Over and Out

It's been a great day with Foster home. We still feel clueless, but it's fun having him all to ourselves. It's so much easier to change a diaper without 6 cords attached to his body and feet!!! He hasn't stuck to the strict schedule of the NICU (eat every 3 hours) but he has mostly slept and ate all day. It's more of a challenge not having a scale to weigh him on before and after nursing, but if he still seems hungry after nursing, we offer the bottle. Trial and error at this point, no more nurses to guide us. We won't know if he's gaining weight appropriately until his first Dr's appointment on the 30th.

The cats seem indifferent to Foster's arrival...unfortunately I can't say the same for Parker. She is intensely observing every move with him (the herding instinct). I think once she gets accustomed to his strange garbled noises, things will settle down.

We can't thank all of our family and friends enough for your support over the past 5 weeks. Even if we didn't reply, your phone calls and emails have lifted our spirits and made us realize we weren't going through this alone. I'm sorry we've been totally engrossed in our own lives and perhaps neglected and missed other important events in your lives, but we are on the rebound. Having a newborn home will be demanding, but we feel we have our own lives back. If I miss blogging, perhaps I'll start a new one, but for now, I'm signing off. I hope everyone has a happy, healthy, and fun summer!

Foster has a new blog...http://fosterlittle.blogspot.com

Finally!

Countdown!

We were pleasantly surprised last night when we arrived for the 6pm feeding and Foster had passed his carseat test and was already hooked up to the 12 hour pneumogram. I guess he got moved to the top of the queue and passed with flying colors! This means that if he continues to eat well ad lib over the next 24 hours, he can go home tomorrow or Wednesday. We are thrilled, and running around frantically trying to get things ready. You'd think 4.5 weeks in the NICU would have us better prepared, but it's all the little things we want to get done without a baby in tow (installing air conditioners, Home Depot, Target, car seat installation, etc). We just learned he ate only 50/60mls at noon, but not to worry, as long as he doesn't lose weight. He weighed 6lbs 7.5 ounces last night. Almost a normal newborn! This picture is of one of our favorite nurses, Kate, who took care of Foster for a significant part of his hospitalization. The nurses are amazing and we've learned so much from them. One of them also made plaques (see below) for the dads on Father's Day.
As much fun as I've had writing this blog, I won't be continuing it in its current form when he comes home. I'm sure life will settle down and all I'd have to write about would be dirty diapers, breast feeding woes, and sleep deprivation. Perhaps I'll start a weekly one for family, but I won't bore the rest of you with the mundane details of life with a newborn.
Hopefully tomorrow's post will include pictures of his homecomming!

Happy Father's Day!

Happy Father's day to Chris and all the dads out there who are following this blog. We are happy that Foster arrived early enough to celebrate with us this year! He got dressed up in a special outfit for the occasion (I couldn't resist the urge to buy it) and seemed particularly happy to be in dad's arms this morning. The best present will be him coming home this week. He is up to 60mls for each feeding and is eating like a champ. Last night he tipped the scales at 6 lbs 4.5 ounces and he is really starting to look and feel like a real baby...less fragile and much stronger! Diaper changes are getting a little more challenging with his strong kicking. He seems to "perform" each time we attempt to change it, and you never know where it is going to end up. The joy of a boy!
Foster is going to have his car seat test this afternoon which entails an hour and a half period where he is monitored to make sure his head doesn't flop forward causing him to have periods of apnea. After that test, the only remaining hurdle is the 12 hour pneumogram, during which he is intensely monitored (even more machinery hooked up to him) to record respiratory activity, apneic events, and cyanotic episodes. Since the NICU is very busy right now, there is a queue for this test (there is only one machine), but he will likely move to the top of the list tomorrow or Tuesday. We can't wait to get this little dude home!
(yes, I bought a new camera...how could I not have one for Father's Day and for his homecoming???)

Look ma, no tube!

