Tuesday, April 29, 2008

We've been busy......

Hi All! We apologize for taking so long to post anything new. The NICU has kept us very busy since the 20th. The girls moved to the "growers and feeders" side and it has been a whirlwind. They are on the fast track to coming home, but it takes a lot of work for them, us and the nurses. There are three basic skills that preemies have to obtain: Regulate their own body temperature (get to wear clothes and sleep in a crib not an incubator); Eat from a bottle (perfect the suck, swallow, breathe reflexes); and the final and often last one is to remember to breathe without apnea episodes (a's and b's). So, here's what we have been up to.....

Avery - Regulates her own temp and is now sleeping in a regular crib with clothes on. She has been taking her food through a bottle and even did well with breastfeeding. She remembers to breathe most of the time, but still has the occasional episode. We were told that she could be home in as soon as a week if she progresses as she has been!!!!!!!

Emily - Still working on regulating her own temp, but she is ALMOST there. She has been taking her food through a bottle as well and is doing very well with it. She is getting better with breathing, less episodes, but she is still working hard in this area. Nevertheless, she is just right behind her sister!!!!!!!

They are both growing and changing SOOOO much. Avery weighs 4 lbs 9 oz and Emily weighs 3 lbs 7 oz, up from birthweights of 3 lbs 5 oz and 2 lbs 5 oz respectively. Miss Avery has hit a growth spurt, wait until you see her cheeks, OMG! I noticed yesterday that Emily is just starting into a growth spurt right now also. They definitely have their own personalities already. Avery is slightly dramatic since she is out of her crib, putting her hands over her face and ears to block out noise and light. Emily is the sportier and more coordinated of the two...she is all over the isolette, kicking and moving. She already knows how to hold her pacifier in her mouth as well as take it out and put it back in!!!!!!! Are you kidding, she's 3 lbs!

The nurses have wanted our involvement so much recently. It's been very important for us to spend as much time as possible with them, as this seems to speed their development. So, we have been learning how to feed and burp them, bathe them, handle them, etc. Also, since there is a chance they might come home on apnea monitors we have wanted to educate ourselves as much as possible in this area, as well as CPR. We have had to move interviewing pediatricians to the top of our list. We are very confused about vaccinations. There is a lot of research for and against. If anyone has any good info on this subject please email us.

We did have quite a trying week with little Emily. A few times we walked into the NICU and she was in less than a desirable state. One time her arm was down in a crack of the bed about an inch wide. Another time she was struggling so hard to breathe that I started bawling and immediately got the Dr. involved. He suctioned her nose out and said she was bleeding quite a bit in there b/c the nasal cannula (oxygen) dried her out. Then she had an apnea episode and there were no nurses in sight despite her alarm dinging. This was very scary. In fact, it prompted us to pop up to the hospital in the middle of the night (when we had just left a few hours before) to keep the nurses on their toes. We ended up staying until 4 am asking many detailed questions about the breathing and monitors. We have decided to take a more vocal approach with the nurses, otherwise they will just go about their job and maybe not take such a proactive approach with checking on them.

More to come, but just wanted to give everyone a quick update! Thank you so much for your wonderful support and keep praying, we are not quite out of the woods yet.

Heather

Friday, April 18, 2008

We've graduated!

When I say "we" I mean the girls. The NICU here at St. Lukes has two separate areas. The one where the girls have been since they showed up is the critical care side. The nurses and docs there spend a lot of time just trying to stabilize their guests. The doc said the other day that our girls were in the best shape of all the babies on that side so they were going to "graduate" to the step-down side. They say that side is for the "growers and feeders"!

So both girls now are off IV, off CPAP, and off the heater in the isolette. Both still have a nasal cannula supplying air, temperature monitors, feeding tubes, heart rate monitors and pulse oximeters. The docs are actually talking about moving Avery to a regular crib soon! Emily is still having some A's and B's so they are kind of watching her closely. She actually had one while I typed that last sentence. dang it. STOP THAT, PEANUT!

