One Step Forward

Jeff and I had a frustrating experience last night (6/5). Kim was his nurse again. Melissa J., who is one of Henry's primary caregivers, was on duty and wanted Henry, but Kim had him the night before and didn't want to switch. Melissa really likes Henry and got him a 5-week birthday present (a cute blanket and an adorable small bull blanket).

When we arrived, Kim mentioned that Henry had been so quiet that she didn't want to disturb him to change his diaper. That was OK, I suppose...although he had had quiet day yesterday and his diaper had to be changed some time. Jeff and I let him sleep for a half an hour longer and then said we were going to change him.

He started spitting up during the changing. Kim told us to suction it out, which we don't mind doing, but she didn't seem to pay attention to how much he was spitting up. This bothered me because spitting up is obviously an indicant of feeding intolerance (hence you'd want to track how much there is).

While changing him, we noticed that his mottled color looked worse. The previous evening (6/4) when Henry looked mottled, I was very concerned. Jeff couldn't see the mottling. Well, last night, Jeff became a bit concerned because he could definitely see it. Henry's stomach had a gray tinge, distinguishable from his chest color.

When Kim comes over to inspect Henry's stomach, she told us how preemies can make it. She once took care of a baby that was very small, and the baby made it. Of course, her twin brother died (who happened to be named Henry). You are probaly wondering why anyone would tell this to the parents of a 25-weeker named Henry. I was wondering the same thing. Rather absurd.

Kim didn't seem to think that there was anything unusual in Henry's state. She thought his color looked better than the previous evening. It wasn't. Jeff and I asked her to get one of the nurse practitioners. We wouldn't have been able to sleep without making sure that everything was OK before we left.

Mary Ann Roberts came over to look at Henry. I explained my concerns to Mary Ann. I told her about how his color seemed worse to me than the before. Kim interjected that she had noticed the night before how he looked mottled and how that was bad (mind you, that's a bit different than how I remembered the evening's events; I seem to recall that I had raised the concerns, not Kim). Mary Ann did a thorough inspection of his stomach. She could feel some air in one of his digestive loops but said the stomach was soft. That was a relief. We really like Mary Ann. We talked with her for about half an hour about various microbiology issues (including the biology behind handwashing). We left feeling comfortable, knowing that Mary Ann was keeping watch.

Jean was Henry's nurse this morning. She told my dad that Henry had been restful. She said that his weight was 840 grams. They do the weighings in the evenings. I thought that his weight had been 860 grams, but perhaps he had been weighed again after we left last night. Or perhaps last evening's nurse had entered his weight incorrectly.

When I arrived at the hospital in the early afternoon, Sherry had taken over for Jean. The big news was that they decided to try him on the cannula again. They had put him on it at 10AM. He wasn't quite as steady with it as with the CPAP, but he was doing OK. His sats stayed in the 90s for the most part, but he did do a little surfing. He had a few apnea and brady episodes, but he got out of them himself. Sherry was on top of the situation. Anytime the alarms went off, she was there in an instant.

Sherry had him swaddled, which seemed to keep him relaxed. He got un-swaddled during 3PM cares and was active. His sats were great during cares. My mom arrived during cares and stayed for about an hour after I left. Sherry told her that she thought that they were experimenting with the cannula, but that given the bradys and apnea, she thought they'd switch him back to CPAP. I'm not surprised. I am glad that his face was getting a bit of a break from the CPAP at least.

He's still on continuous feeds (3ml per hour). They are talking about having him go back to regular feeds soon. Don't know when this will happen. And, they decided to give him one dose of Lasix while I was visiting.

So all in all, things look OK. The move to the cannula is one step forward, but realistically, we might move one step back by this evening.

A Lazy Afternoon

Henry's nurse today was Jean. They stopped the feeds last night but resumed them today around 11AM. His blood tests from last night all came back negative. Jean was able to get some residual from his stomach, but it was a tan color, not nasty green. Rather than being done every three hours, the new feeds are being done continously at a very slow rate. His skin is still mottled-looking.

