The Blip...

Remember how I talked about how the home stretch can mean different things?  Well, his home stretch is starting to show us what it means.

The first type of home stretch was when you're going and going and going and then suddenly there's the finish line!  -- Yeah, that's not Samuel's home stretch...

The second type I mentioned was when you see it for quite a while before you finally get to it! -- Slowly, but surely progressing?  Also not Samuel's home stretch, he's a quick little baby...

Finally one where you see the finish and then you're sent off into a different direction -- Yup, this one is Samuel's home stretch!  As of yet, who knows how many detours we'll have to make on the way to the finish line, but we just made one.

What I didn't tell you when writing that post is that we thought Samuel would be coming home today (Thursday).  Well, that didn't exactly happen, everything was going great for it until yesterday, so this was a very sudden detour indeed.

In order to fully explain I have to back up to Tuesday night.  We opted to have Samuel vaccinated and as discharge was getting closer and closer we decided to give them to him on Tuesday.  So Tuesday night, during the first cares of the night shift, we gave him some immunizations.  Of course he didn't entirely appreciate it (and by that I mean turning beat yet and crying as loud as he could with each shot), but that's to be expected.  Most people, child and adult alike, don't really like shots.

Tuesday night he was extra grunty (preemies come as a small bundle of grunts, I mean squeaks, ok, so they just makes lots and lots of special preemie sounds).  Which meant I didn't hardly sleep.  On Monday I had started sleeping in Sam's room so we can be nursing in the middle of the night as well.  Him grunting and fussing just a little all night made it mighty hard for me to sleep.

That morning he only took 20mL of his 50mL bottle, then the next feeding he nursed very lazily.  Samuel was also being very grumpy.  He seemed to calm down some so we tried to do his 90 minute car seat check (mainly to see that he keeps his oxygen up while in the car seat) and failed it within the first 10 minutes.

Then he seemed better, he ate really well at the next feedings, we managed to do the car seat check again and he passed with flying colors.  He seemed a little more content again.  Then night shift started.  The first feeding for night shift he woke up an hour late.  Now I understand flexibility in scheduling, but he was waking up like clock work up till that point, him waking up a whole hour late was unusual.

We gave him a bath, checked him over and Ben settled down to give him another bottle.  Again he only took 20mL of the 50mL, not a normal thing for Sam to do.  We put him back down in his crib, checked his temperature again and decided to bundle him up warmly.  They swaddled him in 2 more blankets with hot packs and then laid another blanket on top.  They also put a hat on him (infants temp control through their heads).

Based on when he took the bottle he was due to eat again at 1:30am, but maybe earlier as he ate so little.  He didn't wake up to eat at the next time, at 1:45 we decided to try to wake him up to eat.  We got him into position, but no matter how hard we tried, he just wouldn't.  We managed to get him to latch and swallow some milk that I squeezed out, but that was it.  The decision was made, we were going to have to put a new tube down his throat and he was going to get moved into an isolette (you know, the one that he wasn't ever in before because he went from the fancy one to the bed).

******continued writing on Friday******

With that decision I decided to go to sleep, so I laid down on the little sofa/bed thing they have the rooms and passed out almost immediately and didn't wake up until 6:30am.  It sounded like things were pretty calm while I was sleeping, Samuel took the tube feeding well, then right before I woke up the nurse managed to give him a full bottle.  So that was great to hear, that meant that he was on the rebound, eating for himself again.

So I pumped, headed to the shower, grabbed breakfast and tried to relax a little.  We dilated his eyes at 7:30 for his eye appointment (he was not happy about that, it took 2 nurses to get his eyes open enough for the drops...  At 8am (this is all Thursday morning now) the decision was made to see how he does back in the crib.

The belief was, as mentioned already, that it was a reaction to the vaccines, with that the doctors thought that if we can just help him get back to his normal place we should be able to take the supports used to do that away and he should be fine.  So out with the crib.  After he was in the crib I realized I never took a photo of him in that isolette than he only spent about 5 hours in (but he'd never been in one like it before).  Oh well...  You could say I was somewhat tired and stressed feeling at the time.

