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the eric update – day 20: full feeder!

day 20: full feeder!

as his nurse donna said today, eric enjoys making a liar out of her. just yesterday she said that it would be a few days before they discontinued his IV drip and had him solely on breastmilk. but today when we arrived at the nicu we found him sans his IV lines and taking in 5.2 cc’s of milk an hour!

as soon as we stood over his bed, he opened his eyes and made this gesture as if to say, “geee. it’s so nice to wake up and see you again.” or at least that’s what we’d like think think he was saying 🙂

the best part of getting “full feeds” is that he’s had two IV lines removed. one of them, the peripheral intravenous cardiac catheter (PICC), was causing the bulbous thing earlier in the week so it’s nice to have that gone. they also removed an arterial line from his foot.

day 20: snug as a bug

as an added bonus, removing the lines makes it much easier to move him around during kangaroo care.

day 20: beating the wrap

occasionally, when he’s getting feisty, he’ll push his feet against the plastic wrap that covers his bed which is meant to help keep the heat in.

this is probably one of the toughest photos i’ve shot as the light levels are very low so i have to have a slow shutter speed and and the auto focus wouldn’t work due to the diffuse and wierd light coming off the plastic wrap. if i were a better photographer, i would have been able to capture the times that he rammed his foot so hard into the wrap that it looked like he was going to break through it.

incidentally, i’ve been under the delusion that the plastic wrap was probably some sort of hospital grade super magical polymer. eventually i noticed the large rolls that the staff has delivered from the local restaurant distributer.

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 18: mucus interruptus

day 18:  his first diaper change!

we still get to see a fair number of “firsts” each day and today it was the first time that kris had the opportunity to change his diaper! i would have done it, but…er…somebody has to take the pictures 🙂 next time, i’ll be eagerly standing in line. honest.

obviously its not his first diaper change. but it’s the first one that kris gets to do, with a little help from nurse denise. it’s harder than it looks with all the tubes and whatnot, but she did a fantastic job.

given all the relaxing photos of ‘roo care, you might be tricked into believing that he’s not occasionally wisked away under duress.

today, his blood oxygen took a dive and none of the typical measures to get him to breath were working.

day 18:  great gobs of goo

usually that means that he’s collected a sticky wad of mucus in one of his breathing passages, which requires the nurse to suction it out.

his passages were getting clogged a bit more than normal and they were irritated as evidenced by blood getting suctioned out along with the goo. unfortunately, mucous and dried passages come with the CPAP territory. imagine having air blown in your mouth and nose 24 hours a day. i think it’s probably like driving 80 m.p.h. down the highway with your head out the window.

day 18:  kris doing her best attempt to relax

i know it’s “normal”, but it doesn’t make it any easier to watch the nurses shove 6 inches of tubing into his nose and retrieve great gobs of bloody goo. eric doesn’t like it much either. such is life in the nicu sometimes.

in a rare example of restraint, i’ll save you from the picture of what they pulled out of his nose.

he alarmed a bit more than usual during the ‘roo time today from all the goo;

kris did her best impression of someone attempting to relax, but she can’t fool me.

day 18: kick out the jams!

despite it all, eric reminds us that he can teach us a thing or two by taking it all in stride and getting mighty comfortable with his blanket.

he’s not actually listening to music at the moment, but he sure looks like he should be.

the kid knows how to relax, even after a day of having six inches of suction tubes jammed up his nose and down his throat.

and no, sony did not pay for that product placement in the background. hmmmmmmm

and the boy’s Got Milk. he’s on 3 cc’s an hour and tolerating it well.

day 18:  it's hairy back boy!

i know. i know. it’s “lanugo” or as it’s more commonly known as – baby fuzz – and it’s going to go away.

but it’s growing in thick bunches all over the place and it’s amusing to wonder what life would be like for him if it didn’t fall out.

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: a late night massage from mama and holding hands!

day 14: a late night massage from mama

kris decides to give eric a late night massage to celebrate his 2nd week birthday. the massage helps keep his thin skin from drying out under the heat lamps.

day 14: holding hands

during the massage, eric decides he really just wants to hold kris’ hand.

it’s amazing to see him actively search out her finger, grasp it tighly and resist her pulling her hand away.

day 14: bruised foot

i’m on a self imposed massage hiatus, as you can see the results of what happened the last time i gave him a massage.

yes. i bruised my premature son’s foot because i rubbed it too hard. the lesson is that you don’t have to rub very hard at all to bruise a micropreem, which makes giving a massage more difficult than it might seem.