Tag Archives: kangaroo care

the eric update – day 19: new admits. confusion. and countdown to full feeding.

day 19: ruddy red

it might be a little difficult to tell from the photo, but eric is a bright shape of red today. all those new red blood cells from the two transfusions yesterday are working their way through his system and doing their magic.

there have been a bunch of new admits in the nicu over the past 36 hours and the place is packed, with even more hustle and bustle and commotion than normal. it’s a small nicu with only about 15 beds. if i’m not mistaken, there’s only one bed left.

we see many scared and sad faces and it’s tough to revisit the feelings that we know they must be feeling, as a few of the admits are quite sick. the nurses are slightly more harried ( certainly to be expected ) so the ‘tone’ of the nicu has changed a bit. and while eric is in no way being neglected, it still takes the nurses a little longer to get to his bed if he starts to “sag” ( meaning his blood oxygen dips and stays down, but he doesn’t go into a full blown episode of apnea ). it’s hard not to feel ever so slightly ambivalent at the decrease in attentiveness while completely understanding the circumstances.

disturbingly, it appears that they might be having scheduling problems with some planned vacation time colliding with unplanned admits. we see all new nurses for the night shift and suspect that they might be pulling staff from the “bench”. later, eric turned from his ruddy red color to an ash gray during a prolonged case of apnea. while there’s nothing particularly notable about stopping breathing and changing color, it was unusual to have it happen while there appeared to be some confusion about who was his night shift nurse. oof.

and to make matters worse, the new nurse is abrupt and quick in how she handles eric. i’m sure this type of thing happens. people are human. but in the nicu everything is intensified. the seconds that tick by as your child turns ashen last an eternity. moments of brief confusion are amplified.

day 19: laying on hands

in less stressful news, i did find time for kangaroo care today. as usual, he was quite happy and they put his nasal cannula in during ‘roo time, which is less abusive to his system than the CPAP mask, so he was doubly happy.

and the nurses have started to give him 4 cc’s an hour of breastmilk through his “o.j.” tube which delivers it directly to his small intestine. over the next few days they will gradually increase the milk while decreasing the volume of his IV drip. at about 5-6 cc’s of milk they will have completely discontinued his IV and he’ll be officially getting “full feedings”. pooh keeps hearing the nurses referring to the the breast milk as liquid gold and mistakenly thinks they are talking about honey.

day 19:  count down to full feeding

for the one or two of you who might be interested in the caloric needs of a micropreemie – the basal metabolic rate ( the metabolic rate required to simply maintain all vital systems ) of such a small baby is about 70 calories per 1000 grams of the baby’s weight. in order to maintain a steady weight gain, the doctors like to have the baby taking in about 120 calories per 1000 grams. since eric weighs about 700 grams, he should be getting about 84 calories a day. between his breast mild and IV feedings, he’s getting somewhere around 5.2 cc’s of food an hour which is about 125 cc’s throughout the day and that’s 4.2 fluid ounces a day.

both his breastmilk and the intravenous fluid give him something like 20 calories an ounce, which means he’s getting – surprise(!) – 84 calories a day ( 20 calories an ounce times 4.2 fluid ounces a day). which is exactly what he needs to keep him running, while allowing him to put on a bit of weight.

the eric update – day 17: YABPTMAKC

day 17: a transfusion

yes. it’s Yet Another Boring Post That’s Mostly About Kangaroo Care.

today when we arrived i happened to catch him getting a transfusion. there’s nothing out of the ordinary about this transfusion. he’s had 7 of them so far, which is to be expected.

he gets 7 cc’s of blood with each transfusion. obviously he’ll get increasingly larger transfusions as he gets bigger. he doesn’t seem to mind them too much, although after he got this one he started to cry and there didn’t seem to be anything we could do to settle him down.

his jaudice is getting better without any phototherapy. his bilirubin levels have dropped under 4 and went from 3.7 to 3.4 in just the past 24 hours. so his liver is getting better at processing the toxic byproducts of dying red blood cells. interestingly, a nurse told me that they aren’t really sure precisely why phototherapy helps to break down the billirubin, but back in the 70’s they noticed that the babies that were close to the windows in the nicu did better than those that were not.

day 17: and still more kangaroo care

one of the tricks of being in the nicu is learning how to relax with all the commotion going on around you. bells. there are always bells.

kris seems to be doing an admirable job, no?

