BONUS

Justin now gets "bonus" feedings. That is what I call them at least. He hit a certain weight today but stayed in certain limits in order to increase his feedings. Apparently they have some criteria to go by in order to get these "bonus" feedings. He needs to be gaining weight (but not too fast), and hit certain weight requirements before he gets his bonus. He was at 34 mls every three hours and his bonus today got him up to 39 mls every three hours. They were giving these feedings over a half hour time period but that was giving him a little reflux so they slowed it down to 45 minutes. I guess every baby (premature and full-term) has reflux which is what makes them spit up. Justin doesn't spit up but when he is at the end of his feeding, he seems to reflux a little which cause his O2 sats to decrease. So, they just slowed it down a bit and he seems to be doing better. He is at 4 lbs 9 ounces today and is maintaining his temperature perfectly! They have him all swaddled up in his crib and he looks so tiny. He started looking big for his isolette relative to where he started and now he looks tiny all over again. But when he is not in his crib, he looks like a BIG boy! It's weird that we think 4 lbs 9 ounces is big but when you start in the 2's, it really is a huge increase! 

BIG BOY BED

Like I mentioned yesterday, Justin would be moving to a crib soon. Well, he got his new bed this morning!! No more isolette and he is doing great! We got him all bundled up in a onesie, then a sleep sack, and two swaddling blankets in order to stay nice and toasty. They check his temperature every hour for the first four hours to make sure he is maintaining ok. He seemed to do just fine. He gained some more weight for today. He is officially 4 1/2 lbs...4 lbs 8 ounces. We will work on feedings again tonight but the doctor said today to really not expect anything of him until around 35 weeks. We are only 33 weeks and 2 days but he seems to be learning. It will take a while to get him up to full feedings on his own. But, we were told to expect that from the beginning. The doctor did mention today that given how well he is doing, she is very optimistic that he will go home before his due date. We really hope that is the case but also don't want to push him if he is not ready. We will just go with the flow one day at a time. :)

CRIBZ

Justin is doing great today. We worked a little more on his feedings at noon. He is learning, slowly but surely. He did better than yesterday and I am sure he will continue to do so. Whenever I call to check in with the nurses now, they have no news for me other than "he is being a good boy". Which is kind of how I feel today. Everything is status quo and going great. He gained a little more weight and is now up to 4 lbs 6 ounces. One exciting thing we learned today is that he will be moved out of his isolette soon. Could even be today! He is at the weight now that he can maintain his own body temperature and he seems to be doing great at that. So, he will get a new crib in the next couple days and it will be SO much easier for us to change his diaper, do his cares, and get him out to hold him. Yay!

NEW DIGS

Justin had his first full day in ICC today. He was moved last night at around 9pm. He was weighed this morning and weighs 4 lbs 4 ounces...not sure if there is a discrepancy in the two scales between the NICU and ICC or if he is just a machine. Either way, he is getting bigger, haha! He was able to start eating on his own for the first time today. The doctor told me to expect him to eat for about 1 minute and then fall asleep. And that is exactly what he did! He is still a little premature to get the whole sucking, swallowing, breathing thing all at once. But, we are off to a good start. At least he did what the doctor expected. We will keep working on it a little everyday and eventually he will get it. He is doing great on his 1 liter of flow. Hopefully they will keep him on that for a few more days and then see how he does on less. For now, they will just make sure he isn't requiring too much oxygen. Other than that, absolutely nothing new. Will write more tomorrow :)

MOVIN' ON UP...GRADUATION DAY!

I feel like I haven't had a ton of news the past couple days...which really isn't a bad thing when you are in the NICU. But, today I have lots of news...don't worry, all good!

We didn't hit the 4 lb mark yet but hopefully soon. He actually lost an ounce for today but it all depends on when he is weighed. Sometime in the next couple days I am sure we will see 4 lbs. We went down to 1 liter of flow in his nasal cannula and we will see how he does on that. It's a big step for him but the doctor thinks we should try it. I agreed with her that he is ready for another step down because he has gone quite a few days on 2 liters, hasn't had any problems, and hasn't had any spells. If he doesn't tolerate this they will move him back up, but we'll see how he does. He also got a bath today...a full bath this time! Last time we just washed his hair. We were waiting for his PICC line to come out in order to give him a real bath. He did well and then I swaddled him up and held him for a while. He likes to snuggle!

The big news for the day is we are moving out of NICU. Justin is going to Level 2 because he is not a sick baby anymore and just needs to learn how to eat and grow. I know I have talked about both of the Level 2 centers in previous posts (ICC and Special Care Nursery). I mentioned first that he would go to ICC and then we thought he might go to Special Care. I thought ICC was for more chronic babies, and it is, but that just means they can handle sicker babies. It doesn't mean they have to be sick to go there. Basically he would go to whatever Level 2 center that had an open bed spot for him. They had an opening today and the doctor thinks he is more than ready for Level 2 so here we go! He won't move until this evening and we are not even sure where he will go yet (ICC for sure, just not sure what bed spot). This is a really exciting day for us but also a little sad. We have gotten to know so many great nurses (especially his primary nurse, Christy) and we will be sad to leave them. But, this can only mean good things and we are that much closer to getting him home!!! 

SO CLOSE

3 lbs 15.5 ounces this morning. We are so close to 4 lbs that he might get there by tonight. We'll see! The doctor called this morning and said everything looks great but no new news. They did a few labs this morning and everything checked out just fine. She will keep him at 2 liters of flow in his cannula for a couple more days. They should start turning it down by mid-week. We were told today that he can start trying to eat on his own now. It will take some time to get used to that process for both he and I but another exciting milestone! They recommend both bottle (with breast milk) and breast feeding while he is in the hospital. He needs to be able to start gaining weight and eating on his own and apparently the bottle is much easier to do that with in the hospital. So, the bottle will help get him home and then they recommend working on breast feeding exclusively once he is at home and I am with him all the time.

