Tag Archives: cpap

the eric update – day 22: a day of the (extra)ordinaries

day 22: lounge act

here’s to hoping that i can continue with weeks and weeks of posts that are as boring as this one. nothing much extraordinary happened. well, nothing much beyond a relaxing day filled with five hours of kangaroo care with kris, a diaper change from yours truly ( the second one! kris is not exactly quick draw mcgraw with the camera so we don’t get to see any pictures of me changing him. sniff. ), a bit of eye contact now and then and some quality reading time. of course, he still likes throwing out the occasional “a’s” and “b’s” ( nicu lingo for apneas and bradycardias ), but none of them were long enough to make him turn gray or blue, so that’s progress.

i don’t know how he does it, but he seems to spend a lot time trying to impress upon you just how comfortable he is despite it all. trust me. you know when he’s not comfortable. like when he gets done with kangaroo care. then he turns into a writhing mass of clenched fists and thrusting feet while emitting little squeaks.

day 22: watcher

i like how he tends to open his eyes when i come to his beside to visit. his eyesight is probably no better than 20/600 so it’s best to stand 6-10 inches away. he’s getting better at staying focused on the center of your face when you talk, but he also tends to let his eyes wander around the periphery of your face, which is fairly “normal”. i think in about 3 weeks he’s going to have a set of tests from an eye specialist who is going to be looking for signs of a common problem in micropreemies known as retinopathy of prematurity, which is caused by abnormal blood vessels in the eyes. as with most conditions, there are many different stages and manifestations and variable degrees of success from a cadre of treatment options.

it’s my understanding that he’s at a decreased risk for ROP because his “oooohs” ( nicu lingo for the percentage of oxygen that is added to the air going through his CPAP mask ) have always remained remarkably low. in other words, the staff doesn’t have to add much oxygen for him to have and adequate supply in his blood. while oxygen is obviously important, too much of a good thing can cause abnormal blood vessel growth.

but one must always remember that decreased risk does not mean no risk; for now, it’s impossible to know if he has any manifestation of ROP, so it’s strange to look at his beautiful eyes and wonder if there are problems lurking ahead. it’s just one more thing that you try to prepare yourself for, while still attempting to enjoy the moments you do get to look into his eyes.

day 22: call of the wild

in addition to some reading about pooh, eric very much enjoys being read “call of the wild”. for some reason he identifies with buck, a courageous dog, who is ripped from his cushy surroundings and forced into a life-and-death struggle in the alaskan wilderness where he must learn how to use his wits to survive.

day 22: footsie

after all the heaviness inherent in buck and his amazing adventures, eric finds the time to enjoy a light game of ‘footsie’. well. o.k. it’s not really footsie, but it’s the best we can muster at the moment.

notice that piglet really, really wants to play along too.

the eric update – day 16: doing the ‘roo with pops

day 16: doing the 'roo with pops

finally! after a false start earlier in the week and kris hogging all the kangaroo care time recently ( obviously, i hold no malice – moms always get first dibs on kangaroo time ), i was beginning to wonder when i’d ever get a chance to get some skin-to-skin time.

day 16: man in the mirror I

he was quite content the entire time, save for every so often when he’d get squirmy and dig his tiny little fingers into my chest.

day 16: man in the mirror II

he stayed on my chest for two hours without throwing a single, solitary alarm. it’s amazing how much their breathing and heart rate stabilize when doing kangaroo care. he’d been having bouts of bradycardia all morning long that immediately disappeared as soon as he was put on my chest. and his heart rate really does do less “bouncing around”.

day 16:  a quick smile

it’s hard to believe that there are still some fairly prominent nicus that don’t encourage the practice. even if the physiological benefits to the baby weren’t fairly well proven, it obviously does the parents a world of good.

as you can see, he was a very happy boy after it was all done – all smiles and making cutesy eyes at kris.

day 16: all the better to smell you with?

unfortunately, the CPAP mask is doing funny things to his nostrils and making them look upturned and gigantic.

nurse jan promises that they won’t stick that way.

the eric update – day 14: baaaack in the CPAP saddle! and more kangaroo care.

