"He's a big guy"
" He's a good size"
"He seems long"
These are the most common variations of the theme surrounding our new man. Every conversation with every staff member (nursing, aides, docs, RT) somehow includes a comment on William's over achieving dimensions. At 5lb 5 oz and 18in at birth, that put him into the 95% for a 32 wk baby, and is more average for 34-35 wks. Even with the expected weight loss that all babies have, he still is 5lb even today. Will has been getting some protein and sugar through his IV, but the majority of his nutrition is through a feeding tube. He is too young to have developed the suck/swallow/breathe coordination needed for breast/bottle feeding, but has tolerated his tube feeding well. I have been pumping every three hours since about 6 hours after delivery; he started on a preemie formula but now is getting all breast milk which I consider a personal victory. He feeds so well though that they have been increasing how much he gets every day ~ so good for him, but now I need to keep up! The only minor downside to his, as his nurses have pointed out, is that when looking at him he appears older than he is, and therefore ends up creating higher expectations than we should have for him. This is especially important since he hasn't had any other extra problems really, his is just doing what a 32 wk born preemie will do!
In general since being born Will's biggest issue has been needing respiratory support, which is one of those things expected for being born at this gestational age. Initially he was on only CPAP and they increased the settings once on that. However his first full night he had a number of "spells." These spells are events where his heart rate and then oxygen levels drop below specific criteria, and we are told are not uncommon when born at 32 wks. Some babies come out of these spells on their own, others need external stimulation to do so. Will was needing enough extra help to break the spells that they changed him to additional ventilator support. He didn't need an invasive breathing tube put into his lungs, but was able to get the extra support and breaths delivered through his cannula. They also started giving him caffeine thru the IV ~ yes, the same ingredient in the much needed coffee that gets me going in the morning. As a stimulant, it helps preemies "remember" to breathe, making the spells less frequent and less severe. I guess I don't need to worry about having my coffee while pumping/nursing with this one! Fortunately in all this he didn't require much if any extra oxygen delivery, and has not yet needed surfactant, which are both good signs. The spells have gotten less frequent and he has been able to pull himself out of them more often than not over the past day. Today they plan to cut back the ventilator support and get back to standard CPAP; if this goes well they will continue to cut back the breathing supports over the next few days.
Another common preemie issue is jaundice. Initially his bilirubin wasn't too high, but it kept trending up so he was put on a bili-blanket. It seemed to make him uncomfortable, mainly because in order to work has to have access to the skin, so all his little blankets and supports and cushioning had to be moved/repositioned. He is also such a squirmy guy that he kept knocking his eye protection off. Fortunately his labs improved in 24 hours and we were able to remove that again today. Almost right after the bili-blanket was removed he settled down into a quiet, calm, very relaxed state which was comforting to see.
At this point we have pretty much traded one hospital room for another. Everyone in the NICU is very welcoming, the rooms are private and have sleeper couches/rockers etc, and parents are encouraged to participate in as many of the cares as we are able. So I still get to check temperatures, change diapers, and help with dressing. I was able to hold him in "K care" (kangaroo care) twice, but we had to put this on hold when his vent settings and bili light were active; we hope to resume K care again tomorrow. So far I am spending nights at home, but will likely spend some with Will especially as he gets closer to coming home and I get to take over more of his needs. His care team has been wonderful, involving us where they can, answering questions, and speaking directly with us on rounds and in making plans so we are always updated and clear on what is happening and what is expected.
The neonatologist today said it well in that "he is a preemie, and we have to remember to allow him to act like one." Today we would have completed 33 weeks pregnant; instead Will 5 days old. And I have been grateful for every one of them!
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