Updates: January 14th - 12 days old

Well, today little Mario decided that things were going too smoothly for us and he'd shake things up a bit. After not having a spell that needed additional stimulation for 3 days, he had several that got written up today. This morning he had a rough time with his 9am feeding and about half way through it he dropped his heart and oxygen saturation rates several times. He did pretty well at recovering his heart rate, but needed lots of stimulation and a "blow by" with some oxygen to help him recover his breathing. He got written up for 2 of these episodes (only one had the "blow by") within a period of about 15 minutes and they coorelated with his feeding. So, his nurse mentioned it to the residents during rounds and they changed his feeding pump back to an hour and elevated the head of his bed more so he is at more of an upright angle, to see if that helps with his reflux. He also got written up for an additional episode this evening, though that one just required a little bit of mild stimulation (as opposed to the vigorous stimulation noted for the earlier episodes). The nurses and residents, along with us, still firmly believe this is all related to the reflux. You can see that he is in discomfort right before he drops his heart and sat rates. He starts making faces and you can tell it's not at all comfortable for him, just like acid reflux isn't comfortable to any one.

I was very discouraged by all of this today, but the resident wasn't too concerned and just indicated that they will keep an eye on things. There are medications they can give him for the reflux, but they leave those as a last resort and try everything else first (the bed elevation, feeding pump, etc), because they don't want to jump to using medications if at all possible due to side effects and such. The nurses all reassured me that this is pretty common for preemies and that most of the babies in the NICU have issues with reflux. It is just something they tend to grow out of as they mature and the sphincter muscle at the base of the esophagus strengthens. Several nurses told me that this is no where near the worst case of reflux they have seen. One of the other things I mentioned to the nurses was that his bad episodes happened after the feeding with the multivitamin added to it. This is only his second day on the vitamin and I wondered if it may have made his tummy a little upset. So, the one nurse noted it in his chart and spoke with the resident about it. They will watch things over each feeding and especially after the 9am feeding tomorrow, when he gets the vitamin. If we do see a connection there, they can do things like split the vitamin up over several feedings to make it less harsh on his tummy. There may or may not be a connection, but it's worth looking into.

I worked with him on breastfeeding again tonight and he did fairly well with it. I switch sides every day and I don't think my left side cooperates as much as my right (meaning I don't think he's able to get much, if anything out of our short sessions on the left side), so I'm going to talk with the lactation consultants tomorrow and see if they have any ideas. I also have a couple of ideas I'm going to try as well. I'm dealing with some discomfort after pumping, so I'm going to check with them about that as well. The nurses told me this afternoon that my bin in the freezer there for storing breastmilk is overflowing. So, I need to just store the stuff I pump at home in the freezer there and check every few days to see when they need me to bring more in and how much. They will still take anything I pump there, but just don't have the room to store everything I pump. Of course, that is a good problem to have!

Again, Dom and I participated in his care routines throughout the day. I held him for a while this afternoon after his noon feeding and he seemed to really like being held up on my shoulder after eating. Though, no matter what position you put that boy in, over your shoulder or in his crib, he will wriggle and move himself into the position he wants to be in. He is getting to be much more alert around feeding times now and wakes up a little before his feeding looking slightly agitated like, "I'm hungry, where's my food." He is also really sucking on his pacifier during feedings, which are all signs he's ready to move toward nipple feeding.

Tonight, the little man gained even more weight. He is now up to 4lbs, 5.8 oz, a gain of 2.2oz since last night! His head circumference increased by 1cm as did his length. So, all that breastmilk must be helping because he's doing what we want him to do in the growth area. He's eliminating very well too, so all systems are working in that regard.

Great Grandma and Great Grandpa Crowgey visited with him for a bit this afternoon before heading out of Cincinnati. We all hope the next time they see him he is home and doing well.

His night nurse tonight, Nikole, was one of the ones in the delivery room with me and was Mario's first nurse. She had him the first 3 days he was in the NICU (she works a rotation with some day shifts and some night shifts). Nikole noticed I was pretty upset this evening (I was having a rough day dealing with everything today and was pretty emotional, no matter how hard I tried to keep it in) and talked to me quite a bit about everything. She was very reassuring and I felt much better after talking to her. She said that to say they weren't concerned wouldn't be a true statement, because they are concerned about every baby in the NICU and concerned everytime something like this happens (bradycardiac episodes, reflux, any change, etc.), but they are not overly concerned at this point. She reassured me that the watch and wait approach is the best one and that he will likely just grow out of this. A lot of times the babies just have everything click into place in the end.

Nikole and I talked a lot about his care pathway going forward. She said that this week they will try him with the bottle to see how he does. If he does well we will move forward with that to progress to more and more nipple feedings (bottle and breast), which will be his last major hurdle, aside from his brady episodes. She seems pretty confident that about the time he really gets the feeding and is transitioned to all nipple feedings and able to maintain and gain weight, he will have grown out of the reflux and his brady episodes (the ones needing additional stimulation, the ones he recovers on his own are ok). She said that before he goes home he will have to sleep on his back without problem (right now they put him in whatever position helps with his reflux and rotate him every 3 hours - side, tummy, back, head facing different directions, etc), with his bed flat. They will go everything like that when it comes closer to him coming home (how to mix up the fortified breastmilk, etc).

It really helped to talk with Nikole tonight to put some of my anxiety to rest. Of course, I'm still a worried mommy and feel somewhat helpless at this point, but reassuring nurses really help. There have been so many times I ask myself what I should have or could have done or been doing or didn't do, but Dom and the nurses keep reminding me that there is no fault here and all we can do is take things as they come. I'm told that I'm doing a good job (and Dom is too!) and to just keep doing what I am doing. I guess I'm just having an off day too! As a side note, it seemed to be an off day for a lot of people, a lot of the babies in the NICU seemed to be having off days, and on the way home from the hospital tonight we saw 3 accidents and got tied up in traffic waiting to get by a couple of them. You'd think there was a full moon or a Friday the 13th or something!

And, as a bit of trivia for you, did you know the Soothie pacifiers many of the hospitals use, and you can buy for home use, are vanilla scented? Dom and I kept trying to figure out why Mario smelled like vanilla. So, I asked Nikole if it had something to do with the fortifiers added to the breastmilk. She told us it was the pacifier and sure enough, I gave the pacifier the sniff test and that's what smells like vanilla. Of course, Nikole, Dom and I joked that the need to come out with other scent options too.