36 Weeks or T Minus 4 Weeks

Yesterday marked Samson's 4th week outside the womb, but in preemie-land, we say that he's "36 weeks," meaning he's reached the point at which he would have been 36 weeks gestation. For premature babies, until they're 2-3 years old, you are supposed to use their adjusted age to measure their growth and development. So, around November 25th, Samson will be 0 years old and we'll start counting up from there.

Mama and Baby Smurf




















Latest Stats:

• Weight: 4 lbs 15.5 oz
• Nipple Feeds: 4x/day (mix of bottle-fed breast milk and nursing)
  
• Feed volume: 48cc every 3 hrs
• Supplements: Multivitamin, plus liquid iron and sodium, mixed with first bottle of the day
  

And when will Samson come home? WE DON'T KNOW, okay? We hope it will be soon, but he has to get up to 8 nipple feeds/day and go for 7 days with no bradycardia or apnea episodes before he can be released. We probably have another week to 10 days in the NICU, if we're lucky. Until then, enjoy this new series of "The Many Faces of Sam-so-nite":

Sammy's Home Away from Home

This is the crib where Samson now spends most of his time. While he sleeps, the thick blanket shields his eyes from light and muffles some of the noise in the busy room. There are 7-9 more just like this in the Continuing Care nursery.

When we come to visit, our routine is:

1. Greet the nurse on duty. If she's new, learn her name and try to figure out if she's gonna be a friend or foe (we've had our share of both).

2. Open the cover and see how Samson's doing. Is he awake or asleep? Does he have spit on his collar, blanket, or around his head? Is he still swaddled, or has he managed to escape his confines? Is he positioned on his belly, back, or side? Does he look peaceful or agitated? Does he look like he wants to suck his pacifier for the next 5 minutes before he can get his milk?

3. Check his temperature. Find his digital thermometer (which gets put in a different place by almost every nurse) and unwrap his blankets. Stick the sensor in his armpit and hold his arm in place until the reading is complete (usually a LONG couple of minutes while Samson begins to get irritated). Hope the temp is at least 97.7 so the nurse won't put a negative report in his chart.

4. Change his diaper, which is 99% likely to be full of green cottage cheese poop. Get some gauze squares and take to the sink to moisten with warm water; baby wipes aren't used in the NICU, since any resulting contact dermatitus (that a rash to you and me) could be confused with a more serious infection. Unwrap the burrito boy, place the new diaper underneath his bottom, quickly but carefully open the old diaper, and race as fast as possible to wipe off the sticky poop and close the new diaper before a new poop-pee combo shoots out the respective spouts. If the clothes are damp or dirty, change those, too, but hurry before the baby erupts in protest.

5. Prepare for nursing session. Close the curtains around Samson's bay and bring in chairs for Mama (and Dad, if he's there). Get out the camera (to capture those cute smiles once the belly is full), the My BrestFriend (yep, that's how they spell it) wrap-around pillow, the silicone nipple shield (so baby can get his tiny mouth around Mama's massive nipple), a burp cloth, a few extra blankets, a wrap to cover Mama's skin, and the contraband beverage bottle (so that Mama's milk doesn't turn to cream cheese from dehydration; drinks for non-babies are forbidden in the NICU - "infection hazard" - so we have to sneak in something for Mama's thirst). Ask the nurse to warm up a small bottle of previously pumped breast milk, so Sammy doesn't go away hungry if he gets too tired on the breast (it takes preemies a while to build up the strength to get all of their nourishment through nursing). Note the time - he only gets 30 minutes to feed, so each session is a race against the clock.

6. Pick up the baby. Make sure he has on a hat & plenty of cover so he doesn't get too cold. Grab his four sensor wires in one hand (so they don't become tangled & disconnected) and then pick up the boy. While holding the wires & baby in your right hand, wrap the nursing pillow around your waist and secure with velcro. Wedge yourself back into the chair, place a blanket between the wipeable pillow and the baby, and rest the baby on his side, facing you, head near the breast to be nursed. Hold the baby with one hand while removing all the layers of clothing between breast and boy, keeping his backside & limbs well covered. Apply the nipple shield, get the baby in a correct hold, and tempt him to latch-on. Laugh at his growls and grunts as he attacks his target.

