Uncle Tucker Meets the Babies

Uncle Tucker drove up from a business trip in Orange County to visit us. He is the first Brown to meet Cambria and Aegean. He also joined us for our first night out with Cambria. We went to a local Mexican restaurant. Apparently babies get a lot of attention, especially when they are as small as Cambria. We are doing well with Cambria at home. Laura and Cambria still visit Aegean for several hours a day. Laura has also been nice, letting me sleep through 2 of the 3 feedings each night. Cambria has had a lot of gas and a bloated belly. The doctor had a few recommendations, but in the meantime we will have to live with it.

Tucker and I went to the NICU after dinner to see Aegean. Laura told me Aegean had moved from an Isolette (Incubator) to a crib. We confirmed the Umbilical IV was removed. He increased from alternating feeds between bottles and gavage to 2 bottle feeds, 1 gavage. He can have the gavage tube removed when he tolerates the bottle completely. We also got the good news that his stool was now hemaglobin negative for 3 in a row. He weighed in at almost 4 lbs. Aegean continues to have apnea, which is normal for preemies and more prevalent with boys. He has the same rule Cambria had for apnea. He cannot come home until he lasts 1 week without any episodes. There is an option to bring a monitor home, but we would rather keep him under their care if they are willing.

Dr. Mah told us today that Aegean's hemaglobin was low. He was given Epogen to raise the levels. Laura used to make Epogen at Amgen earlier in her career. She remembers an old agreement that employees and their family members can get it for free. I don't think I will ask since Amgen need every bit of cash it can get. I am sure insurance covers it. Apparently most of the babies in the NICU have been taking Epo 3 days a week.

Tucker had to leave early this morning, but it was great having him out.

Cambria's First Graduation

Cambria had the last of her sensors removed yesterday so she could sit with her brother and finally come home. Mom and Dad are a little bit tired today. We are still trying to work out some of the finer points of burping. We will ask some questions when we go to visit Aegean in the NICU today.


Both sets of great grandparents Herb, Millie, Helen, and Less bought the carseats Laura picked out. Laura wanted the carseats that would last from 5 lbs to 60 lbs. You can see Cambria is only a few ounces under the minimum weight, but there is plenty of room to grow. Thanks to the Grandparents!

Aegean was also schedule for a big day as they planned to remove is umbilical IV. He has slowly stepped up to 100% breastmilk. We will confirm the removal happened as planned when we go to visit. This would leave him with the feeding tube as the last foreign connection. Removal of the IV also makes holding him much easier. He will also have the heart rate, O2, and breathing rate monitors still attached. They are much less intrusive.

False Alarm

We ran around Monday all day to get ready for Cambria. I blocked off the afternoon to bring Cambria back. The car seat test was the only thing left before she graduates from the NICU. Cambria needed to breath normally for 2 hours while sitting in the car seat. We found out at 10:00 am that she failed the first test. She had 4 bouts of apnea. The nurses tested her a second time with a towel behind her head and she passed. Dr. Mah thought she needs another few days to get ready. We think she might get to come home this weekend.

Aegean continues in get more food. He is up to 7 mL per feeding (versus over 70 mL for Cambria). He still needs his glucose, protein, and lipid feed to gain weight. His antibiotic course ended today as he continues to improve. Today he continued to gain weight. He reached 3 lbs 6 oz.

Surprise!

Sunday we visited the NICU like we have everyday. When we asked for the daily update, the nurses said Cambria was doing very well. She was taking all of her food by bottle. Both nurses were excited and said she would be ready to go home Monday or Tuesday. We were planning for a week from Monday or Tuesday. We have been running around since then to get ready. My boss loaned us a stroller, bath, and some other necessities. Laura cleaned the house and went shopping. We both took the cat to the vet for the annual check-up. I had to carry the carrier because Laura still shouldn't be lifting things.

Today Dr. Mah confirmed Cambria will be coming home. He also cleared her to have the feeding tube removed. When Laura went to see her she was tube and IV free for the first time!

Aegean also continues to improve. His x-rays continue to show no gas, so they started to feed him again. He only gets 3 mL per meal now and is still supplemented with TPN with glucose and the separate lipid feed. They will slowly increase his feeds to make sure the NEC is completely cleared up. He will continue the antibiotic treatment until the course is complete. He is gaining weight, even with the IV feeding. Laura reported his weight is 3 lb 4 oz. He will need to reach 4 lbs and also feed on his own completely. Assuming the NEC is gone, Dr. Mah thinks he will be ready to come home in 7-10 days.

