Bottle Feeding Practice

Day 89

Emma is still truckin' along.  No significant changes, she's just working on bottle feeding.  She's still having good days and not-so-good days with it.  Still trying to get that coordination down!  She's up to 2105g, which is about 4 lbs., 10 ounces. 

The retina specialist had come to look at Emma's eyes a few days ago and basically said the same thing as the regular opthamologist (mild ROP).  She'll have another appointment in 2-3 weeks and we'll just continue to monitor it. 

The doctors also reduced the extra calorie packets in her milk.  They had been supplementing the milk with fortifiers to add a couple extra calories to help her gain weight.  Since she's been gaining so well, they reduced the fortifiers from two to one.  Also, Emma had been getting a bolus of caffeine every day since she was born.  This is typically done for preemies just to give them a little extra boost to help them keep breathing, etc.  They discontinued the caffeine, so no more daily cup of java for Emma!  Now she's just getting her iron supplements and multivitamins. 

Hi Daddy!

Oh no, is that what I think it is??

A Yankee hat?  *gasp!*  Daddy is a Yankees fan?!?!

Phew, I know Mommy is a Red Sox fan, now I can sleep. 

12 Weeks (and a day)!

Day 85

Everything is still moving along well for Little Miss Emma.  She has been working on bottle feeding and is starting to get the hang of it, but still needs some more practice.  Some days she does great and takes the whole bottle, and some days she only gets about 5 cc's (mL).  She is still working on the suck-swallow-breathe coordination, which is just going to take some more practice until she has it all together.  Sometimes she takes too much and starts dribbling out the sides of her mouth (she forgets to swallow) and then sometimes her heart rate starts to dip (she forgets to breathe).  It's all perfectly normal and she'll definitely get there in time. 

She's still gaining weight consistently and is now 1955g, which is 4 lbs., 5 ounces.  Her feeds were increased to 40 mL every three hours, and she's still being bottle-fed once per shift (twice per day). 

Emma is still on the cannula at around 28% (she had to go up to around 30% after those vaccinations she got, which they said can sometimes happen) so now they've been weaning her back down. 

Once Emma has her bottle feeding down consistently and is taking the bottle every feeding, she'll be ready to come home!  The doctors today suggested that it could be even before her due date (February 8th), which we're very excited about!  Since she is doing well with the bottle and that is the last hurdle she needs to get past, she may end up coming home on oxygen after all. 

One other issue that was brought up today is that Emma's blood pressure has been a little bit high lately.  It is another common issue with preemies, and definitely not too high at this point.  If it continues over the next couple days, they will probably do a renal ultrasound to make sure that her kidneys are working properly.  She has been gaining weight steadily (i.e., not too much too quickly, which could be a sign that she is retaining fluids) so it is likely that her kidneys are working just fine.  Although, they don't want her blood pressure to stay too high consistently since that causes unnecessary stress on her heart, so she may need to just be on blood pressure medication for a month or two if this continues.  Nothing too serious at this point, just another thing to keep an eye on.

sleepy...

cranky...

stretchy...

silly...

"talk to the hand, Mom!"

and sleepy again...

bottle feeding!!!

time for a good burp! 

aww, my first official drool stain.  now i really feel like a mom! 

   

Discharge Planning?!

Day 83

Emma is still going strong!  She has been doing wonderfully on the bottle!  As with everything, they have taken things slowly as far as bottle-feeding with Emma, since it takes a lot of work for her to nurse.  They started off trying the bottle once a day, and now they have moved to once per shift (every 12 hours).  She is doing great!  Her first try, she took 20 mL; her second try, she took 30 mL; and last night she took the whole bottle (35 mL)!  The doctors and nurses have been very happy with this progress.  They'll continue to increase the frequency of her bottle-feedings from once per shift to every other feeding to every feeding.  We're just so thrilled!  Emma is still gaining weight and is up to 1855g, which is almost 4 lbs., 2 oz.  She is also 17 inches long!!!  Compared with 11.6" when she was born, that is a huge amount of progress! 

Emma is still on the nasal cannula and doing very well.  She's been hanging out around 25% oxygen which is perfectly fine.  We had been expecting that Emma would still come home on oxygen (as is the case with many preemies and babies with respiratory disease), but the doctors yesterday said that they didn't think she would need it! 

One of the most encouraging signs we've had this week is that we got a call from Emma's case manager wanting to start working on discharge planning!!!!!!  Emma still has some time before her actual discharge, but the process is getting started!!  We'll need to take an infant CPR class and make sure we have a pediatrician all lined up and a whole list of other items, but we could not be happier.  We're still planning on another month or so until she actually comes home.  They will not set any specific date for her homecoming; it will remain a day-to-day analysis until they give the final approval for her to be discharged.  I've heard from other moms of preemies that this is one of the most frustrating parts; every day you think could be "the day" and it keeps getting pushed back.  At this point, we'll take that frustration if it means she's almost ready to be home! 

One piece of not-so-great news is that we did get the final results of Emma's vision test and it looks like she does have some mild ROP (retinopathy of prematurity).  It is stage 1, zone 2, which means it's not very serious at this point.  The stage refers to the severity, and the zone refers to the location in her eye.  Research says that stage 1 means "Mildly abnormal blood vessel growth. Many children who develop stage I improve with no treatment and eventually develop normal vision. The disease resolves on its own without further progression."  She will have a follow-up appointment with a retina specialist in a week or two and we'll continue to monitor this going forward.  Nothing to worry about too much at this point. 