The opthamalogist then came around 8:30 to do the eye exam.  They were trying out new equipment that actually takes video of the exam from his perspective.  The tricky thing they were finding is that even though the doctor can see things just fine, if he didn't have the linse lined up just right, it didn't show up on the monitor.  He couldn't however look at the monitor to see because that would point the camera at the monitor.  Overall they seemed to like the new equipment they're trying out and that "issue" is more a matter of practice than anything else.

My hope going into the appointment was that his eyes would continue to check out as immature (which is exactly what they are still, as he isn't due for another month to be born!) and we would be told to he'd be seen in 2 weeks.  Well, that didn't exactly work out that way...  They found some beginnings of retinopathy of prematurity on the outer edges of both eyes.  It isn't much yet, so we are now on the weekly appointment schedule.  How many of you know who Stevie Wonder is?  Yeah, ROP (retinopathy of prematurity) is why he went blind.  Now with this kind of monitoring we are able to catch ROP soon and there are procedures that can be done when it is caught at the right stage that can prevent blindness.  Hence weekly appointments.  If it looks more concerning in a week, we'll be going in even more frequently.

So that wasn't exactly the news I wanted to hear from that check up.  But we have a preemie and with that comes all sorts of fun preemie things.  I know my worrying about it isn't going to help at all, so I have decided not to be worried.  Samuel is doing fantastic despite these "blips."

Yesterday (Thursday, the day after the long night), he was back to his normal Samuel self again.  He was being feisty during cares and checks (definitely did not like his diaper getting changed again), demanded food when he was hungry (which I think he was playing catch up for not eating much the shift before, he only had 2 1/2 of the 4 feedings) and was just overall a more content and happy baby.

Along with putting him back in a crib they weaned him back off of oxygen by 3pm.  So he is no longer on oxygen again!  They aren't sure if they will be able to keep him off, so they might train me on the monitors and oxygen this weekend, just in case he goes home on it.

Last night we also had some fun.  He was being fussy after his 6:30 feeding.  I had already tried to burp him and only got littles ones out of him (he can sure burp loud though, don't let his size fool you!).  I tried holding him and he didn't quiet down.  As he just ate, I didn't try feeding him because he showed me that he was clearly done already.  I tried holding him in different positions, but nothing seemed to help.  So I checked his diaper.  Sure enough he'd pooped.  I started cleaning up, had a clean one under him, had pulled out the dirty one and was just about to finish wiping when he squirted out a bunch more.  It kind of sounded like a ketchup bottle when it's almost empty and it squirts out a glob more...

Well he really squirted and got his sleeper dirty, his swaddle sack dirty and his sheet dirty...  So I took that recently fresh diaper out and put a truly fresh diaper under him, closed it up real quick and just waited while he grunted and pushed the rest out.  This was also happening at shift change, so when the night nurse came in I let her know what happened and said that this might be easier to clean up with a bath.  So that's what we did!  The little guy got 2 baths for 2 days in a row!  That normally doesn't happen, but he was a messy little pooper....

That is basically what our little blip was.  We went from being told he'll likely discharge on Thursday to being told the earliest he can discharge is Sunday (which is code for he MIGHT go home Sunday, but it easily could be after Sunday).  So we are back to not knowing how much longer we'll be here, but knowing that he is receiving excellent care and we only want to bring him home when he is truly ready to be brought home.

After all, can you imagine how much of a basket case I would have actually been in if we were home?  As it was, I was slightly emotional as this was happening in the middle of the night, but I very tired from trying to not fall asleep and just wanting to sleep, but wanting to make sure Samuel was ok.  When I woke up I was able to simply be extremely grateful that it happened before we were discharged.  I know I keep saying how the staff is here great and I truly mean that.  I know I don't have to worry about Samuel here.  Today he's still doing great and I'm doing great and we are just hanging out waiting for him to show us he's actually ready to go home.

:-)

Oh and those of you on facebook, the crib did beat him home.

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....