We are heading to the hospital in a few minutes. Oh yeah, we were watching the Vikings game today and during half time there was a commercial on about Children's Hospital. I wasn't paying attention but heard a voice I recognized so I rewound it and it is Justin's doctor, Dr. Hoekstra!

EYES...CHECK!

The little man had his eyes checked this morning. The doctor said they are still immature but no signs of ROP. That is to be expected. His eyes, like everything else, will take some time to develop. They will continue to check his eyes every couple weeks until he comes home and he will probably have eye checks even after he comes home. Better to be safe when dealing with his sight! Other than that, the doctor rounded and didn't change a thing. She said he looks great! I am sure in the next couple days they will take another step to lower his air flow but will give him a chance to get used to the 2 liters that he is on. So, sorry for nothing exciting today. But, no news is good news...right?

Oh, by the way, the nurse told me last night that Justin is getting a reputation in the NICU. Apparently he has created poop problems for a lot of them...requiring LOTS of cleaning. :) Yikes!

Oh yeah, almost forgot. He is 3 lbs 15 ounces!! We could be at 4 lbs by tomorrow!

AHEAD OF THE GAME

Today was an uneventful day in the NICU for us. FINE WITH ME!!

Justin looks great and is pretty low on his O2 levels which means he is doing great as well! I talked to the doctor when I got there and he was pleased with how Justin is doing. The only thing we changed today was increased his feedings by a small amount. They seem to change the max amount so often that I am having a hard time keeping track. I think we are going to a max of 28 mls at some point today but just not sure when. I did ask the doctor what he thought about Justin and how things are going. Jason and I have obviously never done this before so we have nothing to gauge this with. We didn't know if he was where he should be O2 and breathing wise and were just curious if he should still be having spells at this point (he has about 2-4 per day). Dr. Hoekstra said "he's ahead of the game for his gestation" and doing great! His breathing and O2 needs are better than expected and at this age he is still supposed to be having spells. They actually have tons of spells when they are still inside mom but the placenta does all the work for them so it doesn't matter. So, to only be having a couple a day is really good. Other than that, nothing new. The brain ultrasound was actually scheduled for Monday and he will still have his eye test tomorrow. Will let you know how that goes but again, I will not be there for it. Too hard to watch those procedures!

SWAT Baby

I know, I know...this post is really late! Sorry. 

Everything is fine at the hospital. Justin got to wear his new camo outfit today (see picture). He is back up to 3 lbs 13 ounces and looks great. Remember, we have to gain weight the "right" way. They are increasing his feedings a little at a time. He was getting 20 mls every three hours and they have started increasing that 1 ml every six hours. The maximum is 26 mls but it will take a little while to get to the max. Justin will have his second brain ultrasound tomorrow but nothing to worry about there. He already had an ultrasound at one week and they didn't see any problems then. They are looking for brain bleeds and the doctor told me that the likelihood of him having a problem at this point is slim to none because he didn't have anything at the first ultrasound. They will check tomorrow and then once more right before he goes home. Also, he is getting an eye exam on Saturday. They are looking for Retinopathy of Prematurity (ROP)...how do you like my vocabulary these days?!? I guess premature babies tend to have eye problems due to the fact they are premature and also because the oxygen can cause their retinas to detach. That is the case in babies that have been ventilated for a LONG time and also babies on high amounts of oxygen for a long time. Nothing to worry about with Justin, but again, better to be safe and check it out. They have a neonatal eye specialist that does the exam. He is coming at 7:30am on Saturday and I don't really want to be there for the exam. Doesn't look like much fun. The nurse said it looks alot worse to the parents than it actually is...so we will just go later after all is said and done. 

VERY LUCKY

Some new babies came into the NICU a few days ago and I can't help but take a look at them every time we walk in. They are twins that were born on Sunday at only 24 weeks. One weighs 300 grams (a little less that 11 ounces) and one weighs 500 grams (1 lb 1 ounce). They are the smallest little babies I have ever seen and I just can't imagine if that were us. I feel so lucky that we have such a healthy, big (relatively speaking), and growing boy! 

Today, Justin actually lost a few ounces which is exactly what the doctor ordered. The medicine he gave him yesterday did the trick. He was looking a bit puffy because he was retaining so much water and he was finally able to get rid of some of it. He is back down to 3 lbs 11 ounces and now he will start gaining weight the correct way. He was getting fluids when he had his IV in and sometimes babies can't get rid of all the water on their own. But, we are back on track. They changed his bolus feedings to every three hours now and he will get 20 mls each time. He did great on the first day of bolus feedings and should continue to do fine. Since they moved him down to 1.5 liters of air yesterday he was requiring a little more O2 then necessary. The doctor talked about the fact that Justin will be at the hospital for a while still so there is absolutely no reason to push him. If he were 36 or 37 weeks they might push him a little harder with the air/O2 but he is just 32 weeks (they still talk in gestation terms at this point even though he is a little over 3 weeks old). So, they moved him back up to 2 liters and will give him some time to get used to that. Afterall, he was only at 2 liters for one day before they went to 1.5 liters. We will give him some time on this and gradually go to less. That is all for today. I do have some new pictures. I will post them later. :)

IV FREE!!!!

Yay! We finally were able to get the PICC line out. Justin had his last round of antibiotics at 1pm this afternoon and he is done! They wanted to take the PICC line out right after. So, he is not connected to anything anymore, other than his nasal cannula and feeding tube. He is still gaining weight and is 3 lbs 14 ounces today. They still think some of that could be water weight and they gave him a medicine to make him pee more and get rid of some of the water. We'll see if he stays at the weight he is at or gains/loses for tomorrow. They changed his feedings a little bit today too. They are doing what's called bolus feedings now (as long as he tolerates it). Instead of a constant flow of 9 mls per hour, they will give him 16 mls every 2 hours. This will help him get the hungry/full effect. They feed him the 16 mls over a half hour period (still in his feeding tube) and then stop for the next hour and a half. They also give him a pacifier when they feed him so he associates the sucking with full belly. He had his first bolus feeding when I was there today and seemed to do just fine. They checked his tummy and he digested it all which means he is tolerating it and they will continue to check for that every time they feed him. Oh yeah, they also adjusted his flow to 1.5 liters today. I think the doctor's goal is to have him out of NICU by the end of the week. At that point, we will be transfered back over to Abbott in the Special Care Nursery. I originally thought we would go to ICC across the hall but I was told that is for more chronic and longer stay babies. The Special Care Nursery at Abbott (which is run by the same team of Children's Hospital docs and nurses) is for the "feeders and growers". Basically healthy babies that just need to grow and learn how to eat on their own. Will keep you posted on our move date and everything else that is happening! Justin got a new present in the mail today...a camo NICU outfit. He will be ready for SWAT just like his daddy! 

