Category: Baby Emmett

Baby Emmett, breastfeeding, NICU

NICU day 60

Keeping up with the Hoffmans

I didn’t get to spend a lot of time with E today — D spent the night last night and we had two birthday parties to take T to today. After getting home from the second birthday party, I rushed to the hospital just in time for his 5:30 cares. He was very alert so we decided to try breastfeeding again. It went better than yesterday and he latched a few times, but he still isn’t really getting it, which is discouraging. The nurse thinks it’s fine, considering how eventful the past few days have been for him, but I’d be lying if I said I wasn’t worried that he might not ever get the hang of it. It’s a very common preemie problem.

The good news is, the nurse said he had a pretty good day today, and he had a really great evening with me too. His breathing sounds clear and he doesn’t seem quite as bothered by the reflux as he had been. The nurse still had to suction him earlier this afternoon, but I have hope things are starting to look up. Weight dropped 12 grams, but that’s not surprising, with him on the diuretic. Still holding steady at 5 lbs 1 oz.

Baby Emmett, NICU

NICU day 59

Keeping up with the Hoffmans

This morning the doctor prescribed Emmett a prednisone nasal drop to help with the inflammation. He’ll take it twice a day for 7 days. They also put him on a fast-acting diuretic for two days, twice a day to help with lung inflammation and edema. If we don’t see improvement, may look into a longer-term diuretic.

After a rough night last night, I was both looking forward to getting away from the hospital, and dreading leaving Emmett at the same time. The fact that Theo has swimming lessons on Saturday was a good excuse to get away. Sometimes I need that extra nudge to peel myself away. While I was gone, his breathing got so bad again that the nurse decided to suction him even though we’ve been trying not to as much because of the inflammation. It’s a good thing she did, because she got what she described as a “gremlin” from his nose that had formed a complete plug. No wonder he couldn’t breathe. She said she was so impressed with the size that she called the doctor in to take a look!

Unfortunately, both his cannula and the feeding tube may be exacerbating his congestion. The feeding tube is giving all that refluxed milk something to cling to, and the cannula is blowing dry air in, which is basically the perfect recipe for monster boogers that are so far back in his nasal/throat area that they’re really difficult to suction out. We have some humidity on the cannula, but it’s still drier than if he were just breathing room air. The feeding tube also keeps his esophageal sphincter slightly open, which can exacerbate the reflux. Unfortunately, life is basically one giant catch-22 right now. We can’t remove the cannula until he’s having fewer events, and we can’t remove the feeding tube until he gets the hang of breast/bottle feeding. But the reflux and difficulty breathing are inhibiting feeding and causing events. And around we go.

We may try another round of systemic prednisolone, since he responded so well last time. If we do, they may try removing his cannula toward the end of the course while it’s still in his system. Meanwhile all we can do is try to keep breastfeeding him whenever he’s alert and hungry, but he’s working so hard to breathe right now that the nurse described it as like you or I trying to do aerobics and eat at the same time. Our attempt at breastfeedng today was a complete bust, so after about 20 minutes I just pulled him up into a kangaroo hold. Despite my disappointment over continued breastfeeding failures, he ended up having a really good rest of the afternoon. He was calmer than I’d seen him in a couple days while on my chest, and hardly had any desats. Those steroid drops really made a huge difference with his congestion, and while he’s still bothered by the reflux, at least he’s breathing clearly now. His weight was up 24 grams tonight, bringing him to 5 lbs 1 oz.

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Baby Emmett, NICU

NICU day 58

Keeping up with the Hoffmans

I had the below post all written out last night, and then things took a turn for the dramatic. It was by far the worst night I’ve had with him yet. The reflux has been getting worse and worse, and he’s had so much suctioning to remove everything that keeps accumulating in his nose, that he’s now developed some irritation in his nose from all the suctioning. His nasal passages got so swollen last night that he could not breathe out of them at all. Babies are obligate nasal breathers, so it’s not like when an adult is stuffed up and just breathes out of their mouth instead. So he would turn purple holding his breath, then gasp and cry out (which thankfully would get some oxygen in him), but then he’d repeat all over again. I felt so helpless. All I could do was stand there holding him upright, sobbing, while listening to him gasp for air. This all went on until about 2 a.m., when the doctor gave him some steroid drops in his nose to calm the inflammation. That at least allowed him to get some air through, but he’s still really struggling to breathe and just sounds so miserable.

Anyway, here’s the rest of what I had originally written yesterday. I don’t have the energy to merge the two or rewrite anything.

* * * *

This morning Emmett’s team started him on Prevacid [edit: I had originally written Prilosec – oops, wrong med!] to help him with the reflux. It will take a few days to see whether it makes a difference. I’m really hoping it does, as it’s pretty miserable seeing him so miserable. This evening his nurse mentioned we would take him off of it if it didn’t seem to be making a difference, “because of the potential side effects.” When I asked her what the side effects were, she kind of stumbled and admitted she didn’t, know and then said I could just google it. Um. Not impressed with this nurse so far. What medical professional tells you to google? Of course google came up with all kinds of awful stuff. I’ve been so good about not consulting Dr. Google when it comes to Emmett, which is very unlike me, so I’m kind of annoyed she sent me in that direction. A few minutes later the nurse came back and said she talked to the doctor and he said the side effects are so rare that they aren’t even worth mentioning unless something seems off with him or he stops growing. Reflux is really common in preemies — and even in term babies — and the treatment with antacids is pretty common.

