Archive | December 2016

Preemie Christmas Part 12

It’s finally here,  albeit a little off schedule. 
On the 12th day of Christmas, the NICU gave to me: 12 feeds to freedom, 11 silver linings, 10 specialists a-knocking, 9 dads kangaroo-ing, 8 moms a – pumping, 7 monitors chiming, 6 nurses charting, 5 needle sticks, 4 brain surgeries, 3 minute scrubs, 2 blood transfusions, and a micro preemie in an isolette. 
In the NICU, we never said “when is Little Miss Minion going to have her next bottle?” It was always “her next feed is in an hour.” Nicu jargon seeped into our lives so much, people actually thought I had medical training, with my talk of vents and shunts and tpn and csf. 
When things were starting to look like she would be coming home soon, the nurses talked to us about what she would need to be able to do in order to leave the nicu. The easy parts, the parts that she would either do or not do, included passing her car seat test (90 minutes in her car seat without setting off her monitors), a hearing test, going a week without setting off her monitors, and maintaining her body temperature without the help of the isolette. The big one was that she had to drink all of her milk by herself for about three days. 
From the time she started getting milk, she took it via a thin, flexible tube that went from her nose to her stomach. When she started taking bottles, it was very tiring for her, so they would give her a little bit from a bottle and “gavage” the rest through the tube. As she got better at drinking from the bottle and her mouth muscles got stronger, she took more and more at each feed. 
In order to leave, she would have to drink all her milk by herself for 24 hours. At that point, they would pull the tube. If she could keep it up for two additional days, or 12 feeds, she would be out the door. 
About a week before she was actually discharged, when we were playing a game of “so close, but not enough,” she pulled the tube out herself. The nurses decided to leave it out and see if she still needed it, which she did, but for those 2 hours, we could see her face without nasal cannula, without tubes, without duoderm tape on her cheeks. We had seen her face without some of these things when they would redo the tubes and tape, but never all at the same time. She looked like any other baby, even though she was almost 3 months old and only 5 pounds. We could really see her face, her expression. It was wonderful.  

Preemie Christmas Part 11

On the 11th day of Christmas, the NICU gave to me: 11 silver linings, 10 specialists a-knocking, 9 dads kangaroo-ing, 8 moms a – pumping, 7 monitors chiming, 6 nurses charting, 5 needle sticks, 4 brain surgeries, 3 minute scrubs, 2 blood transfusions, and a micro preemie in an isolette. 
The thing about the nicu is that it makes you appreciate things you wouldn’t normally think of as a new parent. Things that most parents probably take for granted. Here are my top 11 silver linings. 

11. The fact that there is a special team in the operating room just for your baby. This means they have a fighting chance. 

10. You will congratulate every pregnant person you meet on reaching term (37 weeks).

9. Being in the nicu gives you 24/7 access to medical advice. 

8. Hearing your baby cry. Babies on ventilators cannot cry. 

7. Cares. This is the time of each day when you can interact with your baby. Every three or four hours, the nurses will open the isolette and you can take your baby’s temperature, change the diaper, and see her without the thick plexiglass between you. 

6. Farts. Getting excess air out of the intestines means its easier for your preemie to breathe. 

5. Getting to see (not touch) your baby. After a quick kiss in the operating room, I had to wait several hours to see her again. I’ve heard of other moms who had to stay in the ICU for several days, unable to go to the nicu. 

4. Taking care of your baby. Changing diapers, taking temperatures, arranging the baby back in their Snugli. The nurses will have to show you how to handle all of the equipment.

3. Getting to hold your baby. Sometimes it takes hours, days, weeks, it even months until they are stable enough to be touched. 

2. Getting to leave the hospital as a new mom, even though you can’t bring your baby with you. Preeclampsia/eclampsia is one of the biggest killers of new moms.

1. Getting to take your baby home from the hospital, no matter how long it takes for you to leave. You’ve watched countless other parents take their (giant) newborns home, and now it’s finally your turn. You’re waiting for the nurses to come get you and say they made a mistake. You don’t really believe it until you are home.

Preemie Christmas Part 10

Having a cold can really derail things. 

On the 10th day of Christmas, the NICU gave to me: 10 specialists a-knocking, 9 dads kangaroo-ing, 8 moms a – pumping, 7 monitors chiming, 6 nurses charting, 5 needle sticks, 4 brain surgeries, 3 minute scrubs, 2 blood transfusions, and a micro preemie in an isolette. 

Preemies are often “followed” by various specialists in the nicu. Depending on their specific health concerns, some babies could be followed by several doctors in addition to the normal neonatologists. 
Little Miss Minion had a very diverse medical team looking after her during her 3 months, so get ready to meet them! 

1. Neonatologist: a doctor who specializes in preterm/newborn babies. These are the main doctors of the NICU. Every baby in the nicu is followed by the neonatologists. 