His oxygen was set at 30% when I arrived a little after 12PM. Jean asked me if I wanted to hold him. I asked her if she thought it was a good idea given last night's episode. She thought it was, so I ended up doing skin-to-skin. I asked if we could do it with the cannula, but she said he needed to wear his CPAP. I don't know if Jean wasn't aware that Dr. Cahan said cannula was OK for 1 hr kangaroo care sessions or whether Dr. Cahan has changed that decision after last night. I decided to go ahead with the CPAP, and things went well.

Henry cried for a little bit as he was getting positioned onto my chest. I was in the recliner. While Jean was trying to sort out all of the wires, Henry squirmed and lifted his head up like he was about to do a push up. Jean helped me get him settled down with his head to the side. We ended up doing the skin-to-skin for two hours. He was relaxed the entire time with sats ranging from 92% to 100%. Most of the time, they were around 97%. His heart rate and respiration looked good.

My sister Erin stopped by for a little while during the kangaroo care. She said Henry furrows his eyebrows just like I do. Shortly after she left, my mom visited. After two hours of skin-to-skin, Jean put Henry back into the isolette. He settled down pretty quickly. My mom stayed and watched over him after I left. She said that he kept his sats up and was restful the entire time. It's nice to have a day where Henry isn't sat surfing.

Henry's New Clothes

The good news first, Henry got to wear his first shirt today. It was a bit big for him but it was kind of cute. Of course he spit up on it within about 10 minutes and Janice had to take it off. He's back to just the tiny little diaper.

I don't know why I found that so exciting. Probably the commercial society we live in pressuring me toward conspicuous consumption in an attempt purchase approval from others as well as my child. Hello, Baby Gap, I'd like to find a shirt that has long sleeves and provokes feelings of envy from other parents as well as shoes that have good arch support while simultaneously evoking feelings of joy from my child that I can misinterpret as love.

Now for the not so good news. The plans for the week Kate mentioned in the previous post look to be on hold. Tonight Henry went backward a little bit. He had green colored residual in his stomach from his previous feeding which isn't good. His color looked mottled, at least that is what I'm told. For some reason I just can't see it.

Dr. Cahan and Moe Kane both took a look at him. Dr. Cahan ordered an xray of his stomach and intestines as well as several different blood tests. The xray showed a lot of air in his intestines. There was no air in the walls of the intestines which was good. Air inside the walls of the intestines is one of the signs of NEC (Necrotizing Endo Colitis, sp?) which is very bad and one of the things they are constantly checking for.

Apparently air in the intestines is not uncommon for babies on the cpap because it is forcing air down their throat which can go down the wrong way. Kate just called and the results of the blood tests don't show any major problems. Dr. Cahan has ordered the feeding to resume in the morning. Hopefully the air will be gone by then.

My theory is that this is the result of his feeding tube. A few days ago Gene had taped it to his upper lip and had it coming straight into the mouth. He explained that this way it goes down the throat in a way that doesn't make as much contact and causes less irritation. This morning they removed Gene's tube job and replaced it with the typical taped to the side of the face style. Henry pulled the tube out several times today. Every time I saw him he was trying to work it out with his tongue. I believe the attempts to work it out with his tongue are causing him to swallow even more air than normal. Maybe I'll fly this up the flag pole tomorrow.

The nicu seemed rather chaotic tonight. His nurse was Kim and she seemed to be overwhelmed so Jenny, who took care of him before, helped out a lot. Henry was very active and his cpap was not sitting well tonight so he required a lot of attention to try to get it on right. By the time we left he was steady but they had turned up his oxygen to 40. His reported weight was 840 grams. That is up 30 from yesterday. I'm kind of suspect of this number because that is a rather big gain. We'll see what they say tomorrow.

The Plan for the Week

As I was washing up to enter the NICU this morning, my dad was coming out. He found out some information on how decisions are made in the NICU. Each baby is assigned to a resident. The residents are assigned to the NICU for one month. A doctor is assigned to supervise the residents on a three week cycle. The residents make recommendations that the doctors either approve or disapprove.

Dr. Cahan is currently supervising the residents. Each morning from 9AM to 12PM, the residents have rounds with the doctor in charge. The NICU handbook that they give parents suggests that parents and guests should not visit at that time. But Jeff and I quickly figured out that they don't pay attention to this policy. The only time that parents really can't visit is between 6:45-7:45 in the morning and evening when the nursing staff does its shift change.

