Tag: bradycardia

Baby Emmett, NICU

NICU day 17

Keeping up with the Hoffmans

Today was a rough day. Lots of bradys and desats. The doctor said it’s just normal preemie behavior, but I couldn’t ignore the fact that this was out of the ordinary for him. So the nurse suggested we check his blood gases to make sure he was still oxygenating well overall. He was, thankfully, but it’s just so nerve-wracking listening to those alarms all day. He seems to have the most events around his feedings, which the nurses say is normal since we’re pushing a lot of volume on him for his size, and when his stomach is full it can start to crowd his lungs. But since growing is the primary goal, and he’ll outgrow these events as he gets bigger, they feel we’re on the right course of care, especially since he always pulls out of these events on his own. The good news is, he’s up 30 grams to 1020 — or 2 lbs 4 oz — and three nurses mentioned tonight how much bigger and healthier he’s looking.

I’m finding all these events kind of hard to handle. At one point this evening I just had to go home for a few hours. It’s tough. On the one hand, I’m afraid to leave because I don’t want something truly catastrophic to happen while I’m gone. On the other hand, I can’t do anything about it anyway, and the mental break is probably much-needed. Someone once told me to make sure we go home often — after all, we have the world’s most expensive babysitters. I guess that’s true, but it’s certainly easier said than done.

D feels like he may be coming down with a cold, so I’m back here tonight for the third night in a row. I’m tired. At least E seems to be sleeping peacefully now and hasn’t had any events since I got back (never mind – spoke too soon).

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Baby Emmett, breastfeeding, NICU

NICU day 15

Keeping up with the Hoffmans

Today was a good day. D spent the night at the hospital last night and said he had way fewer alarms than the last time he roomed in. And today was the same. Fewer alarms are always good! Despite wanting to hold off yesterday on increasing his fortification, the doctor today decided to up it to 26kcal just to see how he did. He did great! He isn’t losing excess water any more, so it seems he’s handling the increase well. And he put on another 20 grams since yesterday, which is awesome.

D and I attended rounds this morning, and there wasn’t a whole lot to report, which is a good thing. We’re in maintenance mode right now. Or as his nurse said to me, “this is the boring part.” I’m totally fine with boring. He’ll have his third and final brain ultrasound on June 18 and will have his eyes checked on June 23rd. Barring any surprises or changes in health, until then they’ll just be fine tuning his breathing assistance and feeding.

Speaking of feeding, I’m finding that I’m getting a little obsessive with pumping output. I’m still a little behind what I should be producing at this stage, but I’m rapidly catching up. The lactation nurse says I should ideally be making 24 oz per day right now and I’m on track to get 21-22 today, up from 19.75 yesterday, which is up from 18.5 the day before. I’m taking fenugreek, drinking mother’s milk tea and trying my best to stay well hydrated. I’m tracking all my sessions on an app that puts everything into graphs and tables for me. I do love me a good graph! Breastfeeding was always something that was so important to me with Theo, and even though I got off to a rough start this time around, I’m trying really hard to make this work. I’ll be the first to admit, I have control issues. And since so much of what we’re dealing with is beyond our control, this is something I feel like I can control, though not without a ton of effort on my part.

E and I had a great kangaroo session today. He did have one brady episode, but aside from that, he was great and we snuggled for more than two and a half hours. I was completely blissed out, and E got down to 21% oxygen and still managed to keep his saturation in the 90s most of the time. In fact, I went home for dinner shortly after our session and came back a few hours later and he was still hanging out happily in his isolette at 21%. It really is amazing what that human contact does for him. And it makes sense. Babies need to be held a lot, and he should still be on the inside – the ultimate hold. It’s just too bad it’s such a process to get him in and out of his isolette and that we can only do it once a day. I’m looking forward to the day I can hold him all the time. I did a lot of babywearing with Theo and I have a feeling I’m probably never going to put E down once I get to take him home.

Bliss.
Bliss.
Baby Emmett, musings, NICU

As long as he’s okay, I’m okay.

