Andrew had a great day. His morning x-rays looked good and the caffeine was keeping him from having the episodes of holding his breath, so they put him on canula. Right away they put him on the lowest dose of oxygen because he was doing so well. At one point he even only had one of the prongs in his nose and was still breathing OK. He made Mom very happy. When it looked like he was going to continue to do well his feeding tube was placed through his nose. He loves his pacifier, which is a good thing. If he is crying we can stick it in his mouth and he calms right down. He also sucks very well, which is early for him as babies usually don't have a sucking reflex until 32-33 weeks. If all goes well he can start nonnutritive feedings this week. That means that while he is being fed he will be put on Mom's breast to see how he does. If after a week he is doing that well, he can begin to breast feed. He also had his PERC line removed today so now all he has attached to him are his leads for respiration, heart rate, CO2 and oxygen and his canula and feeding tube. It is much different than all he had attached to him before!
Cassie pulled her tube out in the middle of the night but her color turned gray on the little bit of oxygen they gave her so instead of trying CPAP they re-intubated her. Her culture came back with a bacteria so they are waiting to see what it is so they can treat it. Her hematocrit came back low so she had to get some blood today so an IV line had to be started. She had a pretty quiet day except for when Mom held her. She had crooked her neck so she had a few spells of apnea, but the nurse took care of it. She is a sweetheart!
Elena did not have too great of a day. Her films also looked good in the morning so they tried her on canula. She continued to have the apnea spells and her CO2 reading was slightly high so they decided to do a blood gas level. The levels were really, really high so they couldn't even put her back on CPAP, they had to re-intubate her also. She was very, very angry about that. It took her a long time to get settled down. Mom held her right afterwards, and that calmed her a little, but any sound would make her flinch. Dad jingled his keys and she flinched. When we went back at night her night nurse told us that she was still very jumpy. They wanted to give her a different sedation so they had to start an IV line. She did finally calm down and went to sleep. What a day!
Andrew had an episode where either he held his breath or forgot to breathe, but his oxygen saturation went down really low. He turned purple and they had to "bag" him or put the oxygen into him. However, that was the only episode and his heart rate stayed normal. The nurse practitioner said that if he does it again he will either have to go back on nasal CPAP or the respirator. His potassium was a little low so they are supplementing it into his feedings. He is also on caffeine. The caffeine will perk up his brain and remind him to breathe. Now that he is a big boy we are dressing him in clothes. It is actually just a little T-shirt, but he looks so cute in it!
Cassie does have an infection of her ET tube, which is the respirator tube. She is being treated with antibiotics. She has been doing what is called swinging. At one moment she has too much oxygen so they turn it down and then she decides she has too little so they have to turn it up. It is a thing that babies do as they get older and are still on the respirator. Hopefully when her infection clears up she can get off of the respirator.
Elena may also have a possible infection, they checked a urine culture and it was negative. They are going to check her ET tube to see if she has the same infection that Cassie has. She is also doing the swinging.
Andrew had a great day. He is still on trace oxygen and is tolerating it. The respiratory therapists took his TCM monitor off which is the monitor that measures the CO2 in his blood. It is a major step! Mom got to try nonnutritive feedings with him which is practice breastfeeding. We were all impressed because he did latch on and sucked a little bit, which is very good for a baby his age. Since he no longer has an IV we were able to give him a tub bath. He loved it!! He seemed so tiny for the tub, but he enjoyed every minute of it. It was so fun to cuddle a wet baby! We got it on video. One of the respiratory therapists told us that it appears that Andrew will be coming home before the girls, hopefully in a few more weeks, if he continues to do as well as he is.
Cassie is doing about the same. She is still swinging, but it appears that the antibiotics are helping. Dad held her and she loved being snuggled with him.
Elena is also doing about the same. She got mad today because the respiratory therapist couldn't get there fast enough to suction out her secretions. She likes things done when she wants them. She is great! Mom held her at night and she practiced sucking on her pacifier. She is just as good as her brother!
Check out the newest photos of the babies!
Cassie: 3 lbs, 1½ oz.
Elena: 3 lbs.
Today is the babies' one month birthday. The NICU put up a cute sign for them. We bought them some Dr. Suess books to read to them.
Andrew is doing well on his nonnutritive breastfeeding. They tried him on room air since he is only on a trace of oxygen through his cannula, but he failed it. We will try again soon.
Cassie is going to start antibiotics to treat her infection.
Elena extubated but did not do well on her own so she was re-intubated. Her ET tube showed an pseudomonas, which could potentially turn into pneumonia, so we now have to wear a gown and gloves whenever we get in with her.
Cassie: 3 lbs, ½ oz.
Elena: 3 lbs, 1 oz.
Andrew is ready to start nutritive breastfeeding. If that goes well and he continues to gain weight, we could possibly have him home in three weeks!
Cassie had her PERC line put back in since she will be on antibiotics for 11-12 days. After the course of antibiotics they will try her off of the respirator.
Elena had a bronchoscopy which is where the doctor sticks a fiberoptic camera down her ET tube to see what her trachea is doing. Hers showed that the cartilage was immature and was collapsing anytime the respirator was not supplying the pressure. So, we will wait 1-2 weeks to try her off of the respirator again. If she self extubates herself again, the orders are to re-intubate her.
Cassie: 3 lbs, 3 oz.
Elena: 3 lbs, 1 oz.
We are still trying the nutritive breastfeeding with Andrew. He is not too interested. He really likes his pacifier, so we had the occupational therapist watch him to see if we should start a bottle. She suggested we did not do that until he was much older. She said that he is doing well for his age.
Cassie got changed to a more powerful antibiotic as the culture came back with a specific bacteria. Her oxygen needs are going down and that is an indication of healing.
Elena is still gown and glove. She self-extubated at 1:00 a.m. and 1:00 p.m. Again, she was just re-intubated. She was tried on a different cycle of her respirator, one that would make the transition off of the respirator easier, but she wasn't quite doing a good job on it, so they switched her back to the other cycle. We decided to try a tub bath with her since she had her IV removed. We needed four people to give her a bath; Dad, Mom, nurse and respiratory therapist. Dad was holding her as we got her undressed and she was really mad that we were bothering her. She had a poopy diaper, then she pooped in the blanket. We got her in the tub and she immediately calmed down and...pooped. We changed the tub and gave her the rest of her bath. She did not complain at all and then had a calm and restful rest of the night. It was so great to see her like that!
E-mail us at dls52@email.byu.edu.
(c) Dane Seeley, 2000