Today is the day that Foster got his NG tube pulled! I had a great picture of his tube-free face, but then proceeded to drop the camera on the NICU floor. They didn't make me throw it out (see previous post on the strict floor-drop policy); however, it appears to have some serious lens damage and refuses to power up. So, we're stuck with old pictures, probably for the remaining life of this blog. We've had bad luck with this camera...when Foster was born, we had lost the battery charger and had to rely on my mom's camera when she came to visit. Now, Foster is about to come home and we are camera-less again. I should probably make it a priority to find a camera shop today. I'm just having one of those classic "Liz" days...I dropped the camera, then I dropped my reusable grocery bags in a puddle before going into the grocery store, and then once in the grocery store, I plowed over a whole display of baby belle cheese. Who decides to put 40 boxes of cheese on a flimsy cardboard display in the middle of a busy grocery store isle? But back to Foster...he reached 6 lbs 1 ounce last night and is downing his bottles and putting in some serious breast feeding efforts. He had an eye exam yesterday, since preemies can develop a retinopathy of prematurity (ROP), but his retinas were still too immature to assess. Therefore, the exam will get repeated in 3 weeks. It looks pretty promising that he'll be an outpatient at that point.

Happy Birthday

Today Foster is 4 weeks old. In some respects, the past 4 weeks have flown by...he has grown before our eyes (he is expected to reach 6lbs tonight) and it is hard to picture him as fragile as he was at the beginning. But, for the most part, his birth seems like ages ago. The NICU will (hopefully) soon be a thing of our past, but it has been a long 4 weeks of painfully cautious optimism. Foster has made rapid progress and passed every milestone quickly, but we have always had to temper our excitement and anticipation in case of unexpected setbacks. Just when he seemed to make a leap, the doctors would remind us of all the threats still out there. Even though he is doing incredibly well this week (he ate all of his feedings overnight and nursed a full feeding this morning) and there is much talk of him going home next week, it is hard to get our hopes up until he is in the car with us as we cross the bridge from NJ into PA. So, I am elated he is slated to come home, yet also terrified of a setback at this point, when it is least expected. Everyone keep their fingers crossed that the next 4-5 days go by smoothly and he is home by the end of next week!

Blue Steel

Today has been a spit-up free day so far, although Chris will be there for the noon feeding, so maybe Foster is saving it up for dad! Foster got examined by a preemie physical therapist yesterday and he checked out A-OK..except that he can only turn right. That is, he primarily lies on the right side of his head. A side preference is typical for babies...we will just have to encourage him to mix it up so he doesn't get a flat head over time. It makes him a mini Zoolander (who could only turn right on the runway), which is appropriate since he is also really really ridiculously good looking. This is his killer Blue Steel.

I've decided this is my last week of work and I feel great about the decision. Most of the doctors and nurses are very optimistic he will go home by the end of next week. It will be great to have more time with him in the NICU and to catch up on my "To Dos" before he gets home. He still needs to pass a 24 hour apnea test, the car seat test, get circumcised, and have an eye exam. Hopefully that all goes smoothly and he passes with flying colors.

Weight: 5lbs 14 ounces!!

guest post: best of intentions

Hi everyone, guest poster Dad here.

I got my first "alone" time with Foster this morning, and our lovely NICU nurses were prepared, dressing Foster in a cute blue outfit with a dinosaur and "I love my Daddy" printed on the front of it. I fed him his bottle (52 ml!) and was spending a few quality minutes with him looking up at me when he proceeded to projectile spitup over my back, down my front, and all over his outfit.

I had no idea a 34 week old could spit up with such power and violence. Anyway I screamed for help and our nurse picked him up and cleaned out his nose while I got my bearings.

Although they were sympathetic I'm sure the NICU was laughing after I left.

To work or not to work....

