Four weeks 1 day old

Written September 30, 2013 9:39pm

Evan and I got some quality snuggling time in today. We snuggled for a whole hour. It seemed like it was over way too fast though. Evan is still hooked up to his monitors while we cuddle. The nurse keeps an eye on his stats just to make sure he's doing okay. Kangarooing is great to help preemies learn to regulate their own temperature. With our previous snuggles, the temperature monitor has been silent (except for Sunday when it was unplugged so it alarmed every. minute. No lie.). After about 45 minutes, the monitor all of a sudden started going off. I could tell that Evan and I were still nice and cozy so I couldn't figure out what the problem was until the nurse said, "Yeah, the monitor is saying "hot baby"". Whoops - guess Evan and I were a little too snuggly! I pulled the blanket off the top of his head to let a little heat escape.

Andrew and I learned tonight that today's echo of his heart showed that the PDA had closed up on it's own!! What a huge sigh of relief. If the hole hadn't closed, it would have meant surgery. We're both so happy we won't have to go down that path. The resident did say that Evan still has a small PFO. Apparently he's had this along with the PDA but we were never told. The doctors were more concerned with the PDA. Again, let me turn to my trusty medical book of Google to define a PFO (from http://www.nlm.nih.gov/medlineplus/ency/article/001113.htm):

"Patent foramen ovale (PFO) is a hole between the left and right atria (upper chambers) of the heart that fails to close naturally soon after a baby is born.

A foramen ovale allows blood to go around the lungs. A baby's lungs are not used when it grows in the womb, so the hole does not cause problems in an unborn infant.

The opening is supposed to close soon after birth, but sometimes it does not."

Thankfully this does not sound like a big deal. Hopefully I'll be able to learn a little more about it tomorrow during rounds.

Evan was very, very wiggly tonight. We measured his head (about 26 cm circumference) and changed his diaper. He was very handsy and kept pulling out the prongs in his nose. Every time he would get one out, he'd smile and kick his legs. Little man definitely thought he was playing a game.

Andrew was able to change a diaper before work this morning. He also held Evan up while his bed was changed. I'm glad to know the nurses put him to work!

Tomorrow is Evan's one month birthday. It's hard to believe he's a month old already!!

Four weeks old!

Written September 29, 2013 5:56pm

Evan hit the 4 week mark today! To celebrate the milestone, the PICC line was taken out of his arm. I take this as a great sign he won't need instant access for any continuous meds anymore.

After Evan's busy night last night, I kind of assumed we'd just observe him today. I was super excited to learn that I'd be able to hold him again today. We snuggled for about 45 minutes. He was all bundled up like a little taco and just slept on me. He has to get a little bigger so I can look at him easier. Right now I'm stuck trying to sneak glances at an awkward angle!

Evan's respiratory situation seems to be settled. He is on a CPAP (continuous positive airway pressure) now. This provides pressure to his lungs (to continue to help with the weakened lungs) but he does all of the breathing. He didn't try to pull the nasal prongs out of his nose today, but he did try wiggling out of them.

Evan did successfully pull out his OG (feeding) tube - again. He pulled it out last night too. Andrew and I both thought it was a process to put it back down his throat, but it isn't. It takes the nurse about 15 seconds to put it back in place. Since Evan is so drooly, the saliva helps loosen the tape holding the tube in place and then he just slowly sneezes/coughs/pushes/pulls it out. I'm not quite sure what his thinking is since he likes to eat! He certainly isn't ready for a bottle yet. (They can start bottling as early as 33 weeks.)

Speaking of eating, Evan is receiving all his nutrition from breast milk now! He no longer receives supplemental nutrition via an IV. The doctors have pumped up the calories in the breast milk so he can continue to bulk up. There are 20 calories per 1 ounce of breast milk. There are 30 mL in 1 ounce. Evan will be at 20 mL of breast milk this evening. They are holding back a little bit since he does have the PDA. They don't want to over work him until they know how the PDA looks. He has an echo scheduled tomorrow to check on the PDA. I am really hoping it closed on its own so he can start really packing on the pounds. (His cheeks are pudgy, but they could stand to be pudgier.)

It's so hard to believe everything that has happened the last few days. When I was holding him today I had the overwhelming urge to just bolt out the door with him. Yes, he's little, but he looks and acts just like a full term baby! Andrew and I have to store up all the happiness that we're feeling. Evan is only about 75% "cooked" (as Andrew so eloquently put it today) so he still has plenty of milestones that he'll need to hit. Every week may not be as amazing as this one.

We'll keep wishing and praying for Evan to continue to amaze us. Nurses and doctors stop us in the hallway to tell us what a great job he's doing. He is so strong. I keep telling him to slow down, that he can just take it easy.

What is PDA?

Written September 11, 2013 6:54am

I thought I'd drop a quick explanation of PDA or Patent Ductus Arteriosus.

PDA is very common in premature babies. In Evan's case, we were told that he has mild to moderate PDA. He didn't experience any symptoms of the PDA in the first 8 days of life so they decided to wait it out. The medication to treat the PDA can be harsh on the developing system. As Evan was okay, the doctors didn't want to put him on the medication too early.

Because I'm not a doctor (yet!), I'll let the National Institutes of Health (http://www.nhlbi.nih.gov/health/health-topics/topics/pda/) explain PDA.

When a baby is born with PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. These arteries are the aorta and the pulmonary artery.

Before birth, these arteries are connected by a blood vessel called the ductus arteriosus. This blood vessel is a vital part of the fetal blood circulation.

Within minutes or up to a few days after birth, the ductus arteriosus closes. This change is normal in (full term) newborns.

In some babies, however, the ductus arteriosus remains open. The opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can strain the heart and increase blood pressure in the lung arteries.

Evan's doctors are monitoring his PDA with frequent echos. He has a follow up echo scheduled the morning on September 11th to see if the medication (Indocin) was effective.

I typically need to know the worst case scenarios (what if the medicine doesn't work, what happens next, will he need surgery, where does the surgery happen, etc). For some reason, I'm taking Evan's PDA on a day-by-day status. It's easy to get caught up Googling other babies and their treatment. Evan is his own little man and he'll do things his way.

Hopefully this helps a little bit with understanding PDA. Just remember, it's very common in premature babies. It is treatable and it shouldn't (won't!) have lasting effects on Evan's quality of life.