Speaking of growth, he had a wimpy 2 gram gain tonight, but they’re actually happy with a modest gain, as he’s been a little puffy the last couple days and they think he may be retaining water. He’s had several days of large gains, which would corroborate the edema. The nurse earlier today was even talking about starting him on a diuretic to flush him out. I need to talk to the doctor more about this, as the nurses have been fairly vague and I hope it’s not indicative of something potentially more serious.

Theo came to visit his little brother this evening. I had gone into the office today and after work I got him from daycare and we swung by the hospital for a few minutes. He hadn’t seen him since he got out of the isolette and immediately asked where the top of his bed was. He was happy to see that baby Emmett was bigger, and when I picked him up and crouched down low to the ground so T could get a better look, unprompted, he kissed the top of E’s head. I wish I had gotten a photo, but my arms were full of baby. It was a very sweet moment.

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Baby Emmett, breastfeeding, NICU

NICU day 57

Keeping up with the Hoffmans

Today was kind of a rough day. Emmett’s reflux is getting pretty bad. He isn’t spitting up much, but it is backing all the way up into his nose, which creates massive boogers, which causes him to have trouble breathing, which causes him to desat. He’s also clearly in a lot of pain over it, and he grunts and cries a lot. Because of all the desatting, there was some talk about putting him back on caffeine, or possibly increasing his oxygen support again, but after talking with the doctor, he said it’s not really a lung issue; it’s just the reflux. The caffeine would likely make it worse, and the extra oxygen support wouldn’t even really do much good. We may start him on antacids though.

Breastfeeding was a little discouraging today. He was pretty sleepy and didn’t latch as much as he did yesterday, and having him laying sideways made his reflux worse, so after a few minutes we gave up and I held him upright, but shortly after that he needed his nose suctioned because he was having difficulty breathing. It’s just been a draining day. I know the reflux isn’t anything terribly serious; it’s more uncomfortable for him than anything. But it’s just so draining.

On a positive note, weight was up another 62 grams. He is now 5 lbs!

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Baby Emmett, breastfeeding, health & body, NICU

NICU day 56

Keeping up with the Hoffmans

Today had its ups and downs. After yesterday’s conversation with E’s team, I was excited to get to the hospital today and try breastfeeding. When I mentioned it to the nurse this morning, though (a new nurse we’d never had before), she said, “we usually don’t try that with babies who have breathing problems.” I instantly felt disappointed — and a bit defensive. First of all, he’s on 1 liter of oxygen and we were told we could try nursing once he got down to 2. Second of all, he has chronic lung disease, so by her standards we’d never breastfeed. Third, despite the CLD, he’s been doing pretty well lately (and the doctor said he’d hesitate to even label him CLD at this point since he responded so well to the steroids) so her “breathing problems” comment rubbed me the wrong way. Thankfully I was able to talk to the lactation consultant, who was still on board with trying today, and the doctor was in agreement this was the right time too. So the nurse finally agreed.

The nursing went pretty well. He would latch and then fall off, latch and fall off, and then went to sleep after about 20 minutes of this. So I don’t think he really got much and they didn’t bother weighing him before and after to check, but the LC said it was a great effort for his first time, considering how little he still is. Our plan is to do this once a day until he starts to get the hang of it, and then we’ll kick off the official 72 hour breastfeed. Meanwhile, he’s still getting full meals via feeding tube.

Unfortunately, his reflux seems to be bothering him quite a bit today. He was desatting a ton and he just sounds so uncomfortable when he breathes. This evening at one point he even sneezed and milk shot out his nose. It had been over an hour since his last feed so it was all his previous meal that was backed up all the way into his nose. It’s frustrating listening to him snort and grunt and not be able to help him.

This evening I went to barre for the first time since before I gave birth. It was good to be back, but I definitely felt like I hadn’t been there in two months! I am definitely going to be sore tomorrow, but it feels good to work out again. I’m back to my pre-pregnancy weight, but I just feel squishy. I need to build up some muscle tone again. I grabbed a quick beer with my friend after class and then headed back to the hospital for the night. I have a feeling we’re in for a long night with all the snorting and desat alarms.

Weight was up 78 grams tonight, bringing him to 4 lbs 13.5 oz.

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Baby Emmett, breastfeeding, NICU

NICU day 55

Keeping up with the Hoffmans

Today was another pretty good day. Emmett’s desats were brief and infrequent, and he only had one brady that I saw, which was also quick. He still gets pretty uncomfortable with the reflux, but he doesn’t seem to be desatting as much as a result, so maybe it’s either improving or he’s learning to deal with it. They increased his feeds to 41 ML and he put on 64 grams tonight, bringing him to 4 lbs 11 oz.