As things are slowing down here, I feel like I have little to report. Foster is doing great with his oral feedings, but we've heard it could be anywhere from 1 week to 3 weeks before he consistently takes all 8 feedings orally. The doctor reminded us last night that even though Foster has made fast progress, he is still only 34 weeks old. This week I'm really struggling with whether or not to continue working. It keeps me busy and from obsessing about him coming home, but it's also very hard to focus. Now that he is bottle feeding, I wish I could visit more. If I stopped working now, I could at least be there for more of the feedings, but if he is in for another 2-3 weeks, it could get frustrating. I have 10 weeks left of my FMLA, and I know I'll want as much time as possible at home with him before I have to return to work in September. We'll see how he does today I guess!
Weight: 5lbs 9.5 ounces.
Picture: Mimi with sleepy Foster

Family visit

Foster had the pleasure of meeting his extended Mills/Marchant family this weekend. Unfortunately Uncle Will had a cold and was not allowed into the NICU. Aunt Sarah and Mimi both got to feed him and he continues to eat well. He is now on "semi-demand" bottle feedings, meaning that if he is awake and hungry at feeding times, they will offer him a bottle instead of tube feeding him. I am still breast feeding twice a day and he takes about 75% of his total feeding from me. Hopefully at this rate he will be home in at least 2 weeks. Last night he was up to 5lbs 8.5 ounces...he's packing on the pounds!

Save the Gonads

There is not much to report today, except that Foster is doing well with his 4x-a-day oral feeding. He is taking almost the full serving each time. This morning he got almost all (44 of 47 ccs) from nursing alone. If he keeps this up he'll be home in no time! He is now 5lbs 6ounces. The nurses swear he is a very "happy" baby and rarely cries. They also warned us he is probably saving it up for when he gets home!
I was saving the below picture for a slow day...it hangs by his bed. You can speculate about its purpose (and it has nothing to do with circumcision).

All dressed up with nowhere to go

Happy 3 week birthday Foster! It's appropriate that in recognition of this day they are upping his oral feedings to four times a day. As you can see...it is all going straight to his cheeks! I've received so many adorable outfits as gifts or hand-me-downs (thanks Valerie!) I haven't bought any clothing for Foster...until yesterday. I was in BabiesRUs for something useful, like a mattress pad, but then I happened to pass by the boy preemie section. The selection was minuscule, but I couldn't resist buying one tiny outfit that will only fit him for a week. He was swimming in the matching hat, but it still looked adorable. For the past 24 hours he has taken his complete oral feedings without tiring out, and our nursing technique is definitely improving. Last night he weighed 5 lbs 3.5 ounces.
This weekend Foster gets to meet his Mimi (my mom), Aunt Sarah, Aunt Erika, and Uncle Will. He's very excited and will hopefully put on a good feeding show!

Chunky monkey

We finally have a five pound baby on our hands! Even though he is still a small dude and weighs way less than any of our cats, it seems like a major accomplishment on his part. He also ate very well this morning...taking all but 5 ccs from nursing and the bottle.
I've had a lot of comments about how much hair Foster has...but compared to many of his neighbors in the NICU, it seems pretty sparse. It is amazing how much hair babies come out with, even 10 weeks early. We think his eyelashes and eyebrows are blond, although occasionally I think they have a hint of red, like dad. No freckles yet!

Cousins on the way!

Foster continues to do well nursing and bottle feeding. The last three nursing sessions he took in 18, 32, and16 ccs. In addition to what he takes from the bottle, he is ingesting at least half of his 45ccs orally. Hopefully that means he will advance to oral feedings three times a day soon. The doctor said that if he keeps up this progress with no major setbacks, he may go home in about 2 weeks. Two weeks seems like eternity, but it is still much earlier than if he was full term. I have to keep reminding myself of that.
We are very excited that Foster will have two new cousins arriving this year. Chris's sister, Laura, is due in August and my sister-in-law, Erika, is due in December. May they both be FULL term!!

Remedial Parenting 101

Although we can't wait for Foster to come home, the cats are in no hurry to share the house with him. Let's just hope he isn't allergic to animals. They tend to ignore his nursery, but Elvis just discovered this comfy new spot to sleep.

