Wow, I can't believe our little man is 2 weeks old already. Where has the time gone? He has changed so much in such a short amount of time. I'm sure everyone who has kept up with the pictures can see a change in him too.
Today was a pretty big day for Mario. When Dom and I got to the hospital around noon today we found that they had changed him to a continuous feed due to his episodes. I had some questions and concerns regarding this change in care and we met with both his primary resident and the attending neonatologist to discuss his care pathway. They were both extremely helpful in answering our questions and listening to our concerns and feedback. Dom and I expressed a desire to work with Mario more on the nipple feeding, so we can make progress toward getting rid of his feeding tube. We all agreed that the feeding tube could be contributing to his reflux, because the sphincter muscle cannot completely close with the tube going through it, thus allowing acid to leak through and cause reflux. Dom and I explained why we thought he was ready to nipple feed, based on the cues we are seeing and conversations with several of the nurses who have cared for him. This information had not been passed along to the resident and the attending until we brought it up and they were very interested in it. So, after discussing everything we came up with a new plan of action for his feeds. For any feeds that I am there, I can offer him the breast. We're limiting his time at breast to 20 minutes/feed right now, just so we don't tire him out. I am going to keep a journal of how he does each time at breast so we can track his progress. For the time being, he will then get an entire feed through the tube over 1 hour via the feeding pump. For the feeds I am not there, when he is awake and interested they will offer him the bottle. Then, whatever he doesn't take from a bottle, they will infuse over 1 hour via the pump. They also increased his feeding amount to 37mL/feed.
Dom and I also asked about the fortifiers they are using and Dr. Nathan, the neonatologist, explained that it's not only extra calories, but extra calcium and phosphorus to make up for what he didn't get from me during the third trimester of pregnancy. He'll be on fortifiers for about 3-4 months, to make sure he gets everything he needs. The multi-vitamin helps with his iron levels.
We breastfed this afternoon at his 3pm feed and he did very well. There also seems to be a pattern with his bad spells and the position he is in. He doesn't like being on his back, and when he is on his back he has bad spells. I think some of this is due to the way he moves his head around and can restrict his airway. His nurse this evening said that a lot of the preemies she's worked with don't like being on their back and it can make the reflux worse.
He got his first bottle at his 6pm feed and the nurse had charted that he took 12mL from the bottle and then she did the rest over the pump. Not too shabby for his first try. We'll see how he does with it next time.
Tonight, I got to give him a bath in addition to his normal nightly care routine (Tuesday and Friday are his bath nights). He still has his cord (though it's just barely hanging on), so it was still basically a sponge bath. But, I got his hair all washed and now it's very fuzzy. He did very well with everything. Then I put lotion on him to help with is dry skin. Of course, I didn't think about it when I put lotion on his tummy and we had to wash it off so the monitor leads would stick. At his weigh in, he gained .6oz and he's now up to 4lbs 8oz.
He was awake and very alert during his whole care routine, which lasted about 45 min or so, and was telling us he was hungry and wanting to eat. So, I breastfed him for his 9pm feed. Even after all of the activity, he was very interested. He didn't even care when the nurse was messing with his leads trying to get them to stick. He wasn't letting anything distract him from eating. So, we did that for 20 minutes before tucking him in for the night and hooking up his feeding pump.
He had a big day today, but sailed right through it. I'm very glad Dom and I met with the doctors to discuss things and that they were agreeable to starting the nipple feedings. We all know that he may or may not do well with them every time, but I wanted to at least give him the chance to tell us what he was up for. So, we'll see how things go from here on out.
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