STATUS QUO

Justin is looking so big and chubby today! He gained another couple ounces and is 3 lbs 13 ounces. Over a pound more than when he was born. He is still at 9 mls per hour of milk but as he continues to grow, they will increase it a little at a time to keep the right amount of calories in him. Dr. Hoekstra rounded when I was there today. He walked into the room and said he needed an easy baby for a change. It's been pretty crazy in the NICU and for us to be the "easy" ones felt good! No big changes today. He did lower his flow from 3 liters to 2 liters and we are working towards getting his nasal cannula off. It will take some time but shouldn't be too long. That was really the only change for today. He did mention that Justin's last dose of antibiotics will go in tomorrow and he will take the PICC line out immediately following that. So, he will be IV free tomorrow! It will be so nice to have that out! 

I am just at home washing Justin's clothes. We had another poop explosion today (apparently that is pretty common for these little guys) so the clothing needs to be washed. Jason and I will head down again after he is done with work. Our favorite nurse is working tonight. 

CHUNKY MONKEY PLUS SOME

Justin did not lose weight today! He actually gained another ounce. HAHA. He is right under 3 lbs 11 ounces. So, I guess it wasn't water weight and he is just growing like a weed. I don't have alot of news today. They did decide to do the transfusion this afternoon. He was having a few spells (the anticipated that) so they decided today was the day. They put in an IV to give him the transfusion and it takes two hours to get all the blood in. Then, they can take the IV out....not his PICC line, just the new IV. He will, however, get his PICC line taken out on Tuesday because he will be done with antibiotics then. The nurse told me that when they give babies IVs they give them a "sweety" to block the pain. It's very weird and doesn't make any sense to me but is very interesting. They put some sort of sucrose on a pacifier and let the baby suck on it. Apparently the sugar is a pain receptor block and they don't feel anything. So, when she put the IV in he was sucking on his sweety and didn't even cry. I have no idea how they ever figured that out but it seems to work. And, it only works for babies. Interesting, huh? 

Jason and I are heading down to see him shortly. He should have more energy and better O2 saturations now that he had the transfusion. Hopefully he is nice and awake for Mom and Dad!

CHUNKY MONKEY

3 lbs 9 ounces today!!!! Can you believe it? The doctor mentioned that he will most likely lose weight for tomorrow. Sometimes babies hang on to water weight and if they haven't pee'd in a while, they tend to weigh more. So, now that he is peeing and pooping again (not that he stopped, he just took a break right at weigh-in time), he will probably weigh a little less tomorrow. Either way though, that's a big jump in weight! Not much else new. He is doing great on feedings, no spells, and wearing some new clothes today.

The doctor did mention that typically babies at his age have had a blood transfusion by now because they don't produce red blood cells yet.  He hasn't had one but his levels are pretty low. They are low because babies (premature and full-term) always dip after they are born and they have also been taking so much blood from him for labs and tests. Plus, as he gets bigger and gains weight (apparently he is good at that :)  ), his blood oxygen levels will become even more saturated because he is not producing new blood cells yet. So, the doctor was going to watch him today because a sign that the level is too low is to have more spells. Then at some point, he will probably need a transfusion. Just an ounce of blood. I wasn't really excited about that idea but I guess it is very common and just about every premature baby gets one. He said that in all the years he has been there he has never encountered a problem with the transfusions and it doesn't affect the baby at all. He will actually do better because his oxygen saturation levels will be much better and then he will need that much less help breathing. Whatever is best for Justin is what we will do. It probably won't be until tomorrow or the next day, he will let me know before hand. 

Justin was wide awake today while I was at the hospital and Jason and I will go back later. He had training today from 10am-2pm so we will head down this afternoon/evening. It is his turn to hold Justin today and I will read books. Finally, back to our old routine! Oh yeah, Justin is 3 weeks old today!!!

FULL FEEDINGS AND A NEW OUTFIT

The doctor has not rounded yet today so I don't have a full report yet. I will add more to this post later once I hear from her. We are back to rounds in the afternoon (since he is healthy again) so that is a good thing. Today, Justin is 3 lbs 5 ounces. He was at 8.5 mls of milk per hour when I was there at noon and they will increase to 9 mls at 4pm. He will stay at 9 mls for a while as that is where he needs to be for his current weight. They will increase it as he gets bigger. Because he is at full milk feedings he is done with his TPN and lipids (the nutrients and fats through his IV). They will keep his IV in only for the antibiotics and once those are done next week, he will get it out! Also, when I got there today, the nurse told me to take a look at him because he looks different today. I opened his isolette cover and he had clothes on! He has never had clothes on before and he looked so darn cute (see picture). It was a brief clothing experience though, as he spit up on it shortly after. Oh well! There will be plenty of outfit changes for that reason in the future. The nurse went to look for another outfit but they were all too girly so we just left him in his diaper. I will take down some of his own clothes tonight. They also changed the temperature in his isolette. So far, he has been on a fluctuating temperature that changes when his body temperature changes. Now, they set it at a constant temperature in his isolette because he can start managing his own temp. As his weight increases, the will decrease the temperature more and pretty soon he will be in room air and out of the isolette! That's all for now. I will add more to this post later if I learn anything new from the doctor.