today, she’s humming a tune to eric and a guy in the next bed over is humming a tune to his child. they’re both horribly out of key and using slightly different time signatures, which is driving me batty.

apparently, i stand corrected about kangaroo care and its adoption in the states. kangaroo care is “becoming” standard practice in america, but it’s not as fully adopted as in europe, where it’s not uncommon to have separate rooms with beds to encourage parents to stay 24 hours. i had commented yesterday that i was surprised that there were prominent nicus in the u.s. that didn’t advocate kangaroo care, but that was based on old information ( from a book that was only a couple of years old, so you can get and idea of how quickly it’s being adopted ), according to nurse jan ( whose hands star in part two of ‘the fourth’ and whom we think eric enjoys immensely ). in fact, the other nicu in town is going to be building a new facility and rumour has it that they will be adopting the european practice of having sleeping areas for parents to encourage them to stay for as long as possible.

day 17: and still more kangaroo care.  II

sadly, from what we’ve seen, it might not be appreciated by as many nicu parents as you might think. this might come out all wrong and i might just regret saying it and i’m not trying to cast any dispersions or make any judgements, but we’ve been stunned at how few visitors come to see the other babies. the nurses have commented that it’s not that unusual and that it’s very difficult for them to see how little time your average nicu parent will spend with their children. i think we see people visit for see average of a half and hour a day. period. including on the weekends. and nights. again, i know this is going to sound like i’m saying “ooooohhh, we’re sooooooo great and you’re not. neeener. neeener” and i’m not trolling for “you’re such fantabulous parents” comments; and i certainly understand that people react to the trauma of being in the nicu fishbowl differently, but it’s honestly shocking when you think about the fact that most of the kangaroo care studies recommend at least two hours per day. and those crazy europeans want you to sit around all day.

i guess i’m honestly wondering what the other nicu parents are going through. i’m sure there’s a nicu family counselor out there that could shed some light on the many varied ways that families react. [ update: see this thoughtful response for many rational reasons as to why nicu parents might not be around as often as one might think. given what i’ve seen i supsect i might not be being as sensitive to the ‘distance’ ( we live a mere 4 blocks from the nicu ) and the ‘other responsibilities’ ( i guess those other responsibilities don’t go away on the nights and weekends ) issues. ]

day 17: after 'roo cleanup

did you notice he had a nasal cannula in during the kangaroo care? he’s breathing so well, that they’ve decided to take him off the CPAP mask while he’s doing the ‘roo.

day 17: contented

oh. and he’s on 2.5 cc’s of milk per hour! and he’s producing poops on a regular basis! well, he still needs a very tiny suppository to keep things regular, but he’s pooping nonetheless.

no smiles or cutesy eyes today, but he’s content nonetheless.

he has a whole 3 hours of ‘roo time with kris, which is a new record.

i know i’ve said before, but he really, really likes it.

if you look closely at his arm you can see that the bulbous thing has disappeared.

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 15: more of the same. in a good way.

day 15: yet another finger grab

nope. you never get tired of seeing the finger grab.

we had another great day today. his white blood “differentials” are all back to normal and he’s now getting a whopping 1.5 cc’s an hour of breast milk, which – if i’ve done my math correctly – is a little over an ounce a day. he didn’t forget to breath at all today and he had 8 episodes of bradycardia ( slowing of the heart rate ), but they can all be attributed to a buildup of saliva in the back of his throat. micropreems don’t have a fully developed swallow response ( and all the tubes don’t help ) and somehow that leads to his heart rate slowing down. nurse cheri said he lets them know that he needs his mouth suctioned by throwing a bradycardia alarm or two. he’s funny like that.

day 15: the finger grab

day 15: and still even more kangaroo care

and he got two more hours of kangaroo care with kris. maybe tommorrow i’ll get my chance.

day 15:  something bulbous

he’s got a bit of a bulbous growth near the entry point of his pic line. besides being fairly nasty looking, it’s not anything that overly concerns the staff. fluid collects at the entry point of the pic line that threads close to his heart. he keeps his hand folded in such a way that fluid tends to pool in the area. it’s really not very pleasant to look at, but it’s fairly harmless. they did try to get him to keep his arm extended more today and it got better, but he didn’t cooperate for very long.

day 15: fingernails

i’m studying his fingernails, which have just started to grow out past the end of his fingers.

nurse denise said that they won’t ever clip them; apparently, they are so soft that they wear down simply from rubbing them against the blankets.

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.