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.