Sunday, August 14, 2011

Week Six

This Friday Lillian turned six weeks old.[1] She's made some more progress:
  • She's up to 6 pounds 11 ounces
  • She's moved up to nursing four times a day instead of three
  • She's also started nursing "back-to-back"
  • She's moved up to "12-hour request
Those last couple bear some explanation. The procedure for bringing home a baby from the UVRMC NICU is as follows: nurse twice a day → nurse three times a day → nurse four times a day → nurse "back-to-back" → "12-hour request" → "24-hour request" → "24-hour on demand" → bring baby home. Allow me to explain what each of those mean in more detail.

WARNING: If you are bothered by pictures infants in intensive care, you probably shouldn't read on.

When nursing 2, 3, or 4 times a day, the baby is gavaged (fed through a feeding tube) at least once between each nursing. This was to give her time to rest before being breastfed again, which wears her out. The "back-to-back" steps mean that the baby eats twice in a row without being gavaged in between. "12-hour request" means that the baby is nursed whenever it wakes up over a time period of 12 hours, with no gavage. Babies in the NICU are normally gavaged every three hours. On "12-hour request" the baby is allowed to go as long as four hours without a feeding. But once the four hour point is hit, the baby has to be woken up and fed. The neonatologist or pediatrician (depending on which is in charge of the baby) sets a minimum volume as a goal for the baby to achieve in those 12 hours (as determined by weight). The baby is then given a 12-hour rest before starting the "24-hour request" the next day. All the same rules apply except that instead of having a minimum volume to achieve, the baby simply has to make it through 24 hours successfully feeding itself, based on time spent nursing and how rigorously the baby performs. The "24-hour on demand" (or sometimes called "ad-lib") is the same except the baby can now wait up to 5 hours before being woken up for a feeding. If the baby has to go home on oxygen or with monitors, then it is put in a separate room with the parents to make sure they know how to handle the equipment and respond appropriately to the alarms or emergencies. If the baby does not need to go home with oxygen and/or monitors, then it does not get to stay in a separate room with the parents. "Bring baby home", well, that's pretty self-explanatory.


As part of getting Lilli ready to come home we had to do a "sat study". This is to verify that she's able to keep her blood oxygenated on her own. If not, then she would have to go home on oxygen. To pass she had to maintain over 90% of her hemoglobin saturated with oxygen for more than 98% of the time. We had to keep a careful record of what she was doing for the 12-hour test period, including breastfeeding, burping, sleeping, etc. For at least 90 minutes she had to be in her car seat (she actually went 4 hours). Up to this point we were starting to think that she was getting pretty big. But once we saw her in the car seat we were reminded that she's still really tiny. She went 4 hours in the car seat and was fine. She passed her "sat study" with flying colors.

video

Sometimes when she's asleep, Lillian still tries to suck. This is particularly aggravating when we've just spent an hour trying unsuccessfully to get her to eat. For the most part her reflux and spitting up have gone. But this week, for the first time, she spit up all over my shirt. And our pediatrician was there to help celebrate.


When we peaked into her bassinet one afternoon and saw her chilling in this position, we were reminded of her position in one of her ultrasound videos.[2]

video

The video is kind of dark, but at the beginning you can see that when we're not around the nurses have been corrupting our little one and teaching her offensive hand gestures. That's not the kind of birdie that Mom and Dad like to go watch… [3]


And to my ongoing surprise, we still have plenty of Lilli's lilies.


Notes:

[1] For more about her unexpected arrival, see here. For week one milestones, etc., see here. For week two milestones, etc., see here. For week three milestones, etc., see here. For week four milestones, etc., see here. For week five milestones, etc., see here.

[2] It's the fourth video on my post It's a Girl! She had her hand behind her head and her legs crossed.

[3] You can read about some of our birding adventures here, here, and here.

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