today was yet another day tiny little steps of progress. first, eric had the rate of nasal cannula air flow turned down from 2 to 1.5 liters per minute. you might recall that the last time they turned down his flow, he started alarming often that the nicu staff thought he might have an infection. it’s amazing to see how differently he responded after only ten days. it’s even more amazing when you think about how much lower his hemoglobin levels compared to then ( he’s still due for another transfusion ), which means his oxygen carrying capacity should be lower, but his stronger lungs can more than make up the difference.

the fortifier seems to be working, as he put on another ounce and weighed in at 3 pounds 12 ounces or 1700 grams.

eric completed the transition to three hour feeds appears to be tolerating the increase in feeding volume wonderfully. his first “3 hour” bottle feed was an enormous 36 cc meal and the nurses didn’t really expect him to take the whole thing down before getting too tired. but they were pleasantly surprised to be proven wrong. he drank the entire bottle in about 22 minutes!

you’ll notice that we’re very aware of exactly how long it takes eric to eat. that’s because we have exactly 30 minutes to get him to take his food via a bottle. if he doesn’t get everything down in that time, then he’s “gavaged” ( the term for tube feeding ). the strict timing is due to the fact that you want him to have the most amount of time to fully digest his food before the next feeding; and the staff begin to get concerned about how many calories he’s burning while bottle feeding after a half an hour. it’s strange to think that the extra calories burned from being out of the isolette can make a big difference.

so there’s a bit of strategy involved to get him to take all the food in the proper amount of time. one tactic is to switch his bottle nipple during his feeding to make it more or less difficult to get the milk. you can differentiate the nipple by the color of the plastic ring surrounding the nipple. a white ring indicates the most difficult and a red ring is the easiest, while peach is a medium difficulty nipple. we found that we had to use all three nipples during his feeding to make it easier for him to get milk as he got increasingly tired. why not just start with the “red” nipple? because if he’s not tired, he’ll get too much milk at once and gag.

who knew that feeding could be so complicated? that said, he’s doing fantastic and word spread quickly through the nicu that he was able to take his first “3 hour feed” bottle in the proper amount of time.