Heather is kangarooing Avery while I'm typing and the nurses are trying to see why Emily keeps having bradys.

ok... so we aren't totally out of the woods yet. It still is a time where things happen that are scary. Even three weeks into this the rollecoaster continues. So please keep them in your thoughts and prayers.

bob

Wednesday, April 16, 2008

"What is Kangarooing?" you've asked.

from babylinq.com

Kangarooing Care BenefitsBy Krisanne Collard

The Benefits of Kangaroo Care
Kangaroo Care has been studied in depth since 1983 when neonatologists Edgar Rey and Hector Martinez first implemented it in Bogota, Columbia. Kangaroo Care consists of placing a diaper clad premature baby in an upright position on a parent's bare chest - tummy to tummy, in between the breasts. The baby's head is turned so that the ear is above the parent's heart. Due to lack of power and reliable equipment, Kangaroo Care was found to be an inexpensive and very beneficial experience to babies in Bogota. The mortality rate fell from 70 % to 30 %.
Most studies have proven that Kangaroo Care has a major, positive impact on babies and their parents; some studies have proven there is no change; but no study has proven that Kangaroo Care has hurt either parent or baby. In this article, my goal is to inform parents, nurses, and doctors on the benefits of Kangaroo Care. I have selected one study or article in each group that best sums up all the studies done to date. If anyone wants a complete copy of all Kangaroo Care research, please feel free to E-mail me at
roopage@yahoo.com.

Sleep Time/Colic
Researchers have come a long way in determining the major cause of colic. The common conclusion in 1999 is that colic is caused by a baby's (whether premature or full term) inability to transition from one sleep state to another - like from an alert state into a sleep state and back again. The gas associated from colic is caused by the excess of crying during these transitions. Kangaroo Care performed in a quiet, low light environment with ANY baby has been proven to reduce crying and help the baby learn to transition from one sleep state to another. A study done by Patricia Messmer, et al (Pediatric Nursing,23 (4): 408-414) in 1997 found a significant increase in sleep time for the neonates during Kangaroo Care. I want to impress upon all that Kangaroo Care works just as well with full term infants as it does with premature infants.
Apnea, Brady, O2 Saturation, Respiration and Heart Rate
The newest studies that are being done in Sweden and other countries concentrate on full term babies in respiratory distress. They take these babies, who would normally be put on respirators, and place them on the mom's chest immediately after birth in the Kangaroo Care position. Babies stayed on mom until the respiratory distress was gone - within 48 hours for most babies. Oxygen hoods and canulas were used if needed. In preterm babies, the effects of Kangaroo Care on these functions is just as dramatic. In 1998, Susan Ludington (Acta Paediatrica,87 (6): 711-713 ) found a four-fold decrease in apnea during Kangaroo Care and mechanically ventilated babies were able to tolerate transfer and position changes without increased oxygen requirements. In 1997, GM Cleary, et al (J. American Osteopathic Assoc., 97 (8): 457-460) concluded there was no increase in bradycardia episodes during Kangaroo Care. In 1998, Gay Gale and Kathleen Vandenburg (Neonatal Network, 17 (5): 1-3) concluded that the heart rate was more regular for Kangarooed infants. All-in-all, the baby fared much better when placed in Kangaroo Care. With my own ventilated preemie (1 pound 12 ounces at birth) I noticed a 50% reduction in oxygen requirements, no apneas or bradys, more stable heart rate, and more spontaneous respiration when I held her skin-to-skin.

Body Tempature and Lactation
I believe this is truly the most amazing benefit of Kangaroo Care. In 1990, Susan Ludington (Heart and Lung, 19 (5): 445-451) concluded that mothers showed thermal synchrony with their babies. A recent study placed babies in Kangaroo Care position on the mother's chest and temperatures were taken periodically of both the mother's chest and the baby. The study concluded that when the baby got cold, the mother's body temperature would increase to 'warm' the baby up. The reverse was also true. Given a suggestion of "Your baby looks warm to me" by a nurse, the mother's chest temperature would decrease within minutes to compensate. Extra blankets and monitoring of baby's temperature might be needed when Dad or others practice Kangaroo Care, but in 1997, Karl Bauer, et al (Journal of Pediatrics, 130 (2): 240-244) concluded that one hour of skin-to-skin contact (Kangaroo Care) was no cold stress to preterm infants.
In 1998, Papi A Gomez, et al (An Esp Pediatr 1998 Jun;48 (6): 631-633 - Spanish) found infants in Kangaroo Care for > 50 minutes were 8 times more likely to breast feed spontaneously. Kangaroo Care allows for easy access to the breast, and the skin-to-skin contact increases milk let-down. A receiving blanket, strategically placed to catch extra milk is extremely helpful - especially if the baby is unable to breast feed.

