Category: General Family News

Here’s today’s update from Dr. Schrager, the neonatologist:

Micah is doing much the same as yesterday. His weight remained roughly the same (maybe a very slight drop of 0.3 oz): 4 lbs 15.5 ozs.

He has been doing well with his bottle feedings. Last feeding (at 9:30 a.m.) he took 60 CCs.

His apnea/brady episodes are improving in the sense that they did not require intervention over the past 24 hours. However, Dr. Schrager is “concerned about his heart rate drifts” and is ordering a pneumogram for either today/tomorrow. Even though Micah’s current episodes didn’t require intervention, the combination of his smaller episodes and the few times over the past week (where he has changed color to a “dusty” or “blue” and the nurses had to stimulate him) is cause for concern. Dr. Schrager will read the results on Sunday since he will be on call that day. The heart rate drifts, he said, “may be reflux-related, and it certainly looks that way on the monitor, but not when you look at the baby.” (We aren’t seeing a lot of spit-up either through his nose or mouth. But he said you aren’t always able to see it.) The pneumogram will record breathing effort, heart rate, oxygen level, and air flow to the lungs during sleep. Micah will also have a pH recording to measure how often stomach acid comes up into the esophagus. This is done through a tube in his nose, down the esophagus.

Micah is mostly ready to come home (as far as taking the bottle, holding his temp, etc.) But the results of the pneumogram will help them decide if he should be coming home on the apnea/bradycardia monitor. Friends (who had preemies on the AB monitor) tell me that those monitors can make your life very miserable with all the false alarms, but I would much rather have the monitor, than not know if Micah was in trouble. So I’m praying that God will make it really clear whether or not he should be on a monitor!

Dr. Schrager said that with these tests, Micah definitely won’t come home before Monday. . . The heart rate drifts are the dr’s main concern, and he wants to be sure Micah is really ready to come home. (It was reassuring to hear the doctor say that!!)

I told Dr. Schrager that Mara has been congested, coughing, and running a fever around 101 yesterday and today. So I asked him whether I should hold off on visiting Micah today. He said as long as I don’t have any symptoms, it should be okay, if I wash my hands well before seeing him . . . So please pray that Micah will stay healthy!!

Well, according to Micah’s nurse Pat, his feeding tube is staying out! At his 9 a.m. feeding, he took 60 CCs (2 ozs.) by mouth. Yesterday’s feedings were 50 CCs, 30 CCs + a little breastfeeding, 45 CCs, 40 CCs, 50 CCs, and 50 CCs.

At his weight check around 1 a.m. he was 4 lbs. 15.6 ozs. (a gain of 0.8 ozs from yesterday).

He had one episode of shallow breathing last night at 11:45 p.m. where his heart rate dropped down to 76.

The nurse thinks he will be going home w/n about a week, so she is asking us to have the car seat prepared for his car seat test.

Micah has moved from the “acute care” side to the “continuing care” side of the NICU. 🙂 They had a bunch of babies come in last night–and he’s one of the “better” babies, so they moved him. . .

Dr. Schrager says he is “very close to ready” to go home. Since Micah pulled his feeding tube out of his nose yesterday, they decided to see how it goes without it. He is bottle-feeding on demand usually every 3 – 4 hours (no more tube feedings or fortifying the breastmilk, as of yesterday afternoon). He weighed 4 lbs. 14.8 ozs last night, so he gained about 1/2 oz. The nurse was feeding him this morning at 10 a.m., so I will try to go in between 1 and 2 p.m. today. Dr. Schrager encouraged me, if I want to breastfeed him, start offering that as early and as often as possible, once my milk supply is in. He recommends trying to nurse him every time I get a chance.

A couple of things they are watching:
1) He needs to keep gaining weight & holding his temperature while taking the bottle. If he can’t, he will have to go back to tube feedings.
2) The “periods of alarm”–he’s still having apnea/brady episodes.
These can be related to feeding: reflux/spitting-up/gagging sometimes causes them: this is less of a concern, and different than a premature infant “forgetting” to breathe while sleeping. However, if he is “forgetting” to breathe while sleeping, this is more of a concern.
The goal is for him to go three days without an episode requiring intervention. If he comes out of it by himself, they are not too concerned–he could still go home. Yesterday he had 2 episodes requiring invention before midnight, so Dr. Schrager would not see him going home w/n the next few days. Micah has had no episodes so far today. If these continue, he may need to come home on a monitor–they will discuss all that with us as he progresses.