Nothing new from the doctor today. Dr. Hoekstra is back tomorrow and we will see what he has to say about the little big man. I did however get a nice little note while I was at the hospital tonight. Jason wasn't going to be able to come to the hospital today because he had to work until 10pm tonight. So, I went down to hold him by myself tonight (for the first time since he got sick). I was also going to pump afterwards since it was about that time. I have all my equipment under Justin's bed and when I opened the bag with all my stuff I found a piece of paper. On it was written (in quite familiar handwriting):

"Mom, Tell Dad that I would like my own snowmobile. Love, Justin"

Uh oh!! I am in trouble already! I did find out that Jason had an hour in between his normal shift and his over time shift so he made a quick visit to the hospital. I thought it was interesting that the note looked like it came from a cop's notebook....hmmmm.....they must have been chatting. I am really glad Jason was able to make it down to the hospital though. It would be hard to have to miss a day! 

ONE MILLLLLLLLLLLION DOLLARS

As you can see from all of Justin's pictures, he is very expressive. Today, his new look is Dr. Evil from Austin Powers. He puts his hand up by mouth with just his pinky up like Dr. Evil does when he requests 1 MILLLLLLLLION DOLLARS. My dad got a great shot of him in this pose and I will post it later tonight as soon as I get it. 

We are up to 3 lbs 4.5 ounces today. He is getting 6 mls of milk per hour and our goal is 9 mls. They keep increasing the amount because his weight is increasing so they need to keep up with that. They also increased his calorie intake to 24 calories versus 22 calories. They have two different fortifiers, one adds 2 calories and one adds 4. They decreased his high-flow to 3 liters instead of the 4 that he was on and he seems to be tolerating it well. He is still on a very low (if any) oxygen level. For the most part, he just requires room air which is great! The doctor is very pleased with his progress and is not worried about the infection at all anymore. All of the results came back negative. He should just have a few more days of antibiotics (until mid-next week) and then he will hopefully get his IV taken out...for sure this time! Other than that, things are great! Check out Dr. Evil later. Ha!

GREAT DAY

We had a great day and great report from the doctor today. Justin is at his heaviest weight today despite the minor set back at the beginning of the week. 3lbs 3.5 ounces. They are increasing his feedings by .5mls now every 4 hours. At 4pm today he was at 3 mls an hour. He is on his way up and he even looks bigger today. I also measured his length yesterday and forgot to report. He is 16 inches long now. When he was born, he was 14.5 inches. WOW!

They have done many tests over the last 24 hours (a blood culture and also checked his spinal fluid) to make sure the infection is not still in his blood and didn't spread anywhere else. They didn't anticipate any problems due to the fact that the infection was caught so early and he bounced back so quickly. Both preliminary cultures have come back negative so we are thrilled about that. He is still on antibiotics and will continue to be to make sure the infection is totally gone. Also, she left him on high-flow today of 4 liters but he is down to room air and not requiring ANY oxygen. She will readdress the flow again tomorrow but just wanted to give him a little extra help in that department since he has been working so hard on everything else.

So, not much news today but no news is good news. Will write more tomorrow :)

Thanks everyone for all your comments and support. I know some people are having a hard time commenting and I am sorry to say, I have no idea how to do it. You're on your own. Sorry!

WHO'S HUNGRY?

Justin is hungry! The poor guy has been so mad that they were giving him all this food and then they took it all away! Darn infection! But, good news, we started back at 1ml per hour today! 

They have confirmed his infection is a strep infection and have tailored antibiotics specifically for that. He will be on them for a minimum of 10 days and could go as long as 21 days. They also did another tummy X-Ray today and have confirmed that he does not have NEC. They took the tube out of his mouth/tummy today and I'm pretty sure he would have taken it out for them if they didn't. The tube was there to take out all the milk and air from his tummy when they noticed the infection. The doctor said that he is a little anemic (normal) and they will continue to watch that. It is hard enough for babies to produce red blood cells in the first place and they have been taking so much blood for all these tests that it is even harder for him. They will leave him on high-flow today at 4 liters because he is still not up to his full energy level yet. Once he is feeling a little better they will start to decrease that but the doctor just wants to help him out a little since he has had a rough start to the week. They will draw blood at some point today and recheck that for the infection hoping that it is all out of his system. The way he has been acting, it should be!

A pretty calm day in the NICU today...at least at our bedside. There have been tons of new babies admitted so the place is always buzzing. Hopefully things stay quiet in bed 7 (that's us). 

QUICK UPDATE

Hello!

All is well at the hospital tonight. Justin is doing just fine. He is very feisty and is telling all the nurses that he is BACK! He is also working on the tube in his mouth and trying to pull it out. Hasn't successfully done so yet but hopefully the nurses can take it out in the morning for him. We didn't hold him tonight because he just needs to rest but we read to him and helped with his cares. Jason got pee'd on for the first time, but we all know it won't be the last. :) 

Sleep tight and I hope to have a good update tomorrow!

ROLLER COASTER

I'd like to start today by talking about a conversation I had with some NICU nurses while I was still in the hospital and before Justin arrived. They are very good at Abbott in preparing you for the weeks to come and what to expect in the world of NICU. They talked about all the different statistics and what happens to babies when they get there and some of the complications that are also a possibility. They compared the time we will spend with Justin in the NICU to a roller coaster ride. We would have ups and downs and go forward and backwards and that is all normal but our time there would be very hard. 

Well, all we have had in the past two weeks were ups. We thought maybe we were different than EVERY other family in the NICU and that our journey wouldn't be a roller coaster ride. We were wrong and last night night, we sort of went straight down. I will tell you, this will be a long post with many details from last night and this morning but know that Justin is doing just fine so DON'T WORRY!!