7. Feed the baby. If he seems too sleepy or rests too long between suckles, caress his scalp, stretch out his arm, or wiggle the nipple in his mouth to get his attention. If he's still too sleepy, sit him up and pat his back, open up some of his covers, and/or change to a different nursing position. If Dad's here, grab the chart and see what they're saying about Samson today; hurry before the nurse comes in a gets defensive about you seeing the chart. Nurse for 30 minutes (or longer if the RN gets too busy to interrupt), and then switch to the faster flowing bottle. Let him eat as long as he is interested or until the nurse insists that "It's time for him to go back to bed, as he is burning too many calories and won't gain any weight if we let him suck for too long."

8. Burp the baby. Sit him up with a burp cloth underneath his chin and firmly pat his back. This may need to happen a few times during the feed, or only at the end. Sometimes, there is no burp; sometimes there is one big, loud burp. Sometimes there is a silent, wet spit-up burp. Sometimes, there is a huge spit-up and we worry that he just lost half his lunch. Wonder if you should tell the nurse about the state of the burp (or lack thereof), and which type results in a negative report in his chart.

9. Hold the baby. He may be sound asleep, quietly alert, or screaming for mercy (or more milk). Enjoy the precious time feeling the weight of the boy in your arms and having him gaze into your eyes. Wonder when he will finally come home.

10. Return the baby to his crib after the nurse reminds you, "Isn't it time for you to go pump?" Re-swaddle him tightly and place his bendy-bumpers and Freddy-frog barriers around him so that he feels secure. Place some gauze or a burp cloth under his chin in case he spits in his sleep. If it's a good day, he continues to sleep soundly and doesn't notice you leaving. If it's a bad day, he shrieks uncontrollably as if to say, "How can you leave me again in this terrible place? Come back!"

11. After pumping milk and turning it in to the nurse on duty, shuffle out to the car and cry a little. Remind yourself that this won't last forever. He's your son and he's gonna be with you as soon as he is strong enough to come home.

Quick Status Report - Day 25

Weight: 4 lbs, 11 oz
Feeding: 44 cc every 3 hours, 3 breastfeeding sessions and 1 bottle feed; additional nipple feeds added as tolerated
Meds: None! Stopped caffeine on Monday.
Bed: Open bassinet

Did I mention that Samson moved to the Continuing Care Nursery (aka Level II) section of the NICU on Saturday night? This place is SO much more comfortable than the Level III section, as the babies are more stable and the noise & activity level is much lower. There are about 10 babies there and 3-5 babies per nurse. Our stress level (and surely Sammy's) has fallen a few notches with this move. Now it's all about sleeping, eating, & growing. No more needle sticks, no more terrible treatments. It won't be long now....

Horns 22, Huskers 20

A Date on Friday Night

Mama and Daddy had a romantic dinner for two at the DQ drive-through on the way to the NICU last night. We were in a hurry to get there on time for one of our favorite shared activities: bathing the boy. You can view some pre-bath action video here. See Daddy clean-up spit just before being sprayed by pee-pee from precious progeny - priceless.

Here is Samson, post-bath, wrapped in his Swaddle Me. The nurses call this the "Burrito Baby" look. It's very fashionable in the NICU.

Day 20 Status Report:
- Weight: 4.5 lbs
- IV removed! Now only 4 wires attached, all painless sensors to monitor heart rate, temp, blood oxygen saturation, and... I forget the other one.
- Antibiotics complete. Now only receiving caffeine for apnea, and this will be weaned before he comes home.
- Feeding: 40 cc every 3 hours, still 2 nipple feeds/day. Breast milk is fortified with some additional calories and vitamins to help with weight gain.
- Officially entering "feeder/grower" status at 21 days post-delivery (35 weeks gestational age). This means that his job is to eat well and get fatter (how can I get that gig?)

There's a great deal of jargon in the preemie/NICU world. If we ever use a term here that doesn't make sense, dear reader, check out this glossary from the Tiny Miracles Foundation.