Weight Gain/ Shorter Hospital Stay
Holly Richardson (Why Does it Work? International Midwife Winter. 1997.) concluded that more rapid weight gain was observed in Kangarooed infants. The NICU is a busy, noisy place. Kangaroo Care allows the baby to fall into a deep sleep, there by conserving their energy for far more important things. Left alone on a warming table, a baby cries more and sleeps less.
This increased weight gain also leads to shorter hospital stays. N Charpak, et al (Pediatrics, vol. 100 #4: Oct 1997, pg 682-689) showed a shorter hospital stay in the Kangaroo Care group; primarily in infants -/<1800> grams. Kangarooed infants can have as much as a 50% shorter hospital stay than babies who aren't Kangarooed. This in turn means less expense for the hospitals and/or parents.
Conclusion
In 1998, Gay Gale and Kathleen Vandenburg (Neonatal Network, 12 (6): 49-57) found an increased intimacy and attachment between baby and parent. Kangaroo Care was found to help a parent feel connected. Eye contact led to an experience of "knowing" infant.
I wish that every doctor and nurse in this country could experience Kangaroo Care themselves. As a Mom who was able to Kangaroo her little 1 1/2 pound miracle for two hours every day, I have few words to describe my experience so that others can truly understand. You can liken it to a full term delivery where the baby is immediately placed on mom's chest, kicking and screaming, then quieting to look into mom and dad's face with wonder. Holding that tiny body next to mine, feeling her little hand clutch my collar bone, feeling her drift off to sleep in my arms.... truly the most amazing experience of my life. I hope that soon, VERY soon, all parents of premature infants will be able to experience the same.

Tuesday, April 15, 2008

It's been a long journey.....

Hi All, it's Heather! Has Bob done an exceptional job with the website or what!?! Well, it's been a VERY, VERY long and trying journey to get these babies into the world. It took every ounce of strength I had to make it through. Having been essentially incapacitated for the last seven months, I thank all of you for your patience, help and understanding.

I would like to take this opportunity to personally thank the literal hundreds of people who have prayed for us over the last several months. We feel so blessed to have such support and love for us and our babies. Thank you to those who have shared our story with your networks of friends and family. Also, I would like to say a special thank you to my wonderful husband and family for their unbelievable daily support every step of the way.

These babies are our own personal miracles. For those of you who may not know the truth of the grim picture most drs. painted for the outcome of this pregnancy, let me put it bluntly.... Emily would not be here today if we had followed their orders instead of trusting God and our gut and moving on until we found drs. who we felt comfortable with. We also did our own research and chose to believe the other miracle stories.

It took seven hospitals for us to find St. Lukes in Bethlehem, PA. Dr. Sarno and team are brilliant, positive, timely and professional. I would NOT recommend anyone go to Robert Wood Johnson, Somerset or St. Peters Hospitals for OB (although they are supposed to be "the best").

Some drs. have said I experienced "pretty much everything pregnancy has to offer." If you know anyone experiencing troubles in pregnancy please contact me, I would be happy to help. Also, you MUST take control of your health care. Even after my C-section I had to keep the nurses on track with my medicine after they forgot to give me any pain medication in recovery. Needless to say, I felt everything they had just done to me. Not fun...please make sure and stay on top of your pain meds in this situation. Also, request a belly band (thanks Jami)...this was a great help and still helps for support.

OK, back to the girls. We are getting used to the fact that they are just monitoring them and waiting for them to grow, instead of needing constant attention and treatment. At first we felt ignored and annoyed but we now see it as a good thing that they are not really on the drs' radar right now. Avery weighs 3lbs 9oz and Emily is now 2 lbs 12 oz -- yeah!!!! They are really starting to look alike now. Most of the nurses think they will have curly blond hair....how about that!!

To get an idea of how long they will be in NICU, the drs. said to plan on one or both of them coming home around week 36 (if they were still in utero). They are/would be 32 weeks 3 days. There are certain criteria that they must meet in order to come home. The first one is feeding by themselves. Starting on april 21st we will hopefully start feeding and see how that goes.

Thanks again to everyone reading the website and sharing this experience with us.