2. Respiratory therapists. These people are assigned to babies who are using any kind of breathing assistance, whether it’s a ventilator, CPAP, or cannula. They come in periodically and check the settings, adjust hoses, and generally make sure that everything is working perfectly. 

3. Physical therapists.  Even in the nicu, physical therapy is a big deal. PT is there to create a plan to keep baby’s muscles developing properly. Babies in utero have the resistance of the womb to push against, while “outside babies” have nothing but the special beds of the nicu, which aren’t quite the same. PTs are also the main players in keeping the baby from developing a flat head and/or torticollis, which is imbalanced neck muscles. 

4. Occupational therapists. This one threw me a little at first. What could a Preemie possibly need with occupational therapy? Turns out, they serve a pretty important purpose: setting the plan for baby to learn to use a bottle. Many preemies find bottle feeding to be easier than breastfeeding, Little Miss Minion included (see my previous posts about the joys of pumping). The occupational therapist determines the best position for each baby to feed in, the size of bottle nipple, and they pin point the stress cues that each baby exhibits during a feed. Little Miss Minion was fed by “pace feeding,” which is when the baby is propped up like they are sitting in a chair and the bottle is only slightly inclined. This allows the parent to control the flow of milk. She used an Ultra Preemie nipple for several months before graduating to the regular preemie nipple, and then FINALLY the regular newborn nipple. 

5. Opthalmologist. This is a medical eye doctor. Many micro preemies develop ROP, or retinopathy of prematurity. This doctor’s job is to monitor eye development and see if ROP is occurring or if other issues are happening in the eyes. 

6. Pediatric neurologist. This is a doctor who specializes in the workings of the brain. They make sure that the brain is functioning correctly, that the messages are being transmitted and received. This doctor can easily be confused with…
7. Neurosurgeon. This doctor also specializes in the brain, but in the physical function of it. In Little Miss Minion’s case, the neurosurgeon monitors her hydrocephalus and makes sure her shunts are working. 
8. Lactation specialist. This is a person trained to help new moms breastfeed or pump. 

9. Nicu follow up team. This is a group of nicu personnel who test and measure the progress that the preemie makes once they graduate the nicu until they turn 2 or 3. 

10. Pediatrician. This is the doctor that the preemie will see once they graduate. 

Preemie Christmas Parts 8 & 9

On the (eighth and) ninth day of Christmas, the NICU gave to me: nine dads kangarooing, eight moms a-pumping, seven monitors chiming, six nurses charting, five needle sticks, four brain surgeries, three minute scrubs, two blood transfusions, and a micropreemie in an isolette. 

I’ll start in order. I was super impressed with myself for thinking up day eight. The original verse is “eight maids a-milking,” and my verse is “moms a-pumping.” Lol. Anyway, pumping in the NICU is almost like a rite of passage for preemie  moms. I don’t even remember my first couple pumping sessions because I was so out of it on magnesium. My first memory of pumping contrasts sharply with what I thought my first time feeding my baby would be. I pictured me, in a hospital bed, relatively healthy and not sliced open, with my baby, as we both learned how to do this thing called breastfeeding. Mr Minion would be in charge of bringing me snacks and stuff. 

Instead, I got a hazy couple of days post-surgery, where I was confined to bed due to my epidural and magnesium. The very first time I actually remember pumping was at like three in the morning a couple days after Little Miss Minion had been born. I was on a very erratic medication schedule, since I spent pretty much every waking minute in the NICU, and my pain meds had long worn off. Looking back, this was a serious error on my part. When you are pretty much disemboweled, albeit gently, you want to remember to take your pain meds. Anyway, so I’m in agony, unable get out of bed by myself. Mr Minion and I tried to set the pump up in my bed, but the angle was wrong and I couldn’t change it because of the blinding pain. So he had to pretty much pick me up without opening my incision and help me hobble to the small couch he slept on. I was freezing and shivering aggravated both my incision and my back. I had been sitting and sleeping in pretty much one position for days now, so my back was very tight. I remember crying because I was in so much pain, and I was so tired and all I wanted to was sleep.

 The NICU had given us access to their Snappies, which are sterile milk collection tubes that hook onto any pump. They have measurements along the side, because everything that CAN be measured in the NICU IS measured. Where most books and things I had seen measured the amount of milk a baby needed in ounces, these containers measured in milliliters. I would pump and pump and pump and send off containers with five, seven, two milliliters. Mr Minion would come back from dropping them off and tell me that the nurses were so impressed with my output. He would also stop in and see Little Miss Minion during these midnight milk drops, and then report back to me with how she was doing. 