During 9AM to 12PM rounds, the residents and doctor begin in pod 1, discuss the patients in that pod, and then move onto the next one. Today, I was in our pod (pod 2) before they started discussing the pod 2 babies. I was hidden in the corner behind Henry's isolette, so I got to hear the discussion about him. Nothing that we didn't already know. Dr. Cahan referred to Henry as a "trooper" and said that he was doing "awesome." That's nice to hear.

Someone had questions about his ultrasounds. Dr. Cahan didn't say anything we didn't already know. She's seen babies where the slight bleed (if it is a bleed) resolved itself, and she's seen babies where the bleed worsens and becomes hydrocephalus. They are monitoring his head circumference each week. I found out from Janice, his nurse today, that his head circumference (taken last night) was a little smaller than last week's measurement, but is essentially unchanged. Some of the head measurements are a little different because the nurses have probably measured it from slightly different spots.

As the residents gathered their things to move onto the next pod, Dr. Cahan stopped by and gave me their plan for the week. Dr. Cahan reiterated that she measures progress by week to week changes (something she told us on the first night that Henry entered the NICU). By this time next week, she'd like to see the following: (1) Henry off the Lasix, (2) Henry's weight increased, and (3) Henry on nasal cannula. She is quite methodical in her approach to achieve these goals. She doesn't believe in making all three changes at once, because if something goes wrong, she wouldn't be able to tell what triggered the reaction. So, today Henry's Lasix dose will be reduced by half. Tomorrow, they will begin adding calories to the breast milk to help him gain weight. His weight, taken last night, was 810 grams (same as the day before). If all goes well, then on Thursday, they will try him on the nasal cannula.

Since we have used the cannula during kangaroo care the last two times, I asked Dr. Cahan if it was OK to continue to do so. She said that we could do 1 hr of kangaroo care with the cannula twice a day if we wanted. I gather from talking to my dad who talks with the nurses that the 3-4 hour mark is when Henry's system is probably most tired out by the cannula. So 1 hr on the cannula should be just fine. And, it gives his nose and face a break from the CPAP.

I had missed his 9AM cares by a couple minutes this morning, so I decided to stay past noon, so I could do his 12PM cares. They went well. He had very little residual in his stomach before the feeding. When I left the NICU around 12:45PM, his oxygen set at 30% and his sats were in the 90s.

I'm happy that his feedings are going well. He has had a little reflux, but I heard Dr. Cahan say something about the vitamins being the suspected culprit in causing him to urp. He did have one questionable bout of throw up that had some green color in it on Beth's shift yesterday. But the rest of his residuals have looked OK, and his stomach is still soft. They will continue to monitor it closely.

A Happy Henry

My parents visited Henry in the afternoon (6/3). My dad got to hold the feeding bottle during Henry's cares.

Jeff visited Henry shortly after my parents left. Henry continued to do well. His oxygen was set at 37% and his sats were around 99%, so Beth turned the oxygen down to 31%. Jeff read "Sam and the Firefly" to him.

We returned to the NICU in the evening and decided to do some kangaroo care. Jeff and I trade off on the holding. Tonight it was my turn. Emily set me up on the recliner. It was my first time holding Henry while he was on the cannula. His sats, respiration, and heart rate were excellent during skin-to-skin. He rested on my chest and was quiet once he got settled. Jeff said that he had his eye brows up, which means he was happy. He also openned his eyes to look around.

After an hour, we decided that it was time for him to go back into his isolette. I would have loved to hold him longer, but we wanted to make sure he stayed warm. Emily had given us plenty of warmed blankets during the kangaroo care, but I tend to run a little cold on average. One study that I read on kangaroo care claimed that mothers raise their body temperatures when babies start getting cold, so I was probably worrying for nothing. Before he was put back into the isolette, Emily took his temperature and it remained in normal range (37 degrees Celsius), which was great.

Emily did a nice job getting him back into his isolette. He was of course cranky when she put the CPAP back on him. But he eventually settled down. All looked well when we left.

The Theater of the Absurd

Beth was Henry's nurse today. He was doing well. He did a little sat surfing while I was there. I became frustrated, however, by some of the nurses and parents in the pod.