Heather

Saturday, April 12, 2008

I'm at the NICU

I'm entering this on my cell phone while sitting at the nicu. heather is "kangarooing" Emily right now. Emily gained 2 ounces in the last 24 hrs. She is back to alternating between the CPAP and the nasal cannula. Let's hope she doesn't tire out this time. Avery is just getting over the hiccups and is trying to get to sleep. She is so cute. she also gained 2 ounces today!

All the nurses here believe kangarooing make a huge difference in the development of preemies. they take the baby, in only the diaper, and place her directly on the chest of mom or me then wrap us both up to keep us warm. they like to do that for at least 1.5 hours. heather is right at 2hrs 45min with Emily right now.

amazing.

i'd better run. time to change her and get her settled in. heather thinks Em has a stinker waiting under there.

bob

Wednesday, April 9, 2008

The ABCs of A's & B's

Both girls are experiencing continuous issues with apnea and bradycardia. Here is a little info on this:

from babylinq.com

"Apnea of Prematurity or apnea and bradycardia (A & B's) is when a premature baby stops breathing for more than 15 seconds, the baby's heart rate may slow down (bradycardia), and her skin may look pale, purple, or blue. Because this is a very common occurrence in premature babies, preemies are constantly monitored for apnea by a machine that will sound an alarm if breathing stops or if the heart rate drops lower than 100 beats per minute. If a premature baby is born under 31 weeks, she will almost always experience apnea.

One reason that apnea occurs in a premature baby is because her brain is not developed enough, and it needs to mature. This kind of apnea is called Central Apnea. Another reason that your premature baby may develop apnea is from a blockage caused by mucous or by an awkward position. This kind of apnea is called Obstructive Apnea

Many times a premature baby will begin breathing again on her own, but sometimes she may require stimulation such as a nurse touching or rubbing her arms, back, legs, feet, and etc. Occasionally a baby will require oxygen, a changed body position, a Nasal CPAP, a ventilator, medicine and/or minerals to keep her breathing more regular. As your premature baby gets older the frequency of apnea diminishes significantly.

Bradycardia is the slowing down of your premature baby's heart rate to less than 100 beats a minute. Many times bradycardia will follow apnea, transient tachypnea, feeding tube insertions, and attempted bowel movements. Premature babies with bradycardia also have apnea because the same things cause both medical problems. For this reason, these two conditions are often lumped together and referred to equally.

Bradycardia can be caused by infection, hypoglycemia, anemia, body temperature abnormalities, over-stimulation, airway difficulties, acid reflux, and neurological complications."

Just the facts, Ma'am......

Todays info.



Tuesday, April 8, 2008

wow

What truly amazes me is how with a look and a finger grab they can take your breath away.

Both Avery and Emily tonite were able to interact with Heather and I. Their eyes were open and they were both very active. Emily was off the jaundice lights b/c her bilirubin numbers went way down. Avery's blood tests came back showing NO signs of infection anymore. Both gained a little weight and both were active again.

whew...

rollercoaster again.

but both girls actually kept their eyes open long enough to look at Heather and I. I know the docs say that their field of vision is less than 6 inches, but they opened their eyes and looked directly at us and held our fingers. wow.

bob

Monday, April 7, 2008

They said this would be a rollercoaster.

One of the toughest things about the girls being in NICU is that every day can be drastically different from the day before. Yesterday both of the babies were doing well. They were breathing easier with less apnea and bradycardia events. Emily was off her IV. Avery was off her CPAP. Avery was looking better after her rounds of antibiotics (they thought she was fighting an infection).

Today we walked into NICU in a good mood. We had just picked up their Mountain Buggy stroller (off Craigslist!) and were excited to see the girls to tell them about it. Our good mood turned quickly when we saw that little Emily was not just back under the bilirubin lights (for jaundice) but she was under the "double" lights. In addition we found out that she was having a bunch of A/B events which means she forgets to breathe. When she does that the nurses have to stimulate her to start breathing again. So now she is back on her CPAP as well. Also, she was not acting like she was feeling well so now they are running blood tests to determine if she is fighting an infection like her sister.

So the rollercoaster continues.....

The doctors have told Heather and I not have really high "highs" or low "lows", but this is tough.

We will call the NICU again tonite for an update and be back over there in the morning.

Please keep them in your prayers.

Bob

First Posting

This is our first post on the new blog. We will be adding daily updates about the changes for our NICU girls.