Overall, lots of exciting news!  More pictures will be coming soon, I promise...

Let the Good Times Roll!

Day 81

Emma has continued to do amazingly well.  Yesterday she was moved onto the nasal cannula and is doing great!  Her oxygen level is about 22% right now (she just wants that extra 1% above room air!) which is just fantastic.  She has been doing great in her crib and enjoys checking out her new surroundings.  She got her first set of vaccinations last night and was a brave little girl.  The vaccines are administered at around 2 months of age, regardless of whether the baby was premature or not.  Since Emma was sick when she was 2 months old, they held off a little bit until now.  We are still waiting to get the final results of her latest eye exam but from what we've heard, the test was still somewhat inconclusive since she's still so young.  Although she may have some damage from the prematurity and high oxygen levels she had sometimes required, she definitely still reacts to lights and cameras and looks at people and new things.  So it certainly seems that she can see, and it's possible that there is no damage, or just minimal issues that could resolve itself.  We are not overly concerned at this point. 

Emma has been doing well with her feeds and is now getting 35 mL every 3 hours.  She is up to 4 lbs., 1 ounce now.  She seems to be showing some very slight signs of reflux (just getting a little fussy during/after the feedings and some slight desats) but overall she's doing great.  And today they are likely going to try bottle feeding her!!!  We are just so excited about all these wonderful changes - every day is a new adventure!!

Breaking News! (updated)

Day 79

Emma has been moved into a crib!!!!!  She seems to be doing fine so far, just looking around and making "funny faces" about her new surroundings.  We can't wait to see her tonight (and take lots of pictures).

Emma is getting another vision test today, and she is also due for some vaccinations which she'll probably get tomorrow.  They are going to leave her on the CPAP until these two things are all done just so they don't stress her out too much. 

So many exciting changes!

4 Pounds!!!

Day 78

Emma had a great weekend!  She is now 1810 grams, which is just about 4 pounds!!  Her weight gain has been perfect - about 1-2 ounces each day, which is just where she should be.  She is still getting 32 mL every three hours and has been doing great.  Just one teeny little spit-up today and that was it.  We're told preemies are also very likely to have reflux issues as they get older, so we're keeping an eye out for that.  But so far, so good!  Her feeds are now given to her by gravity feed.  Instead of being given through a pump over half an hour, they are just held in a syringe above her head and allowed to flow through using gravity - not too quickly, so it still takes about 15-20 minutes, but it's another step forward for her. 

Emma is still on the CPAP at 25% oxygen.  Her last blood gas this morning was "spectacular" (according to the nurses) and good enough for her to be moved onto the nasal cannula, but they are giving her another day or two on the CPAP just to keep from pushing her too quickly.  Going to the gravity feeds is more of a challenge for her than the pump, so they will give her some time to get used to that.  We are moving forward and do not want to take any steps backward! 

Similarly, now that Emma is over 1800 grams she is "eligible" to be moved into the open-air crib.  They are also going to hold off on this for a couple days to let her continue to improve and get stronger.  We are very excited that Emma is meeting these wonderful milestones, and more than happy to be patient and take things slowly so we don't move backward. 

Happy New Year!

Day 77

Happy new year everyone!!  We can't believe 2011 is here already.  2010 was quite a year for us, and we know 2011 will be even better, because we will be able to take Emma home with us!  We like to think that we are lucky to have gotten to know her earlier than expected.  If she had been on time, she wouldn't have come home until February anyway, so we've just spent these last few weeks being able to watch her grow and develop, which we otherwise wouldn't have had the opportunity to do.  So here's to a great year for all of us! 

Emma has continued to progress very nicely this week.  She was moved from the SiPAP onto the CPAP and they have been weaning down on her settings on the CPAP as well.  Hopefully in the next couple days she will be put on the cannula again!  Her oxygen level has remained very low (around 25%, and room air is around 21% oxygen) so she is not requiring very much support.  She's getting stronger and has also been very stable. 

She is continuing to do well on her feedings every three hours.  Her feeds were increased to 32 mL every 3 hours.  She has been gaining weight steadily and is a whopping 1700 grams, which is 3 lbs., 12 ounces - creeping up on 4 pounds!!  She looks great and is getting nice and chubby.  It's amazing how much she has grown in a relatively short time. 

We've also noticed that Emma has been sleeping much more soundly.  She seems to be transitioning to more defined awake vs. sleep times, whereas previously she would be continuously moving and bouncing between being awake and asleep.  Now when she falls asleep, she is much quieter and very peaceful, but still active and alert when she's awake.  It seems like she's maturing! 

Here are some pictures from yesterday.  If anyone is wondering, the mask that Emma is wearing needs to have a good seal around her nose in order to work properly.  Therefore, the elastic bands on her cheeks need to be pretty tight to be effective.  Since they can dig in a little into her face, the nurses just put some cotton underneath them to protect her. 

Still snoozing...



Daddy on diaper duty (it was just wet, so his "count" doesn't get to go up yet)  =) 

Mommy cleaning off her face.

All done!

"I don't want to sleep!  I want to play with Mommy and Daddy some more!"

An organization (not sure which one) donated these little gloves to the NICU babies to symbolize how they are "little fighters" and to support them in their fight.  We think they're adorable (and very appropriate)!