The pod had been relatively quiet since the move to the corner of the room. We had hit a snag a couple days ago when someone activated the very loud ringer on the telephone at the end of the pod, about five feet from Henry's isolette. But Gene deactivated it for me yesterday.

Several nurses once again forgot that they should keep their voices low. I sometimes feel like I'm a character in the theater of the absurd and can't change the script. Here today's events in this theater of the absurd...

(1) Intercultural Miscommunication

Henry's pod holds ten babies. As near as I can tell, at least five babies belong to parents whose english language skills can only be described as limited at best. It appears that very few nurses are bilingual, which causes communication problems. Unfortunately, some nurses simply raise their voices at the parents when the parents do not understand instructions. It hasn't occurred to them that if a person doesn't speak english, speaking loudly isn't going to help them comprehend the words better.

The parents of the triplets (who are stationed close to Henry's isolette) do not speak english well. Two of the triplets are scheduled to go home today. All three have different prescriptions that they need to take. And one of the prescriptions got changed since yesterday, meaning that new medication bottles are needed. But the parents were given one of the bottles yesterday with the wrong dosing on it. The pharmacist did not want to issue a new bottle when the old bottle is somewhere out there. The nurse assigned to the triplets today does not speak spanish. So she was trying to convey this information to the parents and decided that speaking english as loudly as possible was the best way to do this. In the meantime, another nurse came in to help. She gets on the telephone next Henry's isolette to call the pharmacist and all but yells at him to get the prescription.

This puts me in a difficult position. I don't want to offend these nurses, one who has been Henry's nurse before. But I can't have them upsetting my child. And frankly, it isn't good for the other preemies in the pod either. So I talked with Beth and asked her if she could talk with her colleagues and have them take their prescription escapade somewhere else.

(2) The Coughing Man

At one point during my visit, one of the parents (I assume it was a parent) of a new baby at the other end of the pod gets up, walks to our end of the pod, coughs, then walks back to his end of the pod, and visits with his baby. I kid you not. If it isn't OK to cough on his baby, why would he think that it is OK to cough in the area of other babies? The selfishness and stupidity of people never ceases to amaze me. Beth wiped down Henry's isolette cover with a sanitizing cloth.

These were just today's events in the Theater of the Absurd. We've experienced several other events that warrant mention.

(3) Washing Hands Is Over-Rated

As you enter a room that leads into the NICU, there is a station for washing one's hands. Parents and guests are instructed to wash their hands for three minutes. There are two sinks in this room. You'd think that the rationale behind handwashing is pretty darn obvious. And yet, parents and guests are often seen to skip this step or wash their hands for two seconds and then head into the NICU. The instructions at the sink are clear. Even if you aren't planning to touch a baby, wash your hands! Why? Because even if you don't end up touching a baby, you may end up touching tables or chairs that other people touch. Duh!

Believe it or not, I actually had a grandparent of another kid try to get me to stop washing my hands for the three minutes because he was waiting and wanted to get into the NICU faster. Having not met me before, he thought he could pressure me into leaving the sink. He kept saying, "You aren't performing surgery. You don't need to wash for that long." I feel sorry for his grandchild.

My mom has seen the nurses send a father out of the NICU to wash up. Guess he was about to hold his baby but had dirt on his hands.

(4) A High Patient Is A Happy Patient

When I was admitted to intensive care, they asked me what I was allergic to. I said two things: percocet and aspirin (luckily not ibuprofen). I was questioned by just about every nurse and doctor about my percocet allergy. I said that I taken it before, and it makes me severely nauseous. In fact, both of my sisters have similar problems with the codeine family.

While they were sewing me up during my c-section, the anesthesiologist gave me a morphine dose that was to last 24 hours. After surgery, every few hours, the nurses would ask me to rate my pain on a scale from 0 to 10 where 0 means you do not feel pain and 10 means that bamboo shoots have been shoved up your fingernails. I rated my pain a 2 or 3. I was hurting, but the pain was tolerable if I did not move too much. And bamboo shoots at 10 sounded pretty damn terrifying.