Cutest Smile in the World

Quick Status Report - Day 18

Weight: 4 lbs, 6 oz
IV: no fluids, only a lock to load the twice daily antibiotics until 10/21
Breathing: Nasal cannula is gone! No A/B episodes today.
Meds: Caffeine, Vancomycin
Labs: Stool still negative for blood
Routine Cranial Ultrasound: no evidence of bleeding
Feeding: 38cc every 3 hours, 2 nursing sessions/day, 1 bottle/day (the rest by gavage); if continuing to tolerate well, up feeds by 5 cc every 4th feed
Other notables: Umbilical stump fell off today! Excellent nursing sessions at 10:30am and pm with the aid of the nipple shield (which makes the nipple more noticable in the mouth, encouraging the baby to suckle more effectively).

Tonight's nurse was Dina, someone we met in the first few days when Samson first moved to Bay 1. She, too, had a 32-weeker by emergency c-section after developing HELLP syndrome. Her story gives us much hope, as her daughter is now 8 years old and about to achieve a black belt in karate.

Our first homespun gift, a blanket knitted by Aunt Zaney:

It Takes a Village

We have a most wonderful group of friends. They gave us a party to welcome Samson into the world and remind us of the community that will support us through this rough patch and the peaks and valleys to come. Here are some of the scenes from the day:

Best cake ever


Some of Mama's side of the family















A fraction of the loot


Beaumont Aunties J, M, & K

Like Father, Like Son

Comments?

Samson is pleased that so many of his friends and relatives have discovered the internet as a result of their desire to hear regular news of his adventures through this online journal (aka "blog," Papaw W). A few of his fans have asked, "How can I leave comments?" Here is a link to instructions on that. More news, shower pics, & baby pics later today. Peace - out.

P.S. This is the AWESOME reward that Daddy gave Mama for all her pain & suffering & the almost dying stuff:
Meet Bevo, the Sony Vaio TX-770P. Note the ultraportable package. Like our other new baby, he's compact but very powerful and adored by all who behold him. All LeftyMama entries are being posted from this machine, which travels effortlessly from bedroom to den to car to hospital to cafeteria and beyond in the diaper bag containing all supplies Mama needs for a day in the NICU (snacks, pumping accessories, spiral notebook, cell phone, nursing wrap, clean preemie clothes, bottle of water, etc.).

Quick Status Report - Day 16

Weight: 4 lbs, 4 oz
IV: only sugar water now
Nasal cannula: room air; no apnea since 10/12
Meds: Caffeine, Vancomycin
Labs: Stool still negative for blood; blood sugar = 76
Feeding: 32cc every 3 hours, 2 nursing sessions/day, 1 bottle/day (the rest by gavage); if continuing to tolerate well, up feeds by 5 cc every 4th feed
Bed: Isolette

Nurse Sarah reported that mighty Samsonite tried to launch off the end of his platform in the isolette again. Strong baby!

Today is the baby shower that was supposed to occur 8 weeks before Samson's arrival. Lots of family & special friends in town for the big event. Can't wait to see everyone and celebrate that our baby's here (even if not the way we expected). Thanks, y'all!

Here's a pic from Papaw Walton's first visit last night:
He says those slender fingers are made for guitar pickin'.

Samson 1, Staph 0

Tuesday, we could see that something was wrong. Samson was very docile, in a deep sleep, and would not rouse for skin-to-skin or our first attempt at latch-on. Unlike every other visit, he did not open his eyes when hearing our voices or cry when returned to the warmer when we needed to leave. The IBCLC said that this is common with preemies, but Dad and Mama were not convinced. Most alarming of all was that as the afternoon wore on, his heart rate shot up near 200 BPM and stayed there, although he was not doing anything but sleeping -- this is not good.

By 5:30p, we received the call from Dr. C that it looked like an opportunistic staph infection common in preemies, entering the blood through one of his numerous IV sites (these get changed every 1-3 days). Samson was put back on the high-flow nasal cannula and constant gavage, and we were told that he might have to go back on to the CPAP if his breathing didn't improve soon. Several types of antibiotics were started and feeding was suspended again (the first time was during the treatment for the PDA the previous week). There were lots of diagnostics: blood cultures, stool for blood, x-rays looking at GI tract, spinal tap (agh!) and more, chasing the source/type of infection. We were terrified (again), back to "your wife could die and you need a c-section right now" anxiety levels.