I called the hospital around 11pm last night as I always call one last time before I turn the lights off. We just like to know that he is doing ok so we can go to sleep and not worry too much. The nurse didn't seem her normal self (she had been on the last 3 nights- so she knows Justin and how he acts) and told me that he had been having a ton of spells since she got there (very unlike him) and was also acting lethargic. She said that when she suctioned his mouth and nose he didn't even cry. Normally, he gets really pissed off and tells the nurses to leave him alone! She mentioned this could be a sign of infection and that the doctors were requesting all sorts of different labs, blood work, X-Rays, etc. We got in the car right away and went to the hospital. When we got there, Justin had 4 nurses and a doctor surrounding the isolette and they were trying to stimulate him to breathe. He was having a spell and needing lots of stimulation to get out of it. They usually just have to touch babies to remind them to breathe but they were all rubbing his back to get him going again. They talked about possibly needing to intibate him (put him back on the ventilator) or maybe the CPAP to help with the spells. His antibiotics had already been started and his feedings were completely stopped. They put a tube in his tummy to extract all the milk that was in there and get any air out. We talked to the doctor about the different possibilities of infection. It could be an infection from his PICC line (IV), could be a random infection from his nose/mouth stuff that has been put in and taken out (sometimes that stuff just gets bacteria on it and causes infection), or it could be a problem in his intestines that they call NEC. NEC is short for something that I can't remember and/or pronounce so we will just leave it at that. NEC was something to really worry about as that is related to his feedings. Everyone has bacteria in their intestines and we need that to digest food. However, preemies get that bacteria because food is being introduced but their intestines are not ready for ANY bacteria yet, good or bad. That is what the placenta is for and they shouldn't be getting milk this early. It is kind of a double edged sword. They need the milk to start growing and developing but their bodies can't always handle it at an earlier date than full term. We sat with him for a while and he stabilized his stats (breathing, O2, etc.) and so we decided to go home at around 2am. He was so limp and didn't even open his eyes for us while we were there. They also poked his heal to take blood and he didn't even make a peep. Little babies spend so much of their energy fighting these infections that they literally can't do anything else, even breathe! We asked the nurse to please call us if anything changed at all and especially if they were going to have to intibate him. We never got a call. Phew!

I called this morning first thing and talked to the nurse. He hadn't had a spell since 2am and was very alert this morning. He was mad at her when she was messing with him and had plenty of energy. All of his blood counts were a little haywire indicating that there is for sure an infection, they just need to pinpoint what the cause is. The blood culture that they took last night takes 48 hours to get back as the bacteria actually needs to grow before they can figure out what it is. The doctor called me back after looking at another tummy X-Ray this morning and we talked again about all the different things this could be. She also said that we caught this early enough and she is very optimistic that he will be just fine. She said that his stats were great this morning, his color was good, and he had plenty of energy...all good signs that the antibiotics are working. We got down there mid-morning to see him and we wanted to be there around noon because they were going to do another tummy X-Ray. He was wide awake and looked great. The doctor came in to talk to us after the results came back and she also got preliminary results back from his blood culture. The tummy looks great and she is not worried about NEC. That is really good because NEC can be devastating for little ones. The culture showed a sort of strep infection and he is currently on the right antibiotics to take care of that. He most likely got the infection from his nose/mouth stuff and they are getting it taken care of quickly. They will continue to not feed him for a few days (don't worry, he is getting nutrients through his IV) and then they will reestablish the feedings once his intestines get a good rest. At that point, we start again at ground zero. They will be able to increase his feedings at a faster rate because his intestines are already primed for milk but we just can't start it up where we left off. His breathing is back to normal and he is requiring much less oxygen than even before. I think the need for more oxygen was an early indicator that something was developing, it's just hard to tell for sure. 

So, that was our roller coaster ride last night. We are so happy, not for the fact that he has an infection, but that it is not something that will cause greater issues in the future. He is doing just fine now and resting comfortably. We have decided that since he was doing SO well, he just figured he wasn't getting enough attention from all the cute nurses. But, he certainly had EVERYONE'S attention last night! And, he gets his very own nurse today, one-on-one. He just likes to flirt and they all think he is so cute. I will try to update again tonight as I am sure you will be interested in knowing how he is when we go back later. As of now, things are calm and I am going to take a nap!! And, as for this roller coaster ride, we are getting off! Hopefully no more ups and downs to come. 

BATH TIME!

Today was an adventure at the hospital. A fun day, but certainly a new one in our books! Let's start with the stats. Justin is 3 lbs 3.5 ounces today and still growing!! He is tolerating the fortifier and they will increase the calories to 24 tomorrow. Today, he is on 22 calories per ounce of milk. We are getting closer to getting that IV out. Not positive if it will be tomorrow or Tuesday. They might give him fluids for a day just to make sure he is tolerating the 24 calorie fortifier. The last thing we would want is to take it out and have to put one back in! His bilirubin levels went down today and he did that all by himself...no lights needed. That means that his liver is up and running and things are in working order. They have been checking his bili levels everyday and the doctor said today that she won't check again for a week since he seems to be doing great on his own. Other than that, nothing new and no changes made today. Just a steady day at the hospital.

Now, on to today's adventure. First, we got to do something new and give him a bath. Well, actually a half-bath. We washed his hair. We swaddled him up to keep him warm, put a basin in his isolette and washed his hair (see pictures). He also got a new isolette today. They were supposed to change it out yesterday but didn't for some reason so they did that while Jason held him. And, of course, now that we were ALL clean, we had to go make a mess again. I was changing him after his bath and we were all hoping for a poop because his tummy was getting a little full. Well, I will spare the details but we had an explosion while I was changing him!!! A major explosion! The nurse and I were laughing so hard that another nurse came over to see what had just happened. Meanwhile, I thought Jason was going to fall off his chair as he mentioned that he wasn't aware that could even happen! He said it was a good thing I was changing him because he would have flipped out and wouldn't have known what to do! HA! We had a little cleaning up to do after that but Justin was happy and ready for bed. 

So, overall, a pretty exciting day in the NICU!  :)

3 POUNDS!!!

Well, today we hit the 3 lb mark. Actually, he is 3 lbs 1.5 ounces! Awesome!!