The day after surgery, I continued to rate the pain somewhere between 2 and 4. I was asked by doctors and nurses if I was sure that I didn't want percocet. I said no, I was allergic. Having just had my abdoment sliced the evening before, I really didn't want to spend several hours puking over a toilet. The doctor didn't seem to believe me when I said no and and really wanted me to take it. He said he could give me anti-nausea medication to take with the percocet. I realize that we live in an instant gratification society, but considering that I had explained that the pain was tolerable, why would one try to push drugs on a patient? I didn't feel great when I moved, but that was pretty understandable. I believe that one shouldn't take drugs that one doesn't need. Mind you, there are many occasions when medication is necessary. I did ask for ibuprofen, which took the edge off the pain. Sometimes pain is a healthy indicator. In my case, when I got into a bad position or moved in a way that my body wasn't ready for, the pain told me to change positions or stop moving.

I was moved down a floor late on the second evening, no longer needing intensive care. Wendy, a nurse from the ICU, helped move me downstairs. She was aware of the situation and informed the nursing staff on the 7th floor that I should be given ibuprofen and then tylenol in three hour cycles. Again, this was to keep the edge off the pain. Basically, the philosophy on the 7th floor during the night shift was to forget giving any medication, if it wasn't percocet. I had to stay on top of the medication schedule because the nurses didn't. My mom once had a doctor tell her (off the record) that she should bring her own ibuprofen to the hospital since you couldn't depend on the staff. I wish I had kept a bottle handy.

Despite one of my many wrist bracelets saying that I was allergic to percocet and a sign on my door saying the same thing, I was offered percocet several times during my stay there. Apparently, no doesn't mean no when it comes to narcotics in the hospital.

My interpretation of the percocet issue is this. The medical staff like giving patients these painkillers whether or not they really need them because a drugged up patient is one who doesn't complain and thus makes their lives easier. There are, of course, a few nurses who don't fit this description. Unfortunately for me, they were only assigned to me about one-third of the time.

As I got ready to check out of the hospital on the fifth day, a nurse came into my room to give me my parting prescriptions. Can you guess what medication the doctor assigned to my case decided to prescribe for me? You've guessed it. Percocet.

(5) Dr. McCreepy

I slept very little while I was in the hospital. Over the five days, I got less than 10 hours of sleep total. The transition from ICU to the seventh floor was hard, owing to my dealings with the night time nurse staff which I won't chronicle here.

Having just dozed off to sleep, I woke up around 5:30AM on the third day to find a doctor hovering over me. He said that he needed to check the incision. While he was doing so, he asked me: "So, have you and your husband discussed what birthcontrol options you plan to use when you leave the hospital?" If there was ever an event that fit the Theater of the Absurd, this was it. Call me crazy, but I had just had a c-section a little over 34 hours previously and had spent those hours wondering if my child was going to live or die. As handsome as my husband is, sex hadn't been on my mind. I calmly replied, "Honestly, my husband and I haven't discussed it." He said, "You two need to discuss it before you leave the hospital." I said, "OK."

Two days later, Dr. McCreepy (as Jeff dubbed him) was back. I was already up when he entered. He again asked the birth control question. "Condoms," I lied. Jeff and I hadn't discussed it, other than to laugh over the situation. Instead, we had spent the time discussing and worrying about our son.

(6) The "Taking Your Baby Home" Video

Before taking babies home from the hospital, there are two videos that mothers are required to watch. One on baby fundamentals. The second on shaken baby syndrome. On days three and four, I was asked every four hours whether or not I had seen the videos. I explained to everyone that I preferred watching the videos shortly before my son was released from the hospital (a best case scenario placing this time at four months from his birth). After I was asked about this for the billionth time, I relented. So, on the Friday morning of my release, Jeff and I watched the "Taking Your Baby Home" video. It would be difficult to imagine a more inappropriate video to show a mother whose baby could very well die. Jeff and I told jokes throughout it. I also occasionally cried as they showed babies being placed in car seats going home or mothers nursing. Just another event in the Theater of the Absurd.

(7) Jeff Has Postpartum Depression?

The day before I checked out of the hospital, I was given a survey to determine whether I had postpartum depression. They give this questionnaire to all women who have had a baby. If you received 10 points on the survey, you are supposed to notify a healthcare professional for psychiatric counseling. And, you are then supposed to recheck yourself on the survey two weeks later. The questionnaire is called the Edinburgh Postnatal Depression Scale. It contains 10 questions, each with four possible response options that you score from 0 to 3. As a teacher of research methods, I couldn't help but critique the questionnaire as I was taking it.