True to his name, Samson came back swinging. Within 12 hours of receiving the meds, Samson was showing improvement, back to his grumpy self, screaming and kicking when anything wasn't to his liking. Oh, thank heavens! We were cautious with our optimism, not wanting to get our hopes up too high, but each report after that was more positive than the next.

By Thursday, he was back on gavage feeds and ready to try that nursing thing again. Successful latch-on was achieved (way to go, little boob-man!) and we started a daily breastfeeding appointment to fit in with his other gavage feeds and single bottle feed.

Dad finally got to hold (yay!) and offer the first bottle on Thursday night. The boy wasn't too interested in that hard nipple after his awesome experience with the breast, so we're gonna try to convince the doctor that his 2 "by mouth" feeds per day be nursing. That will probably be a challenge, as the clinicians like being able to easily measure how much he's consumed and the breast doesn't have those handy mL markings like the preemie bottles do.

Now we are getting back to "feeder-grower" status, and looking forward to once again starting to remove the wires and tubes one-by-one. Friday afternoon, they moved Samson out of his open warmer to a cozy, quiet isolette, and we expect that the nasal cannula will come off soon. He is regulating his body temp well and will probably get into an open bassinet (and get to wear his own clothes) by the end of the weekend.

Of course, after this latest round of panic, we'd rather see him progress slowly & steadily and keep all of his supports until he really doesn't need them any more.

Okay, so after that harrowing tale, now how about some fun pictures?

This is meconium (new baby's poop, which looks really weird, blackish-green and slimy), deposited during Daddy's holding session last night. Hope this becomes a habit with the boy. "Daddy's holding me, so it must be time to poop." Excellent.

And these are some of the many faces of The Boy, Sammy-pie, Sam-so-nite:

Kangaroo Care After 2nd Big Scare

Day 12 (Wednesday). Samson now weighs 4 lbs, 2.6 oz (yay!). First projectile poop today, per Nurse Vickie (we love her!). You can watch a short video of us here. As you can see, the nasal cannula and constant gavage tube are back (we knew this might happen, as babies often go off & back on the treatment for a few times before they are strong enough to breathe totally independently) and the IV has moved back to the scalp for a 2nd time (this looks much scarier than it really is; the scalp is actually the best place for a NICU baby's IV). At least it's not squarely in the forehead like a unicorn (this, too, may be in our future). Next post will fill-in our roller coaster ride from the past 2 tough days/nights. The news from the NICU can't always be rosy...

Just Pics for Now

Dreaming of milk.




















Little piggies.

A Really Good Day

After too many days of worry, we finally had a thoroughly enjoyable "normal" parenting experience in the NICU Sunday night: the first bath. Nurse Ellen (herself the mother of a premie delivered at St. David's; he's the boy gymnast hovering over the "horse" in the portraits that line the hallway leading to the NICU entrance) instructed us in the art of the sponge bath while Samson squirmed on the Chux pad in the warmer. Dad held the head and limbs; Mama scrubbed the boy clean.

Though he fussed a bit after the shampoo and diaper-area wash, Samson was actually quite accommodating. After we'd heard all week that he just didn't like lying on his back, he stayed in that position for a good 2 hours with a completely content demeanor. Has our Surly Samson morphed into Serene Sammy? You be the judge:

After the bath, Mama diapered and Dad read Dr. Seuss' "The Foot Book" while Ellen poured the milk. Happy baby!

When the 10pm shift change signaled it was time to go, we breathed a big sigh of satisfaction knowing that we were leaving our boy in bliss.

Monday morning, the news was even better. Dr. D said that it was time to try removing the nasal cannula to see how Samson will do without respiratory assistance, and the gavage tube can go as well, since air will no longer be forced down his throat. No more tape on the face! Yay!

First Week

Not Just Another Weekend

We were warned that Mama would get sicker
before she got better - and last Saturday was indeed a hard day. I spent my time going back and forth from Mama's recovery room to the NICU. Little Samson was burdened with the following monitors and devices:

• CPAP (for apnea)
• gavage (stomach tube for feeding and to allow air to escape due to CPAP device)
  
• pulse oximeter
  
• heart monitor
• thermometer
• I.V. (for fluids, sugar, and lipids until he can get enough mother's milk by mouth to grow & flourish)
  

Samson seemed to be sleeping comfortably but the frequent apnea spells were scary to watch. The breathing, heart rate and O2 sat monitors would start beeping and the nurse would casually pat him on the bottom or adjust his O2 mix until he picked up again (a few seconds).