We have a new doctor today and she will be with us until Friday. She rounded in the NICU about a week ago and is great. She called today and was so impressed with his progress. She told me that he is actually stable enough to get out of intensive care. The Intensive Care Unit is a level three center (whatever that means) and he is stable enough to go to level two. There aren't any beds open at the level two center right now so they will just keep him where he is until they get an opening. So, instead of being in the NICU, he will go to ICC (Infant Care Center) which is right next door to the NICU. It is still the same team of doctors that see him and he will still get the same attention from the nurses, it just means he is requiring less care and is very stable with his respiratory growth and feedings. He is still tolerating his feedings and doing well. They are adding fortifier to his milk today for a few extra calories. It adds 2-4 extra calories per ml and the idea is to give him the same amount of nutrients that he would be getting if he were still inside me. They try to do everything that way, including positioning him as if he were still inside. They know that he always had his hands up by his face so they lay him on his side with his hands by his face a alot. He is still doing ok off the phototherapy lights. His bili levels went up a small amount again today but they are still not at a level they are concerned with. They will also start giving him some iron in a few days. Apparently, all babies are anemic when they are born, even full term babies. That means that they aren't producing enough red blood cells. Usually, when they hit a level of 20, their bodies automatically start producing more. He is at 34 today and it is normal for that number to drop. The iron will just help him produce red blood cells so the number doesn't get too low. They don't want to have to do a transfusion, but that is very unlikely.

So, we are still on track and doing well. They will watch to make sure he can tolerate the fortifier and he should have the IV out by Monday at the latest. That's all for today. More to come tomorrow.

ANOTHER GOOD DAY

I keep trying to think of clever titles for each post but I feel like I should just keep calling them ANOTHER GOOD DAY. It seems that every day we get more positive news and he is doing great. The doctor today said that he is doing what he wishes every preemie baby would do. That was fun to hear. 

Justin gained another 20 grams, not quite an ounce, but slowly creeping up towards that 3 lb mark! When I was pregnant, my goal was to keep him in there until he was around 3 lbs but he had a mind of his own, obviously, and decided to come a little early!! The doctor increased his flow in the nasal cannula to 2 liters instead of 1 liter. He was still needing a little more oxygen then before and they like to keep those numbers down. It's not a bad thing when they have to increase or decrease those numbers, just giving him a little help. And, so far it is working. His bilirubin levels are slowly creeping up so they are just keeping an eye on things. They are not worried about increased levels at his age (almost 2 weeks!) but will still watch it to make sure it doesn't get out of control. I forgot to mention yesterday, they changed his feeding increases to every four hours instead of every three. Nothing to do with him at all, they just coincide with his cares now. It is easier for the nurses to remember to do an increase every time they do cares which are also every four hours. Today, they decided to increase a little more aggressively by going up .2 mls every four hours instead of .1 ml. The goal, as long as he tolerates everything, is to get his IV out by tomorrow or Sunday. I know the IV is needed to help him right now but I will be SO glad to have it out. That will just be one less thing he will be attached to. Tonight, we will head back down again for our family holding/reading time. We got one of my favorite books as a gift (The Big Hungry Bear) and Jason has never heard of it before. So, I think that will be what we read tonight! Grandma and Grandpa are also coming down for a quick visit but they only get to stay for 10 minutes. I am sure all the grandparents can't wait for longer visits and more interaction with him. It's hard when you can't do as much as you would like, I know how it feels. The first few days of barely being able to touch him were really hard! 

Hopefully we can get some new pictures posted soon. That is sort of Grandpa's (my dad's) task as he takes some amazing shots. We'll see if Justin is more awake tonight to get some good ones. Happy Friday. 

ENERGY

So sorry for such a late post today. I was so tired this afternoon that I took a nap instead of blogging. I have not had a full night sleep in weeks as I am up pumping a few times a night. And, we all know how well you sleep when you are in the hospital...yeah right!

Justin is having another great day. Not a ton of new stuff for the day. When we left tonight, his feedings were at 3.6 mls per hour and the doc said the goal now is to get him to 7.8 mls per hour which is full feedings for his age. It was 6 mls at the beginning but now that he is 30 weeks, it is a little higher. He was also on a medication called amenophlin (sp?) and that is to stimulate his brain and remind him to keep breathing. Apparently it is similar to caffeine. But, I learned today that it isn't as strong as caffeine and so they switched him to caffeine today. The amenophlin was given 3 times per day and it is sort of like a roller coaster as it wears off before his next dose. The caffeine is different in that he needs one dose per 24 hours and it keeps him on a more steady stream throughout the day. This will hopefully eliminate all spells of not breathing. In the next couple weeks, he should outgrow his dose of caffeine and as long as he isn't having spells, they will just shut it off. I know, it sounds harsh to give a baby caffeine but it doesn't hurt him at all.  He is still keeping his bilirubin levels at a good spot and hasn't needed phototherapy lights. I think it's because he is pooping more now. We weighed him tonight at his 8pm cares and he is now 2 lbs 14 ounces!! Way to go buddy! We have almost hit the 3 lb mark! Yay!

That's all for tonight. 

DR'S ORDERS

Hello all! You might notice that my posts are coming later in the day. That is because the doctor rounds on the sick babies first. So, the later the better in my opinion!!

Today, Justin is doing great. The doctor is changing his regular nasal cannula to a high-flow cannula. He had a high-flow cannula right when he was taken off the CPAP but they changed it to a regular one shortly after. Today, he is requiring a little more oxygen (very normal and nothing to worry about) so they will give him a higher flow of air while using less oxygen. They want to keep the oxygen requirements as low as possible. Dr. Hoekstra reassured me that this is completely normal and absolutely nothing to worry about. I asked why he needs more oxygen sometimes and not as much others. He explained to me that because he is not at full feedings yet, he doesn't have the protein in his system for his lungs to properly function. He said that proteins keep water/fluid in our lungs (basically just keeping them wet) and without the full amount of protein, his lungs don't have that. So, by changing him to a higher flow, it simply makes him have to work to breathe a little less. He does not want Justin to struggle and this is what helps him keep his lungs open. He will be on 1 liter (when he started high-flow a while ago he was on 3 liters) of air and they will dial his oxygen needs down as he tolerates it.