Keeping up with the Hoffmans

Predictably, we get asked a lot: “how are you doing?” My answer is usually, “we’re okay.” And it’s true. We’re okay. Not great – this isn’t an ideal situation, no matter how you spin it. But I’m acutely aware of how much worse it could be. And that fearful day I was in labor by myself, I definitely pictured all the worst case scenarios. I was mentally prepared to say goodbye.

But as it turns out, Emmett is a NICU rock star. The doctors and nurses all say so. All of his “setbacks” so far have been minor, and par for the course for a baby born before he even reached the third trimester. So while I can’t help but hold my breath with every desat and feel like my heart stops with every brady, it’s completely unreasonable to expect a micro-preemie to regulate his oxygen levels or heart rate on his own. The doctors have every expectation he’ll grow out of this as he gets bigger and stronger, and by the time his original due date rolls around, he should be a fairly normal infant, just three months behind what his actual age says. Most preemies go by two ages, actual and adjusted, until they’re about two years old, by which point they usually “catch up” to their actual age.

That said, I’m aware that things can change on a dime. As I’ve mentioned multiple times, the NICU mantra is two steps forward, one step back. So far we’re more like three or four steps forward for every step back, but I know that may not always be the case. There may even be days where we are taking more steps back than forward and so I’m trying to temper my optimism with a good deal of caution. People keep telling us how strong we are, but I can’t take credit for that — it’s only because Emmett is so strong. If there comes a day where we take some major steps back, I might not be okay. But until then, I keep repeating: as long as he’s okay, I’m okay.

We can handle anything as long as he’s okay.

Baby Emmett, NICU

NICU day 14

Keeping up with the Hoffmans

Last night was a little rough. It wasn’t anything terribly serious, but Emmett had about a million desats and a few bradys and the alarm was pretty much going off all night. And when he wasn’t tripping his alarm, he was fussing, so I was up consoling him a lot. Needless to say, I didn’t get much sleep. I’m home tonight and hoping to catch up.

The nurse thinks the increased desats may be partially due to the increased feed volumes. Basically his stomach gets so full it pushes up on his lungs and makes it a little trickier to breathe. They aren’t too worried about it and say he should learn to adjust pretty quickly. Right now the highest priority is putting on weight, as the desat and brady episodes are something he should naturally grow out of as he gets bigger.

Unfortunately, we had to postpone one part of his feeding plan. In addition to increased milk volume, we were supposed to increase the fortification of my milk from 24kcal to 28kcal — but he’s losing a little too much fluid via his diapers and the nurse thinks he might not be processing the fortified feeds as well as he should. So we’re going to give it a few more days and try again. At his weigh-in tonight he was up to 2 lbs. 2 oz. Keep growing!

The nurse drew his bili again this morning and it was slightly elevated — up to 3 from 1.5. It wasn’t high enough to put him under the lights again just yet; they are hoping at this point he can regulate his bilirubin on his own. So they’ll check again in a couple days and decide then whether he needs another session.

He also had another head ultrasound today to check for brain bleeds. Apparently this is something they do three times in preemies — at one week of life, two weeks and then a final time at 30 days. I had assumed since our first scan was clear that they wouldn’t be doing one again, so I was a little surprised when the ultrasound tech showed up on our room this morning and I got a little emotional with worry. Happy to report all is still clear. At least now I’ll be prepared for the third and final ultrasound in another couple weeks.

We had a good kangaroo care session today. He was very mellow and stayed on me for about two and a half hours. I also got to help the nurse reposition him in his isolette, which included holding him while the nurse repositioned his sleeping pad.

All in all, a pretty good day, despite a sleepless night before. E is now two weeks old, which is really hard to believe. It feels like it’s been forever and just yesterday at the same time.

Those are my hands holding him!
Those are my hands holding him!
Baby Emmett, NICU

NICU day 12

Keeping up with the Hoffmans

I should be 28 weeks pregnant today. Mondays were the day I got to jump to the next week. It’s surreal to be staring at my baby through an isolette instead of staring at my growing belly (not to mention, my body is almost back to normal again, which is weird too). Never in my wildest dreams did I think we’d be here, and some days I still feel like I’m dreaming. I kind of alternate between just going through the motions in a daze and feeling completely overwhelmed with reality. But at least for now I feel like we’re settling into a pretty good routine, and balancing home life and NICU life – something I was told was one of the hardest parts – hasn’t been as hard as I’d imagined. Part of that might be my tendency to time manage better with a really full plate. But I think a huge part of that is having an equal partner in D, and having a child at home who forces us to maintain some sense of normalcy. And even though D went back to work, his work is very flexible and he’s able to do a lot of it from the hospital. We manage to have dinner together most nights, and lunch together pretty frequently as well. It’s not an ideal situation by any means, and some things like sleep, housework and the dogs have definitely taken a back seat. But overall I’d say the balancing part isn’t as bad as it could be.