Foster is doing better with the nursing...I'm thinking the first weigh-in was a scale error. Last night he gained 10 grams (equivalent to ingesting 10 ccs) and this morning, 18 grams. He is taking about half the remaining amount from the bottle before he exhausts himself. He weighed 4 lbs 14.5 ounces last night.

Having a preemie in the NICU automatically qualifies you for Remedial Parenting 101. Everyday we are surrounded by experts to teach us how to hold, change, swaddle, burp, feed, soothe, and bathe Foster. I now can't imagine having a baby and taking him home from the hospital in 2 days. I would have been clueless. Luckily we'll have plenty of practice by the time he gets home.

More show than action

We are into a new routine with Foster and feeding. Twice a day he gets to attempt nursing and then gets a bottle with the remaining amount he needs. To determine how much he is ingesting during nursing, he is weighed before and after breast feeding. This morning he seemed to be productively nursing for about 3o minutes...I was so confident he had gotten his whole meal. But when we weighed him, he had LOST 2 grams during the feeding. I think he was working so hard he was burning more calories than he was taking in. It's all practice at this point, so with time he and I will hopefully learn how to do it correctly (luckily they have great lactation consultants on staff in the NICU....they are incredible!). When he consistently takes at least 50% of his two bottles (the other 6 feedings are still through the tube), he gets bumped up to 3 oral feedings a day, then 4, 5, etc...When he is ingesting 75% of all his feedings orally, they can consider sending him home. Hopefully we will be able to integrate breast feeding into his totals, but more importantly, we want him home ASAP (even if it means primarily on a bottle at this point). We'll have plenty of time to work on nursing once we are home!

Almost 33 weeks!

Last night Foster was too sleepy to nurse, but we will try again today. He is now 4lbs 13... we can't wait until the 5 lb mark! Just when we think he is looking big, he gets a big neighbor (i.e. 7lbs) who dwarfs him. Or we take a picture like this one of him in my arms, and realize how tiny he is (excuse our clashing outfits and my "deer in the headlights" look). Since he is relatively long, he is fitting into newborn and 3 month clothes, albeit with the sleeves rolled up and some looseness around the belly. It's amazing, since he will only be 33 weeks tomorrow. Although we can bring clothes in for him, they have plenty on reserve. The NICU has a strict "floor drop" policy....ANYTHING that drops on the floor gets thrown out...i.e. knit hats, pacifiers, blankets, clothes, etc. It seems extremely wasteful, but I understand the reasoning around these immune-suppressed babies. Last night I unfortunately dropped the hat I knit for him, but I quickly stashed it away in my purse for posterity sake.

Graduation

Foster has officially moved to Room 3...reserved for only the most "advanced" babies who are learning to eat. He got to attempt nursing last night and this morning, which is a big step in getting out the door. Since sucking is tiring for him, we only tried about 5 minutes last night and 10 minutes this morning. He appears to know what he is supposed to do, but we'll have to work on his stamina. After 10 minutes of nursing this morning, his respiratory rate increased and his oxygen saturation dropped to 85% (it should be close to 100%), signaling exhaustion. When he can latch on for longer periods of time, we will weigh him before and after the feedings to see exactly how much he ingested. They then adjust his tube feedings to make up for the difference. Last night he was up to 4 lbs 12 ounces. His cheeks look chubbier and his thighs are looking a little more sausage-like. He has become much more tolerant of diaper changes and our awkward swaddling attempts...we realized last night we haven't heard him cry at all for a few days. He seems like a relatively happy baby at this point. He is certainly learning to sleep through anything. Although it seems like a NICU would be a quiet place, it is quite the opposite. Every baby is hooked up to at least three alarms (respiratory rate, oxygen saturation, heart rate, fluid pumps, heat sensors, etc) which are constantly beeping (loudly!). Hopefully that ability to sleep will translate at home...sleeping through Parker barking at the mailman. We've heard that NICU babies sometimes have trouble sleeping once they get home because it is TOO quiet. We'll have to set up a few alarm clocks in his room just to recreate the NICU atmosphere. Foster's room is almost ready for him to come home (thanks for the trim painting Chris!), although he likely has at least 2 more weeks in the NICU.