day 14:  a new tube

lots and lots of things going today. he was doing so well on the vent and they were so quickly dialing back the “assist” settings that they put him back on the less abusive CPAP regime last night! w00t! again, they thought it wouldn’t be unusual for him to stay on the vent for a few weeks, so this is a great sign that he’s recovering quickly.

day 14: pooh and piglet marvel at his progress

his white blood count differentials are looking better. they still haven’t found a specific bug and nurse practitioner dawn and i talked about the meaningfulness of the tests for quite some time today. they are useful as a “barometer”, but not as useful as compared to full-term differentials, since there seem to be so many special exceptions to the rules for micropreems, as their immune systems simply respond differently or not at all. n.p. dawn has apparently seen micropreems close to death with no differentials at all and perfectly healthy babies with big swings “to the left” ( she kept referring to a “swing to the left”, which i’m sure refers to a change in the standard differential graph, but i never bothered to clarify the point so i could be wrong ).

day 14: pound puppy looks on

so, in the continuing saga of making Educated Guesses, since they’ve not found anything in his cultures ( again, you might not ever find anything in the cultures ) and his insulin has stabilized, they feel that he could be: 1. responding appropriately to the antibiotic regime. 2. stabilizing after being Just Plain Tired and the differentials were a Big Red Herring 3. stabilizing after having a bout of the earliest stages of necrotizing entercolitis (NEC), which is an inflammatory response in his gut that we talked about the other day and which could cause the differentials that they were seeing. 4. stabilizing after “aspirating” his food back from his stomach into his esophagus, which – for reasons that aren’t well understood – can cause apnea, bradycardia and differential shifts to the left.

day 14:  the arm bend

when eric went back on the vent, they stopped his feedings, which would have reduced the potential inflammatory response ( just one of the many variables that changed ) and/or the potential aspiration events, so they are now moving away from the yeast infection theory and towards the theory that he’s not tolerating his feedings.

day 14:  foot

to that end, the observant among you will notice that he now has a green “o.j. tube” ( oral-to-jejunum ) inserted through his mouth ( can you guess where an “n.j.” tube originates? ) and threaded down his esophagus, through his stomach and directly into his intestines ( you did remember that jejunum is the name for the beginning of the intestines, didn’t you? of course you did. ). the o.j. tube will reduce the chance that he will aspirate his food.

day 14:  the leg bend

the potential NEC is a little trickier to manage ( and much, much more problematic if they don’t catch it in time ). about the only thing they can do is reduce the amount of milk they give him in the “gut primings” and watch him very closely.

day 14:  more kangaroo care

anyway. the greatest part of going off the vent and back to the CPAP is that we can start the kangaroo care again! and this time kris had him on her chest for over 1.5 hours and completely hogged all the time. i think she needs to learn how to share 🙂

the biggest excitement of the day came at the end of the kangaroo care when eric decided to surprise everyone by pulling out his endo-tracheal and o.j. tubes. i can’t imagine that it was very pleasant, so hopefully he’ll realize not to do that too often. he was quite unhappy with nurse donna when she abrupty had to wisk him away from kris to start rethreading tubes.

oh, and it shouldn’t go unmentioned that as of 8:36 tonight, he’ll be two weeks old, which brings his overall survival stats to closer to 85%, which is certainly a lot better than his chances when he first came into the nicu.

the eric update – day 10: care. kangaroo style.

day 10: kangaroo care I

so i guess you really can’t prepare mentally for what you’re going to experience in the nicu. yesterday we had no idea we’d spend the day getting our son to breath and today we thought we’d probably walk in and find him on the vent.

instead the nicu nurse exclaimed, “how’d you like to try some kangaroo care today!”

it was one of those moments where you want to start running laps around the nicu stations yelling, “yeeeeeeehaaaaaaawwwww!” but you don’t. because that would be rude and self indulgent. not everyone else is having such a good day. so you just walk over to your station with a certain jaunt to your step and get ready for Another Perfect Moment. incidentally, this is a good example of the subtleties and nuances that one must observe while becoming a ‘nicu parent’. you’re in a fish bowl with a half a dozen people on their own emotional rollercoasters and you’re all simultaneously trying to figure out how to “become” a parent in front of complete strangers.