He adjusted his feedings today to .1ml increase every three hours versus every six. Today when I was at the hospital, he was at 2.7 mls per hour so that number will continue to climb especially now that they increase it every three hours. Dr. Hoekstra explained that as they increase his milk every three hours, they will decrease his IV nutrients. So, .1ml+ of milk = .1ml- of IV nutrients every three hours. The goal is to be completely off his IV by this weekend and get that thing taken out! He also gained 10 grams today. 30 grams = 1 ounce. He is still at 2 lbs 12 ounces but slowly creaping up! Tonight, Jason and I will go down so we can hold him. We have also started reading to him at night. They call it Wee Read. They recommend 5 minutes per night and it helps babies recognize your voice. Last night while I held him, Jason read Jack and the Beanstalk. Tonight, Jason will hold him and I plan on bringing some of his own books to read to him. That's all for today!

PUTTIN' ON THE POUNDS...OR SHOULD I SAY OUNCES?

This is just a quick update this morning as the doctor has not rounded yet. I will write more later this afternoon but thought I should mention Justin's weight. After a few days of losing weight, which is to be expected, he started gaining weight once he started tolerating his feedings. He is now getting 2.3mls per hour and guess what?!?! He is 2 lbs 12 ounces today! That is what he weighed when he was born! They are really happy with his weight because they say babies can lose for up to 2 weeks if their feedings aren't going well. So, we are in good shape in that department...now, just need a few more pounds. But, that will take time. They are hoping to have him up to 6 mls of milk per hour by the end of the week. They will increase the amounts more rapidly as the week goes and as long as he is tolerating it. The doctor wants to get his IV out by the end of the week. Will write more later when I know more...

The doctor rounded while we were at the hospital this afternoon. It's always nice to be there when they round instead of hearing of changes over the phone. It just gives us a chance to see what they are up too and ask questions. Dr. Hoekstra (he is the doctor that was in the delivery room and was also featured in People Magazine last May) came by today. He said Justin looks great! He ordered a small increase in his feedings and to turn the phototherapy lights off today. He might go back on them but at least he can have a break from his sunglasses for a while. Once his feedings increase a little more they will start adding protein to the milk to give him a little boost in calories. It only adds 2-4 extra calories per ml but that is a big deal for someone his size. We didn't hold him today but will go back tonight and kangaroo with him then. This afternoon we are taking some time at home to celebrate Jason's birthday! What a birthday present to have a special delivery already! Too bad Justin isn't home to celebrate with us but we'll wait until he is bigger and stronger!

A LITTLE TIRED TODAY

I think Justin is a little tired today. He has been working so hard with his respiratory development and done such a great job. But, it is all HARD work and babies at this age get a little tired. Last night before I went to bed they had put the cannula back in for a little help. They certainly don't want him to struggle to breathe! Before, he was getting a flow of 3 liters and now it's down to .5 liters. So, he is just needing a tiny bit of air in order to not have to work so hard. They also turned his phototherapy lights back on today...to be expected. They said that the lights work so well when they are on that when they turn them off, most of the time their bilirubin levels go back up. So, until his feedings are much more significant, he might be on and off the lights. They increase his feedings by 1ml every six hours so he is at 1.8mls as of now. As things continue to progress, they will increase the feedings at a higher pace. We will go see him over lunch time but will only hold him for a short time. We have to give the little guy a chance to rest!!

If anything new arrises while I am there, I will update you later. Or else, we'll update again tomorrow. 

KEEP UP THE GOOD WORK

Today was another good day. Justin got his high-flow nasal cannula taken off. He seems to be doing just fine without it. He was on room air with the cannula but it was just giving him a little extra air. He is breathing on his own and only forgets to breathe every once in a while (completely normal). Some babies need stimulation to remember to breathe again, but not Justin. He just remembers on his own. I held him today for about 20 minutes. Normally, he can handle it for about an hour but he has to work harder to breathe on his own now so he gets tired faster. If he needs more help breathing, they will put the cannula back in. But, he has to get stronger some how! They have increased his feeding to 1.5ml per hour and he is tolerating that just fine. He continues to poop and pee like he should and Jason changed his second diaper ever today. We were able to help with that, take his temperature, put chapstick (Aquafore) on, and give him a taste of milk in his mouth. They like to give him tastes (on a Q-tip) so he gets used to it when he gets to start eating. His bilirubin levels were up a little from yesterday. I guess this is normal after they turn the phototherapy lights off. He gets rid of bilirubin by pooping too so hopefully he keeps up the good work! 

That's all for today. Happy Sunday!

NO MORE LIGHTS

Another good day in the NICU. Justin was taken off the phototherapy lights this morning because his bilirubin (jaundice) levels are low enough that he doesn't need lights anymore. They also say that once feedings are more frequent his levels will go down even more. He gained 2.5 ounces since yesterday which is his first day that he hasn't lost weight. They increased his feedings to 1.1ml per hour and he seems to be tolerating that just fine. When he was born, they put an IV in his belly button (umbilical artery) and that is where he has been receiving all of his meds/nutrients. They took that out today because it has been in for a week and they don't want it to get infected. They started another IV in his arm but it is not a normal IV. This one should last 7-10 days and he shouldn't need one after that (as long as his feedings continue to increase). They use this special IV (not sure what it is called) because the normal ones only last for one day. This will be better because he won't have to get poked everyday with a new one. 

I just thought I would comment...some people have asked when his actual due date was. His due date was December 15th. So, he was 28 weeks and 4 days when he was born. 

I have been able to hold him everyday since the first time. Tonight, Jason will take a turn at Kangaroo Care. They say that it is great for dads to participate too and I think he is looking forward to it. 

