Tag Archives: nicu

the eric update – day 9: the rollercoaster

day 9: glued to his vitals

eric was “throwing” more alarms than usual today. mostly apnea ( forgetting to breath ) and bradycardia ( slowing of the heart rate ). while completely normal, it can still get tiring to sit, staring at the monitor, with a hand ready to rub his back or the bottom of his foot to jumpstart his breathing, if the alarms start. last evening he had 6 apnea/bradycardia incidents alone and he had 8 more over the night. typically, he might have 3 or 4 in an entire day – so the rate has definately increased.

when micropreems are having trouble breathing it means, at best, that they are getting tired and at worst something else is going on, such a systemic infection ( in this particular case, it’s probably not a generalized infection, since they didn’t see an elevated white blood count in his latest labs ). in either case, you’ll often see a range of systems start to work less efficiently as things start to slow down. and when that happens, the nicu nurses have to do many unpleasant things to your baby while you watch. this is the sad part of their job and they are all the more heroic for doing it day in and day out.

the machine creates a quick succession of “bing! bing! bing!”, if his pulse/oxygen levels dip along with his heartrate creating a “low rate alarm”. this is not necessarily a concern, but rather a warning.

a different and more urgent sounding pattern of “bings!” emanates from the machine if the “low rate warning” progresses to full-blown apnea ( not breathing ). at that point nurses will start running to the bed, while you try to remain calm.

eventually, when they see that you’re not going to turn into a mass of useless flesh when the alarms start ringing they’ll teach you how to see that your son really isn’t breathing ( i.e. it’s not a false alarm ), and they’ll show you a variety of ways of getting him “jumpstarted”, ranging from rubbing his back in a specific spot to tapping his butt or the bottom of his foot.

today i got him breathing a handful of times over a few hours, which i guess constitutes a form of bonding. right when i snapped this picture he went into full-blown apnea and i had to drop the camera and rub his back, so i could only get a shot of the less urgent “low rate alarm”.

day 9: the abuses suffered

the nurses are going to put him back on CPAP full time, since the nasal cannula takes a little more work on his part and if they need to start “bagging him” ( ventilating him manually with a small bag like you might see on the tv program ‘ER’ ), then it’s possible that they might put him back on the oscillating vent. i don’t even think they’d call it a set back, but rather he’s just telling us that he’s tired and would like us to take over for awhile while he recoups.

another sign that he’s getting tired came when they suctioned the contents of his stomach and found 1.5 cc’s of undigested colestrum. they are giving him 0.5 cc of colestrum every 2 hours, so clearly his digestion has slowed. if the food sticks around for too long then a condition known as necrotizing enterocolitis (NEC) – which are a big couple of words for rotting bowels – can set in quickly, as the blood supply to his bowels is decreased or interrupted. under those conditions, hypoxia ( lack of oxygen in the tissue) can kill or damage the cells in the bowel wall, eventually leading to perforation and peritonitis ( infection of the abdominal cavity ). advanced NEC is something you don’t ever want to see, since it requires very difficult bowel surgery, so they’ll be watching him closely.

in this picture, eric is suffering through the least of his abuses as nurse peggy is pulling the undigested contents of stomach out through his endo-tracheal tube. he gets a half a cc at each feeding and she pulls out 1.5 cc’s, so he’s not digesting much.

right before nurse peggy sucked out the contents of his stomach, she aspirated his nasal passages to increase air flow. it sounds innocuous enough, but it involves threading about six inches of tubing through his nose, into his sinuses and down his throat, all the while rotating and thrusting the tube to suck out any last drops of mucus.

day 9: finally resting

after hours and hours of alarming and being probed and prodded and “jumpstarted” the alarms have settled down and he’s looking like he might be stabilizing.

he eyes us warily as nurse peggy tells me that he’s doing well, all things considered.

so, in the end, today was quite demanding and typical of the rollercoaster that a 24 weeker can put you on; and when juxtaposed against what happened yesterday, today was a great reminder that one needs to focus on enjoying each moment for what it is.

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.

the eric update – day 7: ooooh. look at my cool nasal cannula!

day 7: ooooh.  look at my cool nasal cannula

late in the evening we got a call that he had been switched from his CPAP respiratory aid to what is known as a nasal canula. it’s similar to the oxygen tubes that you might see on an elderly relative with emphysema. in eric’s case, it means that they are even more confident that he can breath on his own, unassisted. it also means that you can see more of his face, since he doesn’t have his the CPAP face mask on. he still had occasional bouts of apnea today, so they’re only going to try it for 3-5 hours before switching him back to the cpap regime.

it’s hard to tell in the photograph, but they also took one of his umbilical lines out ( his umbilical arterial (UA) line ), which means he’s further on the road to stabilization. they only remove the line when they don’t feel they need to monitor his blood gasses as closely as they needed on prior days.

they might try to remove his umbilical venous (UV) line tonight. and put in a new IV line in his arm.