day 10: kangaroo care II

kangaroo care is simply a way of holding a premature baby so that there is skin-to-skin contact. the process is fairly simple – or as simple as you can get when you’re holding a baby who has attached a variety of sensors, wires and tubes; eric, wearing only a diaper, is placed against mine or kris’ bare chest. in addition to providing both parents with a great way to bond with your child, it has been proven to bestow a range of physiological benefits to the child, from stabilizing the baby’s heartbeat, temperature and breathing to boosting a premature baby’s brain development. and it’s a whole lot of fun.

day 10: the fuzz

after all the kangaroo care, he looked completely content and i noticed that he seemed to have much more fuzz on his face.

if you look close you can see that his eyelashes and eyebrows are coming in.

day 10: the thoughtful fuzz

he strikes a thoughtful, if a bit fuzzy, pose.

day 10: resting after a massage from pops

kris held him for an hour and indeed, his breathing and heart rate improved, as evidenced by a lack of apnea alarms. of course, as soon as the nurse put him on my chest, his oxygen dropped and we basically spent 10 minutes trying to get him to breath deeper before giving up and putting him in his bed. feeling like i got the short end of the kangaroo care stick, i decided to give him a massage with an ointment that smooths his skin, prevents water loss and helps him retain heat.

the eric update – day 8: the perfect moment

day 8: getting prepped for being held by mama

what can i say? the kid enjoys defying the odds and exceeding expectations. last night he had his umbilical arterial (UA) line removed and they thought they might remove his umbilical venous (UV) line if he looked good over the night. they only remove these lines when he’s begun to stabilize enough that he doesn’t require extremely precise measurements of blood gasses, so it’s one more sign that he’s doing fantastic.

they thought perhaps they’d try to put what’s known as a pic intravenous line in a good spot in him, which they’d thread close to his heart. then they’d need to watch and wait and make sure that he faired well after the routine, but still difficult, procedures.

he did so well over the night with all the changes that we were very pleasantly surprised to find the nurse asking us if we’d like to hold him when we arrived at the nicu! they had been telling us that it could be weeks before we could hold him, so you can imagine the range of emotions we felt in an extremely short time period.

first things first. he needs needs lots of swaddling to prevent his temperature from dropping when he’s taken out from under the warming lamp above his bed.

day 8: the handoff commences

nurse peggy is deftly moving tubes and lines around so that kris can hold him.

at this point there’s a red light on top of his bed that’s started to spin and make noise and various beeps and flashes on a multitude of monitors are making quite a commotion.

nurse peggy is calm, so i stay calm. sort-of.

day 8: the landing

more commotion and final adjustments, but kris is finally holding eric!

he forgets to breath a few times, but nurse peggy is a pro and “jumpstarts” him by gently rubbing his back, as nurse jan brings some backup caffeine.

day 8: mama settles him down

after all commotion things settle down quickly as kris hums and talks to him.

he makes little funny noises back at her and opens his eyes eventually.

nurse peggy thought he might only be able to be held for a few minutes and kris clearly hogged the handling time by holding him for nearly 15 or 20 minutes.

day 8: pops gets in on the holding action

finally! i get my chance. kris did a great job of settling him down so he’s just being content and making cute noises.

day 8: gentle hands

nurse peggy lets me hold him unswaddled right before he goes back to his bed.

his skin is incredibly soft and smooth; he’s looking right at me, even though his vision is supposed to 20/600, as his eyes aren’t fully developed.

despite all the lights ( not least of which being the bright flash from the camera ) and the noise, he’s remarkably calm – just gazing up at me.

day 8: back to bed

then, back to bed! he has some new linens and a stylish white cloth cap, which along with the CPAP mask make him look like a sci-fi jet pilot from another planet.

day 8: struggling to keep his eyes open

he’s pretty tired after all the activity, but still managed to muster the energy to open his eyes as i hum to him.

i know this might be bordering on the cliche’, but it truly was one of the most sublime and inspiring events of our lives and the pictures don’t even come close to capturing the essence of the experience.