Oh, by the way, Justin is a week old today and the doctors couldn't be happier with his progress...and us too!! 

Reason to Celebrate

The doctor says we have reason to celebrate today. Justin had a brain ultrasound this morning (they do this for all premies) and everything came back perfect. In the ultrasound they are looking for brain bleeds which is very common in babies at 23 and 24 weeks. They do not expect brain bleeds for babies Justin's age but they check just in case. They have taken him off the CPAP machine and he is doing great breathing with the nasal cannula in regular room air (not needing extra oxygen). They have increased his feedings to a constant flow of a 1ml drip per hour. And, the doctor thinks only one more day on the phototherapy lights.  So, great news today!!!! 

THE FIRST FEW DAYS

This whole week has been kind of a blur. I will do my best to give you the most information as possible.

MONDAY: Justin's ventilator was taken out as he was doing the most of the breathing on his own. YAY! He was put on a CPAP which is constant air flow to help him breathe. This is not as invasive as the vent but is still alot on his face. He is not given milk for the first couple days because premie's tummies can not handle food right away. Their intestines are not fully developed yet. We were able touch him and hold his hand for the first time.

TUESDAY: Justin's jaundice levels were pretty high (very common) so he was put under phototherapy lights. He wears little sunglasses and spends the day sunning at the beach :) They also started feedings. 1ml of milk every 6 hours. If his tummy is digesting the milk they continue the next feeding. He seemed to do ok, do they continued. Jason and I held him for the first time. They swaddled him up and we were able to hold him for a short time. Oh yeah, he pooped for the first time. Never thought poop would be an exciting thing! The nurses like the parents to do "cares" with them. So, I got to change his diaper, take his temp, and Jason helped fix his mask.

WEDNESDAY: Since he did so well on the CPAP machine on Tuesday, the doctor ordered CPAP for 2 hours then an air cannula (in his nose) for an hour. Feedings were changed to 1ml every 3 hours. His lung Xrays look great and they are developing perfectly. Justin is under phototherapy lights today and will continue until his levels go down. They did decrease from 6 to 5. I got to hold Justin today without the swaddle blankets. They call it kangaroo care. That is where you hold the baby skin to skin. It is supposed to be really good for the baby because they can hear your heart beat and they seem to get really comfortable. I was able to do that for about 45 minutes. Oh yeah, Jason changed his first diaper today!!

THURSDAY: Nothing much new today. He is still continuing to do very well. The feedings stayed at 1ml every 3 hours. The CPAP to nasal cannula also stayed the same. I got to hold Justin for an hour this evening.

Today (10/1/09), visiting rules changed at the hospital due to the H1N1 flu going around. Unfortunately, we are not able to have visitors anymore. Just parents. So, please enjoy the blog as I will do my best to update it daily with posts and pictures.

ENJOY!

BABY JUSTIN IS HERE

September 26th, 2009

Justin Robert Gehrman arrives at 3:39pm. 2 lbs, 12 ounces and 14.5 inches long.

Right when Justin was born, he was handed to the NICU team and taken into the room next door to the OR. He was doing great, they got him stabilized, and then they brought him in to the OR so I could briefly see him in the isolette. Jason went with the NICU team over to Children's and I was taken back to my room to recover for a couple hours.

He was put on a ventilator to help him breathe. IVs were put into his umbilical artery (belly button) which is how they administer meds and take blood.

BACKGROUND

I will start by giving you a little background as to how this all started. I began having problems around 25 weeks. I was in the hospital a few times with contractions that never really did anything so the doctors didn't seem worried. The big stuff all happened the week of September 14th (27 weeks). I was in the doctors office on Monday of that week and was in the hospital on Tuesday due to contractions (AGAIN, but this time they felt different). My doctor gave me the shot betamethazone that day which is the most important thing they can do if you are going to deliver early. You need two beta shots in order for them to work and they need to be 24 hours apart. The medicine helps the baby's lungs develop in case of an early arrival. On Wednesday, I went into the doctor for my second beta shot and then went home. I was on bed rest at that point until further notice. At home that afternoon, I noticed some leaking of my water so back to the hospital we went. We were originally at Methodist and they explained to us that if they confirmed that my water had ruptured, I would be taken by ambulence to Abbott in Minneapolis where I would stay until I delivered. Well, sure enough we were sent to Abbott at 1am Thursday morning. That whole night was full of many drugs to keep that baby in so the beta shots had time to metabolize and I wouldn't go into labor right away. It seemed to work. I was moved to another floor where moms like me wait for the big day. They said I would be there until the baby came or they would take him at 34 weeks (November 3rd was the day). The reason I had to stay is because the risk of infection once ruptured is very high and they need to monitor both baby and I daily. Things were quiet for many days. September 24th (Thursday) I started getting contractions again but the nurses could never find them on the monitors. Friday, I was still having them but still not on the monitors. Friday night at 11pm I asked the nurse for something because I had not slept the night before and needed to sleep that night. She gave me a muscle relaxer and said I could have another one if the one didn't work. Well, it didn't so I had the second one. At 2am I asked for the doctor and if I could get checked because I was in so much pain. They told me I was dialated to 1cm and didn't seem too worried because you can be at 1cm for a month with nothing going on. So, they recommended I take an Ambien so I could sleep. They said I will sleep right through my contractions...right! I called Jason at 3am to have him come down as I was in so much pain. Since I was still awake 1 hour after the Ambien, they moved me upstairs to labor and delivery so the doctor could "round" on me in the morning and make a decision as to what was to happen next. We waited until around 11am and still no doctor yet. Since I was still in so much pain, I asked the nurse if she could check me...4cm. Jason and I almost fell off our chairs/bed! So, I was in labor and he was coming ready or not! By mid-afternoon we were moved into the OR for delivery. They had me deliver in the OR because the Neonatal team from Children's Hospital has a room connected. They take the baby right away to stabilize him and then transport him to Children's in the underground tunnel.