My conclusion: This is a bad questionnaire with highly problematic face validity issues. If you have ever had a bad day, it is easy to score over 10 points. I believe that I scored a 12 on it. And no, I didn't notify a healthcare professional. I did however have Jeff take the questionnaire. If you believe in this scale, then Jeff had postpartum depression as well. He scored a 10.

Items included gems such as:
"I have been so unhappy that I have had difficulty sleeping." Response options were "Yes, most of the time," "Yes, sometimes," "Not very often," and "Not at all."

"I have felt sad or miserable." Response options were "Yes, most of the time," "Yes, quite often," "Not very often," and "Not at all."

"I have been so unhappy that I have been crying." Response options were "Yes, most of the time," "Yes, quite often," "Only occasionally," and "Not at all."

I didn't bother taking the survey at the two week mark. I was going to throw it away, but I have decided to keep it for my research methods class when we have our unit on questionnaire design. Some of the items have weird qualifiers that make the statements difficult to interpret.

Perhaps this is just another example, much like the "Taking Your Baby Home" video, of an inappropriate fit for my needs at the time. Let me say for the record that postpartum depression is a serious issue. I'm not trying to belittle it in anyway, but I am belittling their scale. As a researcher, I can't believe that they can't do better than this to screen for it.

Reassurance Gone Wrong

Yesterday was a bit of a trying day. After Kate went in for a morning visit, I stopped by in the afternoon. I happened to run into Dr. Cahan. After exchanging long time no see and no news is good news small talk, she said something to the effect of, oh by the way, that grade 4 hemorrhage in his cerebellum, well, don't worry about that, it's probably nothing.

I had a Gary Coleman moment, "Whach you talkin' bout Dr. Cahan?" We knew he had a slight bleed in his cerebellum. However, we were told that they don't evaluate those on a scale because they haven't been looking at them for very long and don't have much data about them. This bleed had pretty much left our minds as a point of concern. Now we were being told he had a grade 4 which is the worst kind of bleed and basically spells disaster.

Dr. Cahan was trying to reassure me that everything was going well. Instead she basically hit the emotional reset button back to day 1. I think she realized what she had done and tried to back track a bit. She explained that anything outside of the ventricles is automatically considered grade 4, no matter how much bleeding is really there. She almost went so far as to say that she wasn't sure if there was a bleed at all, calling it a blurry spot on the ultrasound.

She also said that she has seen many babies with this type of problem turn out just fine. That type of reassurance is starting to wear thin. If everyone else has beat the odds, can it be long before the odds start to catch up?

The good thing is that the cerebellum controls motor function. He has been very active and has showed pretty good dexterity. He has been pulling out his feeding tube quite well and today Grandpa Hank reported he is now able to pull the cpap off his head. Yesterday he even gave me the vulcan live long and prosper sign with his hand. If you know what I'm talking about, you know it isn't as easy as it looks.

So at this point there doesn't seem to be any impairment. I guess I'll keep rooting for him to pull out his tubes and detach his wires. Heck, at this point he could flip me the bird and I'd just look at him, smile, and say "That's my boy!"

Kate and I went in together last night. The nurse practitioner on duty, Pat, looked at the results and was able to confirm the history of the ultrasounds. The initial utlrasound was clear. The second one showed the bleed in the cerebellum. The third one showed a slight reduction in the size of the bleed. The fourth one was yesterday and showed no change from the third. So at least it is not getting worse. There will be another ultrasound in 2-4 weeks.

At this point I think I've regained my composure. He's no worse off than he was before the ultrasound. It could be something, it could be nothing. Basically, that is true of probably a thousand things with him. Really, all that can be done is to do the best we can for him and hope that all turns out well. He still shows every sign of doing as well as can be expected. Let's just hope it stays that way.

In other news, he is still on the Lasix and we don't know how long he will be on it. He is now down to 810 grams. His feedings are up to 15 ml's as of last night and will be increased 1 ml every 12 hours until he hits 18. He seems to be digesting well so I think that is the best news we can get.