Dr. Schrager doesn’t “like to bet on babies”, but if he did, he would say “Micah would come home w/n a week–maybe 2.” So, that’s today’s update from the neonatologist. . .

Jefta from our home group offered to watch Mara on Sunday, so we both could go see Micah in the NICU together on Fathers Day! (It was really kind of him, especially since he and Tate had made us dinner, watched Mara all day yesterday, and helped me move back to our house from Daniel’s parent’s house.)

Daniel and I had a really special time! He got to hold Micah for his tube feeding for the first time on Father’s Day.

The nurse asked if we wanted a picture of our “family” on Father’s Day. Of course, I said “yes!” 🙂 . . . Too bad Mara couldn’t be there too . . .

Daniel liked how Micah would grasp his finger . . . Micah only recently started doing that!

Father’s Day was a milestone day in Micah’s life!
1) He weighed 4 lbs, 13 ozs., passing his initial birthweight (of 4 lbs., 12 ozs.) by day 11!
2) He has been able to hold his temperature, so when we left that afternoon, he had moved into an open crib out of the isolette!!
3) He finally began to get the idea of feeding by mouth today!! He has not mastered it–he can’t yet stay awake long enough for an entire feeding–but he’s actually starting to get it!!
It was a very encouraging day for all of us!

Each day we are seeing small “improvements” with Micah! I can’t believe he will be one week old tomorrow! His weight is back up to 4 lbs. 10 ozs, which is REALLY good! He is now off the IVs, and his diet is exclusively breastmilk at this point. Needless to say, the pumping has been going great (with the hospital’s Medela Symphony pump), and I am now producing enough that they don’t have to supplement with formula any more.

Another bit of progress is in the area of his ability to suck. Yesterday they gave him a bottle, and he took 30 cc’s (by mouth)—47 cc’s would have been an entire feeding, so they only had to give him 17 cc’s in the feeding tube! That is a huge step forward. Because feeding is progressing so well, the drs want me to try to nurse him once/day. It is going okay. . . he tries to suck, but it’s very inconsistent and sporadic. You can tell he wants to, but he is just so immature still. It is slow progress, but they keep saying to remember that he is still not “old enough” to “suck” yet–that skill is not usually developed until week 35. So he has over a week before we really want him to start sucking–so he is doing great!!

As far as his body temperature goes, tomorrow they will start to bring the temperature in the isolette down, one degree (or was it 1/2 degree?) each shift. They monitor his body temp, and as long as it stays up, they continue bringing the temp down, until it’s room temperature. At that point, if he holds his temp for 2 days, he could go to an open crib, instead of the isolette.

His bilirubin levels are down a bit due to his phototherapy. They don’t think he will need the phototherapy tomorrow, but they will check his levels again in the morning. . .

My recovery is going okay. I think I have tried to “sit up” too much, instead of laying down. I have had a lot of abdominal pains today. But honestly, I don’t know what I should expect, since Mara was born vaginally–it was a totally different experience in every way! (I certainly see pros and cons with each.) Today, Mara crawled across the bed and “pounced” on me–RIGHT THERE!!—and it KILLED!!! She totally didn’t mean to. She was just crawling up to sit on my lap like she always used to–but unfortunately, I didn’t see it coming quickly enough to stop her. . . I know the recovery takes time . . . it hasn’t even been a week yet!

Today was the 1st day that I really had a hard time leaving Micah. Until today, I kept reminding myself that there wasn’t anything that I could do for him, that the nurses couldn’t do better. . . well, today, for the first time, the nurse was saying, ideally i could be there round-the-clock for his feeding, and try nursing him, every time he was awake and alert. . . . Of course, that’s not feasible, so the nurses are giving him the bottle when he wakes up. But for the 1st time, I’m struggling a bit w leaving him there and not being able to care for him like I wish I could. . . This too is part of God’s perfect plan, so I’m trying to be surrendered in my heart and know that God’s way is best for me and best for Micah! 🙂

Every time we go to the NICU, we are thanking God for our blessings. A couple was in there today, who just had a baby boy, born with Downs syndrome and intestinal problems–so he was in the NICU too. They actually watched Mara for Daniel, so he could come in the NICU with me to see Micah for a few minutes. (Kids under 2 aren’t allowed in the NICU, so Daniel has to sit in the lobby w her while I’m in there w Micah.) But ANYWAY, we were thinking how much more complicated their situation is, since those are long-term challenges they will probably be dealing with for life. We are blessed that Micah’s prognosis is so good right now!