Two weeks old!

This is Foster's new big boy bed...no warmers, no lights, no oxygen! He's been maintaining his temperature well and has had only minor residuals over the past 24 hours. He is still around 4lbs 9 ounces as of last night. He was very alert this morning while we held him for an hour, falling asleep only at the very end. There is a good chance they will let me try breast feeding this weekend if his residuals stay low. He has a strong suck on a pacifier, but that doesn't always translate to a good latch and swallowing technique when breast feeding. We'll see!

Still gaining!

Since he moved into a small open bassinet last night, Foster has been maintaining his temperature without any heat support. Now that he is all bundled up in clothes, blankets, and hats, we'll likely do less kangaroo care and more holding him while swaddled. I know you'll all be disappointed to see less pictures of Chris's hairy chest! Last night Foster was up to 4 lbs 9.5 ounces. He had some "residuals" overnight and this morning (food left in stomach) but we are hoping it was due to a backup since he had a bit of an explosion this morning during his diaper change (I went through 3 diapers in one change). It's common to have residuals, as long as they eventually clear and are not persistent. He needs to be able to handle the tube feedings (40 ccs every 3 hours) before they will let him try breast feeding. Tomorrow is his 2 week birthday!

Happy Day

We finally captured a "smile" (i.e. gas) on film today...I like to think Foster is happy because he is off IV nutrition and got his central catheter out this morning. That means he can get bundled up in real clothes and put in a bassinet to see if he can thermoregulate on his own. It was fun to dress him for the first time, although he is still hooked up to a few monitoring machines, so weaving the lines through the clothes took some maneuvering. He is getting all of his breast milk through the nasal-gastric tube, but they offer the first bottle between 32 and 34 weeks...so it could be anytime that he seems ready. We'll just have to be patient and wait until the doctor makes that call. His weight last night was 4 lbs 7.5 ounces, a gain of 80 grams. He seems to be filling out more, with pudgier cheeks and thighs!

2000 Club

Since I'm back to work this week, the blog updates will likely come in the evening. Last night we decided to swaddle Foster instead of kangaroo care...just to get some more eye-to-eye contact while he was awake. As you can see, it didn't last long before he was sound asleep in Chris's arms. Last night he was up to 2000 grams....exceeding his birthweight by 10 grams...yippee! At this rate, he should keep on gaining, barring any major complications (such as necrotizing enterocolitis, another serious concern in preemies, but I won't even discuss it unless it happens). Today, Chris and I split shifts...Chris went early am and I went at lunch. We'll both go together tonight. Chris did kangaroo care for a while, but when I went, Foster was sound asleep, so I didn't wake him. Before I left he started to stir a bit and seemed to be waking up...probably because of his dirty diaper. Although Foster's bilirubin went up a little, they still kept him off the lights, assuming his liver will gradually metabolize the excess. He will be off TPN (IV food) at midnight tonight and after 24 hours, they will remove the PICC line (central catheter) since he will be on 100% breast milk. That will be a relief, since PICC line infection is a major concern.

No more lights!

Foster is 1 week 3 days old, but is 32 weeks gestational age. It's hard to believe he should still be in utero for another 8 weeks. Last night he was up to a whopping 4 lbs 5 ounces...almost back to his birth weight! That could decrease with a single large bowel movement, but we're glad he appears to be putting on the pounds. He is now eating about 25 ccs a feeding...almost an ounce. We thought he looked exceptionally long in this picture...and with a belly full of food. This morning his bilirubin is down to 6, so they are taking off the bilirubin lights for 24 hours to see how he does on his own. Since he is off the lights, we can hold him as long as we want, as long as he gets some sleep while doing so. We were limited to 2 hours a day while he was on the lights, so I can tell already it will be hard to leave him now that we're not limited on time. When we put him back in the isolette last night and this morning, he had long periods of alert wakefullness, during which he appeared to be playing with his arms and legs and was really taking in his surroundings. I think he really enjoys having the purple shades off!