I didn’t get a lot of sleep last night. E’s alarms kept sounding – he had several desats, even though his oxygen was turned up to 28%. He also had a few bradys, which are always a little unnerving. The good news is, his bili levels were low again (1.5) so he got to come off the lights. It’s normal for them to come on and off several times – and even term babies sometimes deal with this – but I’ll be happy when the lights are gone for good. He’s eating like a champ and we’re up to 16 ML every three hours, which is considered a full feed for this age. From here on out it’s just fine-tuning as far as feedings go, depending on his weight and other needs. The doctor mentioned starting him on vitamin D (and something else I’m blanking on right now) and iron. But those will just go in through his feeding tube. Typically preemies get to start bottle or breast feeding around 34 weeks — 33 at the earliest (they have a hard time coordinating sucking, swallowing and breathing before then). But in the meantime, we’re told the pacifier can help develop his sucking, and when we’re doing skin-to-skin I can sort of follow his lead and if he makes his way toward the breast (some babies will do this instinctively – pretty amazing), to let him. As of now he’s still pretty tiny and immobile when we’re doing kangaroo care, so I don’t see that happening any time soon. But that’s encouraging to look forward to.

Speaking of kangaroo care, today’s was kind of a bust, which was really disheartening. He just couldn’t keep his oxygen levels up, even though his oxygen is usually higher when he’s on me. He just seemed kind of stressed out and not breathing well, so the nurse ended up putting him back in his isolette after only about 15 minutes. Incidentally, right afterward she suctioned a large booger out of his nose and then he started breathing a little easier. She said we could try kangaroo care again later, but I had to leave shortly afterward to get home and take T to a birthday party.

D spent the afternoon at the hospital and will stay the night tonight. He said E had a really good rest of the day with no alarms or anything. Maybe it really was just a booger. Amazing how something seemingly insignificant can cause such problems for a preemie. At one point this evening the nurse redid his cannula and D was able to snap a rare photo with E’s face more visible while it was briefly off. He really is growing and changing fast, and I think he looks a bit like Theo! His weight was up to 921 grams today, or just over two pounds. Keep growing, little Emmett!

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Baby Emmett, NICU

NICU day 10

Keeping up with the Hoffmans

We have hit double-digits on days in the NICU. Here’s to hoping we don’t ever hit triple digits.

Last night and today were relatively uneventful with E again. He had a few desats (oxygen saturation levels dropping below the 88% threshold), but only one bradycardia that I’m aware of today. I held him for almost two hours again this morning (he did amazing!), and then I went home and passed D the baton. D’s dad and step mom came to visit this afternoon while I watched Theo, and then they all came home and the in-laws brought us dinner. Then D went back for the night. E got weighed again tonight and is up to two pounds! You know your perspective is skewed when that seems SO BIG! Proud of my boy. Feedings are going great. We’re now up to 12 ML every three hours, and they began fortifying my milk today with extra calories and protein to help him pack on more weight.

So, tonight was supposed to be my night to get some rest at home, but when I was giving T a bath, he complained that his penis hurt. Then after his bath, when he was going pee, he started crying and said it hurt to go. Great. Sounded like a UTI to me, so I got him dressed and loaded into the car, and off to urgent care we went. Only when we got there, urgent care was closed. (D asked me if they had “I hope it wasn’t really urgent” on the door.) I didn’t think it was quite ER-worthy so I told Theo the doctor went home and we’d have to wait until morning. His response: “The doctor was tired?” (Yes, sweetheart. So is Mommy.) When we got home, he went pee just fine and said he was all better. Go figure. I guess I’ll see how he feels in the morning and whether I actually need to take him in. I hope he isn’t starting to make stuff up for attention. We really have been trying so hard to make things as normal as possible for him throughout this whole ordeal.