a few less tubes and a little more weight gain and we’ll be close to being able to pick him up and hold him!

the eric update: he’s no wimpy white boy

eric's home address

on a day that statistics will tell you will probably be a bad day, we received some great news! at noon, we found out that the hole caused by the patent ductus arteriosus (pda) had closed in response to the medicine they gave him over the previous 24 hours. so, at least for now, there doesn’t appear to be any reason for him to get transferred to a different facility for surgery. he also has a greatly reduced risk for a class IV “bleeder” ( our neonatologist’s term for a brain hemmorage ). one of the side-effects of pda is that it sends five times more blood to the brain than is actually necessary, which in turn stresses the brain vessels. he’s still at risk for a bleeder, but much less so.

speaking of brain hemmoraging, when our neonatologist was explaining the effects of pda, he took the opportunity to launch into a discussion of bleeders. it turns out there are four classes of them, with ‘class one’ being not visible with the naked eye and not typically associated with negative outcomes and ‘class four’ being visible through the scalp and often fatal. in what was one of the many conversations we’ve had over the past few days that can be quite disorienting, we found ourselves listening to him calmly tell us that he probably wouldn’t even bother telling us about class one or two bleeders, as he’d end up driving us insane with that much detail.

the machinery

there are many other physiological consequences of the ductus arteriosis closing , the most notable being that they can reduce the percentage of oxygen that he’s getting via the ventilator. we normally breath air that has 20 percent or so of oxygen. for the past few days, eric has been getting anywhere from 30-60% oxygen. after the duct closed, they were able to move towards a schedule of letting him breathe ambient air with occasional enrichments of oxygen. also, they have been actively managing his blood pressure with dopamine and his blood sugar with insulin and they’ve stopped both of those treatments. later in the day, they also told me that they stopped giving him antibiotics to reduce the risk of infection. these are all stupendously wonderful signs that he’s stabilizing and setting himself up for the long haul. of course, he’ll still have bad days and downturns, but things are looking positive.

as donna, eric’s nurse today, was giving me an update about the pda and how good things were looking she stopped and laughed, “you know – he’s not a wimpy white boy!” she went on to explain that, when compared to other races, white male micro-preemies ( a technical designation for preemies that are born less than 26 weeks in gestational age and weigh less than 1 pound 11 ounces ) typically get more sick, have more bad days and have longer hospital stays. “i’ve been doing this for over 20 years and i don’t think i’ve ever seen an explanation for it. but lil’ eric ain’t no wimpy white boy. and that should make you very happy.”

day 3: and yet, he moves.


unfortunately, kris is still not progressing as quickly as she’d like and she’s three days post delivery, which means perfectly natural post-partum emotions are beginning. a bad morning was made worse when the nurses told her they didn’t want to even try to see if she could make it down to see eric, given her current condition. she’s still at an increased risk for a seizure if she has too much sensory stimulation, so they want her to have another day of quiet rest.

her blood pressure is still dangerously elevated even after starting an additional blood pressure management medicine; her platelets has also been down throughout the day, while her liver function is elevated, all of which are trends in the wrong direction. it’s nerve-wracking to anticipate each new lab result and continually discover that she’s not only not stabilizing, but technically getting worse ( although thankfully she’s not in any pain ); however, the doctor reassured us that she’s not atypical for cases of severe preeclampsia such as she developed. he expects her to have another day or two of trending in the wrong direction, followed by a gradual normalization process. first her kidneys will start working more efficiently, followed by better liver function and finally her platelets will go back up. he said her kidneys are looking better, so we’ll patiently wait for the others to follow.

her doctor also gave us a little more information about the specifics of her case. about 10 percent of preeclampsia cases have similar etiologies and, as we discovered, if the baby isn’t delivered immediately it will die and the mom will quite likely die. to highlight the point, as a consequence of the disease process, kris’ placenta had become 30% calcified over a very short time ( possibly 24 hours ). had we waited even a short period of time to go to the ER, the placenta would have become completely calcified and eric would almost definately have died from a lack of oxygen. it’s also more likely than not that an undiagnosed underlying condition will be found that is known to amplify the effects of the preeclampsia ( essentially “causing” the severe “10 percenter” cases ); so, after everything settles down, they will start testing her to see if they can find the root cause.

day 3: kris gets solid food!

amidst all the disappointing lab results, kris is feeling better and making other important signs of progress. she’s started to regularly produce milk with a breast pump, which is getting stored down in the nicu ( neonatal intensive care unit ) for when eric is stable enough to start feeding. she also had her first solid food today, after days of nothing but an IV and the occasional juice. she happily enjoyed what would have otherwise been a bland cheese sandwich. and she also had her catheter removed! if you’ve ever had a catheter, you’ll understand why this made her very happy.

update: later in the evening kris finally got her first set of postive lab results and her blood pressure, while still high, seems to be gradually trending downward. her results are promising enough that they aren’t going to pester her every few hours over the night to draw blood and it looks like she might have a realistic chance of seeing eric some time tommorrow.