Daddy and Me

12/10/2006

Eight Pounds

Our boy is an eating machine. He gained 9 ounces in 4 days and is consuming enough formula for a baby that weighs 3 pounds more than he does. We are working hard to convince him that he isn't hungry after eating a reasonable meal for a person his size. Oink-oink!

As the volume of his feeds comes down to a reasonable level (and the CMA problem is resolved), much of his colic symptoms (reflux and gas pains) should dissipate, meaning less discomfort for Samson and more nighttime sleep for Mama & Daddy.

Tonight, we're on our own again after having had three blissful nights with a doula, Ryka, over to take care of Samson while we got some sleep. For the past three nights, Daddy got 6 straight hours while Mama still had to get up to pump milk, so hers was broken into two blocks of three hours.

Now that we're rejuvenated, we hope we can better manage the nightly ritual we call "Hammer Time." This starts after Samson's 9pm feed, when he begins to get more and more irritated, gassy, and inconsolable, and it lasts until about 4am, with brief 15-30 minute stretches when he sleeps. Daddy and Mama take 3 hour turns comforting the wailing baby, patting and bouncing, walking and talking, singing and humming, swaddling and holding, feeding and burping, wiping and changing. When the sun finally comes up, Samson is exhausted and finally quiets down to sleep, while Mama and Daddy collapse to steal a hour or so nap between feeds & pumping, and the daily cycle begins again. Here we go...

Single parents amaze us & RSV sucks

As I type, Samson is lying in his bassinet (thanks, PaPa and Grandma Buras!), quietly alert and making adorable grunts and sighs, between hiccups and yawns. He just had his late lunch and will soon be sleeping soundly.

So far, so good. We have survived our first 30 hours with the new baby at home, and even got about 6 hours sleep each last night (though not at the same time, and not in a consecutive block).

Being able to have Mama and Daddy both at home to share baby care duty is such a tremendous blessing. Because Mama is still pumping lots of milk until Samson gets strong enough to eat all of his calories by breast, Daddy gets to feed the baby by bottle every other 2-3 hours while Mama either sleeps, pumps, or tackles a household chore. Daddy also keeps the bottles & pump supplies cleaned & sterilized, changes diapers & soaks up spit, and keeps Mama fed & hydrated. Without a tag-team partnership, we can't imagine how all of this could possibly work. As far as Mama is concerned, Daddy is the best baby-daddy in the universe.

Samson seems to be a pretty jolly fellow. For the most part, he only cries when he's hungry or having a bout of reflux (which seems to happen about once per night and can only be soothed by holding him upright against your chest, patting his back firmly, and bouncing while saying in a sing-song voice, "I know, sweet boy. I know. Tell me about it."). After his experience living in a bus bin at the NICU for his first 6 weeks of life, he is content to relax in his crib and doesn't demand a lot of help to fall asleep. Noise and light don't bother him, either. The only downside is that he does tend to be most active at night, as the routine in the NICU dictates that most handling of the babies occurs then. We'll be working to switch his days and nights around over the next few weeks.

And the restrictions never end...

Tomorrow is Samson's first outing (since the trip home), to have his first pediatrician appointment. Beyond those and other doctor visits, he'll be in semi-isolation at home for the next 4 - 6 weeks. This is because September through May (but especially the winter) is RSV season in Austin, and preemies are particularly susceptible for their first 2 years of life. This virus can be deadly for preemies, and the best way to protect them is to keep them from contact with people (especially other children).

Visitors to the Hobbit Hole will be required to wash hands and there'll be a "no kids touching the baby" rule until Spring. Additionally, anyone who has received recent vaccinations with live viruses (such as the Flu Mist vaccine that is inhaled) can't have contact with Samson for 6 weeks past the exposure.

We hope everyone will bear with us as we do our best to protect our little guy from any more hospital stays.

Samson has left the building

Hallelujah!

Samson is home, as of 10:30a Texas time. He's already had his first trip through the Taco Shack drive-thru, his first risky diaper-change on the striped sofa, his first bottle given start to finish by Daddy, and his first nap in his Travel Lite Crib.

Woo-hoo! We are SO overjoyed that our family is finally all together.

We'll be getting adjusted over the next few days and not picking up the phone, so please don't worry if you call and we don't answer.

Set him free already...

The doctors had been telling us that at some point, it would be like a light bulb turned on in Samson's brain and suddenly he'd be an expert suckler, ravenous for nipples and able to keep going long enough to get a full meal at each try. Well, it looks like that day may be here, and it means that we're getting very close to putting him in that fancy carseat and bringing him home to the Hobbit Hole. Here are Sammy's latest stats:

Age: 5 wks, 3 days
Adjusted: -18 days
Gestational: 37 wks, 3 days
Weight: 5 lbs, 12.5 oz
Feeding: All nipple, every 3 hrs; 58 cc by bottle; ?? by breast; gavage at nurse's discretion, depending on volume consumed by nipple

Now we can go in at any of his feeding times and attempt to nurse. This is a huge relief, since it makes our schedule much more flexible and we can try to avoid the horrible gridlock during rush hours. Plus, Mama gets to spend more time holding Samson "skin-to-skin," which helps with increasing the hormones that raise milk production levels.

But enough with the details. We know you're only visiting to see the latest pics. Here you go:

Ahhh... relaxing after a long lunch














Interesting. This time, she's wearing the color of my diaper contents.













Okay, enough admiring me. Off with the shirt, woman, and give me my breakfast!

There's No Time

Sorry it's been a while since the last post. Mama and Dad are in constant motion and the blog has been on the back burner this week. Here's the latest on Sammy:

Gestational Age: 37 weeks
Weight: 5 lbs, 8 oz
Feeding: Nipple, Nipple, Gavage (meaning 2/3 of his meals are by bottle or breast now)
Meds: Prilosec for GERD (reflux); multivitamin; iron supplement

Today is Saturday, so no rush hour traffic to/from the hospital - yay! Except that it's also a home game at UT, so all streets leading to/from UT around game start/finish will be packed - boo! Gotta get going so we'll be there in plenty of time for the 4:30 nursing session.

We've got lots of stories to tell about our adventures as parent advocates this past week (let's just say that we won't be getting any holiday cards from Charge Nurse Kitty), but those will have to wait for another time. Instead, enjoy these recent shots of cuteness:

First Holiday
You can see a short video clip of this momentous occasion here.
















Proud Papa

Samson, someday after puberty you, too, may have such luxurious locks of curls. Don't worry. The coolest chicks dig the mad scientist look.














The Private Room

Now we can breastfeed in peace, regardless of time of day or night. Sometimes it pays to have a Mama who doesn't settle for arbitrary and subjective enforcement of illogical hospital policies, even if it means that we are now known as "those" demanding parents.

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

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:

Like Father, Like Son

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'.