In other T news, he woke up from his nap this afternoon with a runny nose. I’m really hoping neither D or I catch his cold, or we’ll have to stay away from the NICU until we’re better. That would be pretty devastating. So far it hasn’t been so traumatic to leave E at the hospital because we’re never gone for long and one of us is almost always there. Not being able to see him for several days, though? I think that would break me.

Tomorrow I’ll spend the morning with T, then D will come home and have lunch with us and then I’ll head back to the hospital for the afternoon/night. Onto day 11…

Kangaroo selfie. (Pretty sure this ordeal has aged me about 10 years.)
Kangaroo selfie.
Baby Emmett, breastfeeding, NICU

NICU day 9

Keeping up with the Hoffmans

Today was a relatively uneventful day, as far as E is concerned. They increased his feedings to 9 ML every three hours. Tomorrow they’ll go up to 12 ML and will also start fortifying with a high-calorie supplement to help him put on weight. Speaking of weight, he is finally officially back to his birthweight. Actually, he’s a little above (860 grams vs 840 grams, but still rounds out to 1 lb. 14 oz.). So that’s all good news.

His breathing was a little all over the place today. For much of the day he was on 21 percent oxygen, which is essentially room air. But he had a few desaturations, so they’d turn his oxygen up a bit. But then he’d be hitting 99-100 percent oxygen (sweet spot is between 88 and 98 percent), so they’d turn his oxygen down. Repeat, repeat. It was a bit of a dance, trying to keep a balance. He had a few more brady episodes today (heart rate drops), but not nearly as many as we had yesterday. We got to do kangaroo care again today around 2 p.m. for almost two hours and it was blissful like yesterday. My sister-in-law came to visit for a bit this morning, and our friend Matt cooked us dinner this evening at our house. I’m back at the hospital and will be staying the night. It’s pretty quiet here right now and the night nurse is someone I like. Overall, it was a good day.

The one sour part of my day was fighting with insurance. I have been trying for a week to get a breastpump sent to me (thankfully the hospital has given me a loaner in the meantime). The issue is, I need a hospital-grade pump, and the insurance company seems to think that’s not necessary. It drives me absolutely batty that the people in charge of approving or denying insurance claims don’t even have the medical knowledge that should be required to do so. My insurance plan clearly states that a hospital grade pump is covered when medically necessary. And since prescribing a hospital grade pump is nationwide standard protocol for preemies — and I have a preemie — you’d think this would easily fall under the “medically necessary” category. A regular pump isn’t typically good enough when you’re trying to bring in your milk: A) by solely pumping and not nursing (nursing is much more effective) and B) weeks or (in my case) months ahead of schedule.

When I’d initially called to order the pump last Friday, they’d said they were shipping it Monday. When it hadn’t arrived by Tuesday, I called, only to find out I’d been denied (thanks for notifying me?). The insurance rep kept asking me if I had tried a regular pump first and I had to keep repeating myself that that’s not what my doctor prescribed. At one point she even asked me if I’d tried “just nursing him.” (Uh.) They told me my doctor needed to provide a statement of medical necessity – which is pretty much what I thought the prescription was, but okay, fine. So I called my doctor and explained what I needed. No problem, they’d send that over that afternoon. When I still hadn’t received my pump today, I called again. They claimed they had never received the statement of necessity. I had my doctor send it again. They still claimed they hadn’t received it. But then changed their story and said because it was previously denied, I couldn’t file the claim again for a year. I ended up escalating to a supervisor, and an hour later, they finally agreed to cover it. I’m still fuming. With everything I’m going through right now, this is really the last thing I need to be worrying about. The part that makes me so angry is you know they knew they should be covering it. I’m pretty sure insurance companies deny things and “lose paperwork” on purpose because they know a lot of people won’t fight it or will give up.

Now that I’ve gotten that off my chest, I’ll end this post on a positive note with a couple photos. Because it really was a good day overall.

Tiny hand.
Tiny hand.