Both also had an ultrasound of their brains to make sure there wasn't any damage. The nurses reported that everything looks perfect.

Tonight we are planning for our last night of good sleep for a long time. Wish us luck!

Happy 1-Week Birthday - Back to Birth Weight

At the 1 week birthday, everyone is doing well. The babies are back to their birth weight (plus a little). They all lose water weight for the first few days, but we are headed in the right direction. Cambria continues to do well. She is learning to feed from the bottle, but the NICU staff are careful not to overdo it.



Aegean continues to recover from the NEC. He seems to be responding to the antibiotics, and the doctors think he will start normal feeding on Monday. Laura said he was restless while she was there until he finally got to cuddle Mommy. He calmed right down and stayed with her until we had to leave.



Mommy saw Dr. Grossman, who is back from his vacation. He says she is recoverying perfectly. He missed Laura's first visit to the hospital for cramping, second visit to the hospital for pre-term labor, and the third visit to the hospital for the delivery. It was good to hear he doesn't think there are any more hospital visits for him to miss.

Feeling Better about the Scare

Today Dr. Mah recieved the testing and confirmed Aegean has a stage 1 case of NEC (see yesterday's post). He is still not too concerned, and daddy is feeling more comfortable. The x-ray of the colon came back and found the bubbles in the bowels had dissipated. The stool was still bloody through the night, but Aegean did not show any other symptoms. Daddy is learning that being a daddy will be stressful. He remembered that pregnancy taught him this lesson, but he still can't help to overreact.

Aegean had his bililight removed, so he gets to take off the sunglasses. He is almost nearly back to his birth weight. He is also putting on some baby fat. His ribs aren't visible anymore and his arms are filling out. He will recieve IV feeding for a few days while his NEC subsides. This might slow down his weight gain, so he might be in the NICU a little bit longer than Cambria.

Cambria continues to do well. She sleeps a lot, but seems to be a very happy baby.

Mommy continues to pump more milk. She is such a good mommy already. Both days she has spent over 6 hours with the babies. She still has some swelling and pain, but she is doing well.

Our First Little Scare

Daddy got to hold Aegean for the first time since the delivery room. He is small, which makes him even cuter. His nurse found blood in his stool during his next changing. Dr. Mah brought in an x-ray machine to look at his colon. He discontinued feeding and prescribed antibiotics. The two potential concerns he had were that Aegean had necrotizing enterocolitis (NEC) or allergies to food. NEC is a condition that occurs premies. The tissue in the bowels begin to die. It is usually caused by bacteria. Dr. Mah said he was not too worried, but that they take everything seriously in the NICU. I was not too worried until I looked the condition up on the internet. I called in just before bed to see how he was. Apparently he did not have any other NEC symptoms. Food allergies sounded better to me, but finding the allergy would take time. If he has allergies, he will not be able to gain enough weight to come home until the allergy is resolved.

Cambria is doing very well. She is out of the isolette (incubator) and can regulate her own temperature. She had her IV removed and is getting all of her nutrients from a combination of breastmilk supplemented with premie formula. Dr. Mah thinks she will be nearly ready to come home in 2 weeks. Two weeks would be 36 weeks into pregnancy. Babies are not released before they reach the 36 week mark.

Cambria Removed from Bili light

Today Cambria got to take her shades off. The bili light helps remove the biliruben, which causes Jaundice. They try to keep biliruben as low as possible in premies due to their more fragile liver. She seems so much more peaceful.

Aegean enjoyed his newly decorated Isolette today. Both babies were moved toward the entrance (further from the nurses).

Laura sent me an email today with the picture below and the following quote:

"The amount is really about 1 ounce, but that's good!"

Laura came home today. Daddy is relieved, but I think Mommy prefers to be at the hospital near the babies. We are trying to figure out our schedule for the next few weeks.

Removal of the Nasal Prong

Today our nurse, Soon, removed Aegean's nasal prong. The removal allowed him to move from the radiation heating table to the isolette for some privacy. In addition, Laura held both Aegean and Cambria. She tried to breastfeed. Cambria latched on right away. Aegean wasn't quite ready. They are both almost up to full premie formula feeds as calculated by their weight. Once they are able to digest all of the food before the next feeding time, they can have the IVs removed. Cambria should be ready tomorrow.