I had a good conversation with E’s nurse, physical therapist and the lactation consultant about breastfeeding today. As I’ve mentioned before, being able to nurse E is so important to me, and I’m nervous because preemies often struggle to breastfeed. Many preemie moms end up having to pump exclusively, or switch to formula, despite their best efforts to nurse. To compound my fears, E isn’t really cueing the way he should for us to start nursing. He’s been scoring 2s and 3s on nursing readiness, when he needs to be getting 1s and 2s. But today his team thought we should give it a try tomorrow anyway. They said sometimes babies don’t exhibit obvious hunger cues on their own, but when faced with an actual boob, they figure it out. So we’ll give it a shot tomorrow. I’m keeping my expectations low, but am glad we’ll at least try. The process will take a nurse, a lactation consultant and a physical therapist (that sounds like the start of a bad joke), so I’m sure there will be plenty of awkwardness. It’s a good thing after birthing two babies I’ve pretty much lost my modesty and dignity, anyway!

Baby Emmett, NICU

NICU day 54

Keeping up with the Hoffmans

Emmett had a good day today. They officially stopped his caffeine and increased his feeds to 39 ML. He put on 12 grams tonight, which still rounds out to 4 lbs 8 oz. His face is starting to look downright chubby, and he’s getting rolls all over. He looks just like a normal chunky baby now, just smaller all over.

D was with him all day since I went into the office, and I just got back to the hospital around 9 p.m. tonight. In the short time I’ve been here he’s only had a few very quick desats and is hanging out in the high 90s most of the time. He’s still pretty grunty and refluxy, but overall it’s pretty boring here, which is fine by me.

Baby Emmett, NICU

NICU day 53

Keeping up with the Hoffmans

Today was pretty uneventful. No changes, for better or worse; just a lot of the same. In fact, even his weight remained unchanged. Still holding steady at 4 1/2 lbs.

Tomorrow they are going to take him off his caffeine to see if that helps reduce the reflux. They usually stop caffeine around 35 or 36 week, anyway, and he’ll be 34 weeks tomorrow. It takes about 5 days to leave his system, so by the time it’s out he’ll be almost 35 weeks. Interestingly, I’m getting conflicting recommendations when it comes to caffeine between the doctor on rotation this morning versus the one last night, which is a little frustrating. When I pointed this out to the doctor this morning she said there’s no right or wrong way; just different schools of thought. She explained her reasons and then ultimately left the decision up to me, which is a little scary. I hope I made the right choice!

Baby Emmett, NICU

NICU day 52

Keeping up with the Hoffmans

Today was overall a pretty good day, although I did find out this morning when I called the hospital that they had to put the cannula back since E was having apneic episodes overnight. They said it’s normal to have to go back and forth a few times before it stays off for good, but it was still a bit of a bummer to hear. I slept in this morning, took care of some stuff around the house and then headed over to the hospital around noon. I’ve been here all day and will stay the night since T is still with the grandparents and D was going to a concert tonight. Tomorrow we’ll get T back. I’ve really missed him since I haven’t seen him since Thursday!

E is still having pretty frequent desats, but they’re quick and he pulls out of them on his own. He’s still bothered by the reflux, and consequently, so am I. It’s just so hard to listen to him grunt and cry and not be able to make it better, and the pain is causing him to hold his breath, which is contributing to his frequent desats. I may try modifying my diet to see if that helps. I read that cutting out dairy, acidic foods, spicy foods and reducing caffeine can help. Our kangaroo time got cut short today because he was so congested that they had to put him back in his crib and suctioned out about a million boogers that were a result of all the milk backing up into his nose. Poor kid. But at least now I can pick him up when he gets fussy, and being held upright seems to help with the reflux.

Emmett is continuing to grow at an impressive pace. He packed on 102 grams last night and an additional 76 tonight. He’s now 4 lbs 8 oz!

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Baby Emmett, NICU

NICU day 51

Keeping up with the Hoffmans

Last night I went to the Dixie Chicks concert with a couple friends. It was a much-needed girls’ night out, and I was too tired to write by the time I got home. But now it’s 4 am and I’m up for my nightly pumping session so figured I’d get a quick update out while I’m up. Because yesterday was actually a pretty big day… Emmett is off oxygen!

They decided to remove his cannula yesterday morning, despite the fact he’s still having desats from the reflux. Even when they periodically turned up his oxygen through the desats it didn’t seem to make any difference, so they thought they’d go ahead and give him a try. Worse case scenario they put it back. As you can see in the picture below, they left the pads taped to his cheeks in case they needed to put it back. But so far he’s doing great. No increase in desats — maybe possibly even a teeny improvement, if anything. Maybe he’s just more comfortable without something on his face and up his nose, and it’s possible he’s getting less air in his belly now. They warned us that if he were going to need it back, they would either know right away due to an increase in events, or they would know after a day or so on it because he would start showing signs of fatigue from doing too much on his own. Fingers crossed he continued to do well through the night when I call in the morning for an update!