I remember being so determined to breastfeed. It was the only thing left of my “birth plan,” if you can really call it that. The nurses said she wouldn’t be big enough to even attempt it until she reached about 34-35 weeks gestational, so about a month and a half old. In the meantime, I kept pumping. Soon, she was mature enough to start getting my milk through a tube in her nose (nasogastric tube). They started her off with 2 mls every four hours. Then, they upped it to 4 mls. Then, 9mls. My milk supply stabilized and they started freezing it. Then they told us to start freezing it at home because I had an entire shelf in the freezer. One day, I was talking to one of the nurses about how afraid I was about my supply, because I still wasn’t making the amounts usually made by a full term mom. She laughed and walked me back to the freezer, where Little Miss Minion had three big tubs full of snappies. 
Kangarooing is one of the best parts of being a preemie parent. Kangaroo care is when the baby is placed on the chest of the mom or dad, skin to skin, and then lots of heated blankets are arranged over the baby to keep them warm. Kangaroo care is proven to regulate heart rate, breathing, and is the only way to really hold your micropreemie for the first few weeks. It can be a little challenging to work around tubes, wires, oxygen supports, but it’s pure bliss. It helps dads to bond, helps mom to produce more milk, and helps everyone to feel more like a regular family.  The first time Mr Minion and I each held her, it was in kangaroo care. 

Preemie Christmas Part 7

On the seventh day of Christmas, the NICU gave to me: 7 monitors chiming, 6 nurses charting, 5 needle sticks, 4 brain surgeries, 3 minute scrubs, 2 blood transfusions, and a micropreemie in an isolette. 

The chiming of the monitors is the background music to life in the NICU. After scrubbing in, we would walk down the hall to her “pod,” and check the mega screen tvs that held a realtime stream of every monitor in that pod for the nurses. We could see her heart rate, oxygen levels, blood pressure, and respiration rates before setting foot in her room. Sometimes, her section of the screen was quiet. But sometimes, there would be flashing lights and alarms, followed by an immediate sense of panic as we saw what the problem was. Perhaps her heart rate had dropped. Maybe she had forgotten to breathe again. Or, with our brains in hyperactive NICU parent mode, maybe she was crashing. Luckily, that never happened. 

The monitors in each room were linked so that any alarm would split the screen so all the nurses would always be in the loop. It also kept all the parents on edge, because the alarms sounded the same whether they were in your baby’s room or not. Some days, the pod would be quiet. Some days, it seemed like every baby in the place had conspired to set their alarms off in five minute intervals. Some days, you heard silence from your baby’s alarms while another baby set theirs off constantly. I remember watching the monitors one day, early on in our stay. Mr Minion had dropped me off that morning because I still couldn’t drive, so I spent sixteen hours a day there. Little Miss Minion had behaved herself that day, and her alarms were mostly silent, but I watched her monitor split several times an hour as another baby had a very rough day. I watched the blood pressure drop, I watched the heart rate drop, I saw apnea after apnea, and blood oxygen drops into the fifties, forties, thirties. At some point, I know I went down to the hospital coffee shop and got a frozen mocha and took a walk outside in the courtyard, because I was sure the kid wasn’t going to make it. I happen to know that he did make it, and he also happens to have hydrocephalus, caused by a brain bleed. 

One of the requirements to be discharged from the NICU is to go a week without setting off the alarms. Her nurses wouldn’t ever say specifically that she hadn’t set off her alarm as, as a kind of superstitious joke. They would just say that her room had been very quiet. 

To hear the sound that will haunt my dreams forever, click the link below. 

NICU alarms

Preemie Christmas Part 6

On the sixth day of Christmas, the NICU gave to me: six nurses charting, five needle sticks, four brain surgeries, three minute scrubs, two blood transfusions, and a micropreemie in an isolette. 
The nurses are the heart of the NICU. They make everything tick. Eighteen months later, I still remember how they showed us how change a credit card sized diaper without disturbing the wires, tubes, and IV ports coming out of our one pound fourteen ounce preemie. I remember how they taught us to rub her back if she had apnea and forgot to breathe. I remember how they helped us hold her and arranged her oxygen cannula and monitor leads and IV lines. How they took the first picture of the three of us. How they noticed the slight temperature shift and mildly increased heart rate that was the meningitis and sepsis starting to take hold. How they reassured us that she would be ok. How they shared our joy when she was moved to the step down unit. And I will never forget how they cried with us after her first brain surgery. And how I will never be able to say thank you enough times for everything that they did. 

Preemie Christmas Part 5

On the fifth day of Christmas, the NICU gave to me: 5 needle sticks, 4 brain surgeries, 3 minute scrubs, 2 blood transfusions, and a micro preemie in an isolette. 
Preemies get poked and prodded quite a bit during their nicu stays. From blood sugar testing to checking bilirubin  (jaundice) levels to looking for infections…it’s a whole lot of needles. 

This is why some studies show that preemies have a higher pain tolerance than their full term peers. This is also why some preemies, Little Miss Minion included, don’t like to have their hands or feet touched. I think it’s a sensitivity thing or a deep memory of associating hand and foot touches with pain. We have worked with LMM quite a bit with getting her used to touches on her hands and feet. 
All the needle sticks have left their marks. Along with her shunt scars, LMM also has scars from heel sticks and iv lines and needle sticks. But they will be incredible stories to tell: how she survived the nicu.