Emily was his nurse last night. We had not had her before. It amazes me that after 5 weeks we are still seeing nurses that not only haven't cared for Henry but that we haven't even seen in the NICU.

Here is another picture that I've entitled "The Hairy Eyeball." It is a phrase that Kate's father uses when someone looks at someone with that knowing look that says "I know you are up to something" or "Don't even think about it."

Nothing New

I visited Henry this morning. Gene was his nurse. Not a whole lot to report. His oxygen was set at 28%. At one point, he started doing a little sat surfing, so Gene turned it up to 31%.

Nothing new at this time, except that Gene mentioned that they had taken a head ultrasound yesterday but the person taking the ultrasound did not find anything interesting.

Some Enchanted Evening

Sorry, running out of catchy ideas for blog post titles.

Last night was a nice night. Nadine was his nurse. He was doing pretty well on his oxygen levels, 33% with sats in the 80's and 90's. He was doing a bit of surfing. His weight was down to 840 grams but that wasn't too unexpected given the diuretic he was given. I believe his feeds are still at 14ml. He had about 3ml of residual from the previous feed but that may have been due to him pushing it up his feeding tube into a syringe that they leave open to vent the gas from his stomach. That can happen when their tummies are full and they bear down.

I was able to do the skin to skin holding tonight. Gene had pulled the green recliner to the crib side before his shift ended so I wouldn't have to be so upright. Apparently holding him upright isn't good for his lungs. With the recliner I was able to lean back and have Henry lay on top of my chest in a very comfortable position.

We also got the ok to have him on the nasal canulla rather than the cpap while being held. This was great. It scares Kate a bit because she isn't convinced he is ready to breathe on his own and the canulla doesn't supply the pressure to his lungs, it only supplies oxygen. I feel like he can handle breathing on his own for a while and needs a break from the cpap which looks terribly painful. The cpap is also a major problem when trying to hold him because it has to be in just the right position.

Kate fed him while I lay there with Henry. He seemed to twitch quite a bit but his vitals stayed good. The only problem was that he got a bit too relaxed and would drop too low on his breathing rate. I would give him a little wiggle to remind him to breathe. It's not uncommon for this to happen after he is fed. I held him for about 40 minutes. I could have gone longer but they were getting a new arrival at the end of the pod and it was going to be getting noisy in there.

I'm going to add some new pictures to Kate's previous posts so please scroll on down.

Back Off, Mom!

I visited Henry this morning. Gene was his day nurse again. Henry looked quite comfortable. His oxygen level was in the 30s. His oxygen saturation levels were good. For the most part, they were in the high 90s. He did a little sat surfing, but not enough to set off the alarms. His respiration and heart rate also looked good.

The lasix continues to do its job. His previous diapers were adequate but rather low in the weight department. Gene showed me the diaper weights over the last few cares, and they looked much improved since he started taking the lasix yesterday.

I tried to keep to the "Let sleeping Henry lie" rule. But when I saw him wiggle and drop his sats to 92%, I decided to touch his hand. He immediately gave me the "Back off!" signal. His hands arms shot up in the air and crossed slightly, shielding his face. This is one of the preemie signals indicating that they do not want to participate in activity. So, I closed up the isolette and just watched him.

Preterm babies communicate their needs differently than do full term babies. There are several behavioral cues that let their caretakers know that they are ready or do not want to interact. Since they still have a lot of developing to do, it is easy to overstimulate them, so it is very important to pay attention to the "Leave me alone. I need my rest." cues.

Often during cares, preemies get agitated because the cares can be very stimulating (often too stimulating for their systems). Desating during cares is pretty common. Other cues include:
* coughing, sneezing, and/or hiccuping
* changing color (when Henry's mad, he turns dark purple)
* irregular breathing
* changes in heart rate
* abrupt moments of the arms and legs way from the body and then back to the midsection
* quivering or twitching
* becoming hypertonic (body becomes stiff or rigid)
* becoming hypotonic (body becomes limp)
* both arms and/or both legs shooting straight up in the air
* high arm position (the use of the hands and arms to shield the face in a self-protecting matter)
* splayed fingers (fingers extended and separated)
* tightly clinched fists

My mom came into the NICU just as I was leaving. I become more relaxed knowing that my family comes into watch him.