Monday
Samson finally gets off the CPAP and is now using a high flow nasal cannula. Mom finally gets to hold him.

Tuesday
Samson opens his eyes for the first time when mom is holding him. Neonatologist Dr. D tells us that Samson has a common preemie complication known as Patent Ductus Arteriosus (PDA). There is a duct in the heart that allows blood to bypass the lungs while in the womb that should close during birth. They intend to treat it with indomethacin. This treatment can upset the stomach so they suspend milk feedings for 2 days.

Wednesday
Mom is discharged from the hospital. Samson is a bit jaundiced and is diagnosed with high billirubin levels. He is treated by laying under a bright light for a couple of days.

Thursday
Samson is understandably cranky from an empty stomach but further examination shows that the duct is closed and he won't need the third dose of meds. He is also on a low-flow nasal cannula with just warmed/humidified air - no O2. Yay.

Friday
Samson starts eating again and sleeps most of the time. Nurses report his attitude is much improved.

Saturday
One week old! Mama's worn sleeping T-shirts are placed as crib sheets so he can smell her scent all the time. We also bring in a CD player with soft music for his listening pleasure, starting with instrumental Beatles classics played at our wedding.

A Most Unnatural Birth

We finished our final (Bradley) natural birthing class at 9:30pm Thursday. Mama had another routine prenatal checkup Friday morning. At 7 months, mom and baby are healthy and all is well.

The first hint of any trouble came as mom started to feel nauseous and just genererally unwell. Could this could be normal 3rd trimester discomfort or maybe something else? By Friday evening we called the birthing center and went in to meet the midwife. The fetal heart monitor looked good as usual but mom was having some slight but regularly spaced contractions. The midwife on call wasn't sure what to make of it so she sent us to get checked at St. David's Medical Center just to be sure. At this point we thought it was just something that mom ate and a little I.V. rehydration should do the trick.

Now things start to get interesting. We are sitting in a hospital room in the early hours of Saturday morning when the nurse comes in and mentions something about elevated liver enzymes, platelets and further tests. Our hopes of hoing home are dashed: we are handed a stack of worst-case scenario consent forms to sign and mom is admitted. We wait anxiously for another hour before a doctor comes into the room flanked by a couple of nurses. Based on upper abdominal soreness, elevated liver enzymes, and rapidly falling platelet count it was his diagnosis that mom had HELLP syndrome. The only treatment is an immediate emergency C-section. Any delay could put Mama at great risk. Holy sh**t!

Samson W. B. was born by emergency c-section at 2:51am on Saturday, September 30th.


At 32 weeks gestation, the incidence of most common complications related to prematurity is low. In the NICU he is considered an "older" preemie. Measuring 3lbs, 14 oz and 17 inches long with long limbs and wavy light-brown hair, he has already developed a reputation as being among the most feisty of the patients.


Samson (meaning "like the sun", after the Biblical warrior known for his strength and luxurious locks of hair) is receiving great care at the St. David's Medical Center NICU and he has already made wonderful progress for a preemie. He is breathing regular warm moisturized air with minimal assistance from the Fisher-Paykel high flow nasal cannula and he is already receiving some of his nutrition through mother's milk via gavage oral feeding tube (until he learns to suck better in a few days and can try nursing). We are hopeful that he'll soon graduate to an isolette and we'll have him home in time for Thanksgiving, or maybe even before then.

Mama was released from the hospital on Wednesday evening, having returned to normal health for any woman who has undergone c-section delivery. She'll be on restricted physical activity for 4-6 weeks and unable to drive for a couple of weeks, but is expected to make a full recovery. Her main jobs at this time are sleep and spending quality time (20 minutes every 2-3 hours!) with her new constant companion, the hospital-grade breast pump.



We can't thank our friends and family enough for all of the concerned calls, prayers, visits, and offers to help. We are overwhelmed with how much love is out there for our new little family! As you may imagine, mom and dad are exhausted after the big scare & 5 nights at the hospital. We are just now getting some much-needed uninterrupted rest between calls and visits to the NICU to check on and be with Samson.