 

Tummy time (note, despite the fact that you aren't supposed to put infants on their tummies to sleep, it's actually good for preemies and helps them with their breathing - just thought I'd point that out so no one worries! :)
Tummy time (note, despite the fact that you aren’t supposed to put infants on their tummies to sleep, it’s actually good for preemies and helps them with their breathing – just thought I’d point that out so no one worries! 🙂
Baby Emmett, NICU

NICU day 8

Keeping up with the Hoffmans

Last night was a little rough. Emmett had several bradys and vagels (heart rate drops brought on by gagging/choking). He recovered every time on his own and the team says it’s normal, but no parent likes to hear their baby’s alarms going off because their heart rate is dropping. I didn’t get much sleep at all, and I was still stewing about the nurse situation. In addition to last night’s cannula debacle, she just had no bedside manner. Not once did she even acknowledge the stress I’m under, even as I was curled up in the corner, sobbing. And not once did she talk to Emmett while handling him, and she handled him a little too rough, in my opinion (of course, that could just be the mama bear in me).

The good news is, one of my favorite nurses was on today. She is just so compassionate toward me, and talks sweetly to Emmett, which is exactly what a NICU nurse should do, in my opinion. One of the first things she asked me today was how I was holding up, and when I’d like to hold him. Since they like to time kangaroo care around when they do their “cares” every three hours (feeding, changing diaper, taking vitals, etc.), we decided I would hold him after his 2 p.m. cares. They also needed to swap out his isolette, which they do once a week so they can thoroughly clean them, so we decided they’d take care of that while I held him. The type A in me likes having a plan, and the “yellow” in me (a reference my work friends will get) likes being involved in said planning. So the morning got off to a good start. We had a plan.

The team holds parent rounds every Thursday at 10 a.m. so it was good to attend that today. This was our second time attending, though I honestly couldn’t tell you what they said at last week’s because I was still in a fog, less than 24 hours after giving birth. Today’s felt much more productive. I felt like I was more of an active participant in the discussion of his care and I’m starting to understand (and speak) the lingo. It was reassuring to hear the doctor say he wasn’t concerned about the bradys and he emphasized again how amazing Emmett is doing, especially for a baby born at 26 weeks. Part of me sometimes wonders whether they say that to all the parents, to reassure them — but if so, it’s working. I felt 100 times better after attending rounds. Our Emmett is certainly living up to his name, which means “strength.” Interestingly, I hadn’t even taken the meaning of his name into account when we picked it. It’s all a bit serendipitous.

One of the things the team discussed at rounds was starting to give E more breathing independence. Because he’s been doing so well, they decided to reduce his PEEP levels (positive end-expiratory pressure – essentially keeps his lungs partially inflated, even after he breathes out). The hope is to start weaning him from some of his assistance and move toward having him doing more of it on his own, so reducing PEEP was the first step. Unfortunately, it was kind of a bust. He had a few more apnea episodes than before so they turned it back to where it was before. Not a big deal – it was still pretty early to be doing that so we’ll give it some more time and try again.

As mentioned earlier, we planned to do kangaroo care at 2 p.m. I’m happy to say, it went much better than last night. I think a huge part of that was that my nurse really took the time to make sure E was situated on me in a comfortable way, that his wires were all tucked out of the way and his head was positioned in a way that allowed him to breathe easily. She also made sure I was comfortable, with pillows propping my arms up and warm blankets covering us both. E did fantastic and I held him for two and a half hours. Like the first time we did kangaroo care, E’s breathing and heartrate were steady, his O2 rose, and he just seemed so content. I fell asleep again too. One of the benefits of kangaroo care is that it increases prolactin — which helps with milk production but also makes you feel sleepy and euphoric. It was wonderful. I could have held him forever, but I had to leave to get T from daycare at 5 and needed to pump one more time before I went. I think I’m going to try to do kangaroo care during the day from now on since I like our day nurses better than our night nurses for the most part. Having someone take the time to get us situated really makes all the difference in the world.

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D is staying the night in the NICU tonight and I’m back home. Most of the time I really don’t mind staying at the hospital. The bed is comfortable enough, and I like being so close to him (and truthfully I don’t sleep that much better at home, anyway). But after last night, I think it’ll do me some good to get away for a bit and decompress. Right now I’m catching up on The Bachelorette, and I must say, it’s nice to do something mindless.