Monday, April 6, 2009

3 1/2 days of life

A lot can happen. Let me catch you up on their medical progress so far.

Thursday, April 2 - They pulled my hospital bed right next to each of them in the NICU as I was too groggy to be in a wheelchair. I know the nurses were talking to me but I don't remember anything they said. I just stared at my babies in disbelief that they were here and was amazed at how small but perfectly complete they were.

My nurse woke me multiple times in the middle of the night to check my vitals and assist me to the bathroom. I was feeling less disoriented and wanted some time to see the twins again. Shannon had gone home to get a good night's sleep and pack a bag of essentials since we were so unprepared. The nurse was kind enough to take me down to the NICU in a wheelchair at 4:15am to see them.

Both were in a bed with a plastic shield over it to create an environment with controlled, high levels of humidity. Because their skin is so thin, they lose a lot of moisture. Their heads are immobilized with cushions for the first 72 hours as the veins in their neck are quite fragile. They are laying on a pad that circulates warm water and are surrounded by a "nesting bed", which provides a boundary for them to feel like they are still in the womb. You would think they would be swaddled in a blanket but they are just in a diaper and soak up the temperature and moisture from the closed container. Sometimes they sling a leg over the bed like they are just hanging out - it's quite comical.

They have multiple wires and tubes leading to their body. One wire is taped to their belly and provides an electrical feed which measures their body temperature so the beds can be adjusted accordingly. Other wires provide a monitor of their respirations, heart rate, oxygen levels in their blood - all with an alarm that will sound if they are in distress. A white IV line enters their body through their umbilical cord and provides antibiotics and nutrients. An orange line enters their body through their mouth to their stomach and will be the source to push breast milk when they are ready.

Both are connected to a cpap machine (continuous positive airway pressure). There are 2 different kinds of masks which are rotated every 6 hours to prevent skin irritation - one has tubes directly in the nostrils and the other is a mask that covers their nose. There are straps that hook over the head to secure it from slipping. They are breathing room air (21% oxygen) unassisted but this machine provides pressure to help them when they fall into a deep sleep and forget to breathe.

Sara's lungs were a little less mature than Adam's. At 1:30am she was intubated to administer surfactant directly into her lungs and then the tube was removed. A developed lung already has surfactant inside it. Without it the lung deflates to breathe, sticks, and has trouble re-inflating. This is pretty typical for a preemie and she has only needed one dose.

Adam needed a little blood upon arriving in the NICU, due to losing some through his umbilical cord during delivery.

Friday, April 3 - Sara's cpap assistance was increased slightly for a bit but overall her breathing is fine. Her sodium levels are up so they raised the humidity in her bed to 95%. There is so much condensation on the plastic that the nurse has to wipe it off in order to see her. She had a bowel movement but is not peeing much. This is probably due to her magnesium levels. I know how out of it I felt so I can't imagine the effects on the babies!

Adam had 4 episodes in 2 hours with forgetting to breathe and the nurse had to wake him. That is also due to his magnesium levels making him so relaxed. And the brain is trying to remind him to breathe since he didn't have to do that in the womb. If it continues at that rate, they will have to intubate him. He gets frustrated with his c-pap at times because it shifts off his nose.

Test feedings begin. For the next 4 days, they will be given very small doses (2, 2.5, 3 cc - think 1/4 teaspoon) of breast milk to see if their stomachs are developed enough for digestion.

Saturday, April 4 - Sara's sodium is normal again so her humidity is lowered back to 85%. Still no further problems with her lungs. Her belly rubin count is high so it is time for photo-therapy. On come the stylin' sunglasses with gauze around them. Between the glasses and the c-pap you can't see much of her head or face. Her urine output is increasing.

Adam's breathing problems have improved and he still doesn't need to be intubated. No bowel movement yet but the doctors aren't concerned. He is still very laid back. To calm himself, he has taken to a pacifier and I can feel him sucking it when I put it in his mouth. I took his temperature by placing a digital thermometer in his armpit and holding his arm down. He was a good boy - no fussing.

They have made it to the 48-hour mark with no signs of infection. Antibiotics are stopped in their IV.

9:30pm and I am being released from the hospital. One last visit for the day to pray over the kids before we leave for home without them. Sara wrapped her hand around Shannon's finger and wouldn't let go. We talk to them often when we are visiting so they know our voices.

Sunday, April 5 - Sara's photo-therapy continues. Her breathing is doing so well they lower her c-pap assistance by 50% in the morning. When the nurse checks her stomach before her next test feeding, it is empty so she has digested what she was previously given.

Adam starts his own round of photo-therapy but on 2 smaller lights compared to his sister. The doctor was ready to turn his c-pap down in the morning but the nurse who was with him all night said "let's wait and see if he is a good boy all day." When we visited in the evening, he had a good day and it was turned down by 25%. He has still not had a bowel movement since birth. They hear noises and have taken an x-ray to make sure there is nothing wrong. The magnesium just has the effect to slow the digestive process. He is not processing the test feedings as well. All of the previous feeding was still in the stomach and had turned a little green. No concern yet.

I got to change both their diapers - I couldn't believe it! I was nervous wondering how to touch them and if I was going to hurt them, as well as all the wires that can get in the way. Shannon changed Adam's diaper at night - dad's 3rd diaper change of his life - and did an awesome job for being on a 2lb baby!

Both of their magnesium levels are down by quite a bit and you can tell they are more awake. The nurse comments how Sara is always moving and kicking - that's my girl!

Monday, April 6 - We start the day with both being removed from photo-therapy. And both having c-pap assistance stopped. There is just a little pressure right now. They are at an interim step - if they do well the c-pap will be removed completely and they will have a little oxygen prong in their nose. They are past the 72-hour mark and their necks don't have to be immobilized. Nurses will begin rotating them on their side every 3 hours. Sara hasn't pooped since Day 1 of life. Adam hasn't pooped at all. Another x-ray reveals there still isn't anything wrong. Both are given a suppository through a syringe. Adam was not happy - he knows things should only go out that place! Sara's sodium is high again so her bed is back up to 95% humidity.

The intern talked to us about putting in a central IV line. You don't want to keep the IV through the umbilical cord long-term as it could be a point of infection. Instead, they insert a line through the upper arm that cuts across to the heart. Of course there can be complications and an x-ray is taken to make sure placement is correct before using it and removing the umbilical IV. We had to sign documents authorizing their first real procedure and allowing CPR if necessary.

Sara has some levels with her liver that are off. They aren't sure why and will be running cultures to track it down. Typically if it's an infection, there will be more levels than just the liver that are off. We are hoping for more information on that tonight.

Whew...lots of information. At least you are now all caught up!

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