more, but most of the goals just dealt with keep an eye on how he is doing with different things and just get him through his first week of life safely.  They say he is the most fragile during the first week.