Laura started producing milk today. At her evening pumping, she made 3 mL. Her milk is divided between the babies and mixed in with the formula.

Moving to the NICU

Nicole (right) was the NICU nurse assigned to take care of Cambria. Jackie was assigned to take care of Aegean. They were both great, explaining everything they did. Nicole put an oxygen sensor on Cambria's foot, temperature and breathing rate sensors on her torso. She put a feeding in her nose that went down to her stomach. Cambria also got an IV in her arm like adults get.

Aegean had mild respiratory distress syndrome. The doctor thought continuous positive airway pressure would alleviate the problems. They put a nasal prong in his nose with a flow rate of 3 SLPM. His feeding tube needed to go into his mouth. The feeding tube was even more important because the nasal prong pushed some gas into his stomach.

In addition, he needed more samples for blood gas to ensure he had a high enough gas transfer rate in his lungs. Dr. Mah put an umbilical arterial catheter into his stomach to get the samples. He also put the IV in the umbilical vein for feeding. There are no nerves in the umbilical cord. This allowed Dr. Mah to put the arterial catheter and IV very close to the heart. Correct placement of the arterial catheter and IV were verified using x-ray.

Aegean continued to retract (heavy pulling by his lungs). This was probably due to less surfactant production, which is the main cause of lung problems with premies. Aegean was given Curosurf, an artificial surfactant to help his lungs develop more quickly. A tube was placed in his trachea, where Curosurf was pushed in through a syringe. Aegean sucked it up immediately. His retraction improved throughout the day.

The Operating Room

It was at least 1/2 hour (15 minutes more than it was supposed to be) before they called me back for the C-Section. The 15 minute spinal block took longer than expected. Maybe Laura can fill us in later.

They finally called me back, wisked me over to the non-sterile side of the table where I could only see Laura's head. Laura requested a mirror set-up so she could see the doctors cut the layers of her stomach away. I couldn't see, but Laura asked them to put the mirror where we could both watch. This is definitely not my style. I usually get sick to my stomach giving my blood or watching surgery on TV. I could see them finally pull Cambria's head out of the hole in Laura's abdomen. Cambria cried right away. I was called over to take pictures and cut her umbilical cord (something I thought I would never to). I finally finished my duties with Cambria and went to check on Laura. I could see Aegean come out still in the membrane. When they got him out, he did not cry right away. He was also a bit smaller than Cambria. I checked on Laura, who was concerned about Aegean's and had tears in her eyes (but confirmed she was not crying while we edited this post). I went over and performed my daddy duties, which included pictures of the weighing and cutting of the cord. When I came back, Laura was happy again. Apparently hearing Aegean cry made her feel better. Their apgar scores were 8 and 9, both were breathing on their own, were responsive, and had good color. The nurses brought both babies over for a picture, then wisked me out with the babies. I left Laura behind to be sewn back up.

Day of Birth

Cambria Marie Brown (4 lbs 2 oz) and Aegean Chambers Brown (2 lbs 15 oz) were born on May 8th at 8:17 and 8:20. The night Laura went into labor, I was sleeping on the couch. I had been sleeping poorly for the last few weeks because of the snoring (pregnancy induced) and bathroom breaks. Laura came into the living room at 3:30 am to tell me her water broke. We both calmly got ready very drove to the hospital.

Laura was in active labor with contractions every 3 minutes by the time the doctor arrived. Aegean was breech, so we agreed a cesearean section was the right thing to do.

Pregnancy - The Short Version

May 8th was 33 weeks 4 days into pregnancy, or a little over 6 weeks premature. We were counting weeks since the 24th week when we learned that Laura was at risk for pre-term labor. She was immediately put on bedrest. Laura was hospitalized at ~28 weeks for pre-term labor. We thought the babies would join us that weekend. We met the neonatologist from the neotanal intensive care unit (NICU), Dr. Mah. He was a very comforting doctor who told us what to expect if we were to deliver a 28 week old babies. Our perinatologist, Dr. Jadali, had already told us that at 28 weeks there is a 95% chance that each baby could be born and have no long term effects. We also knew that at 32 weeks (the next major milestone), the chance of long term problems were equal to that of full term babies. We were both relieved when we made the 32 week milestone and we were looking forward to 34 weeks. We would expect the babies to have coordination to manage breathing at eating at the same time at 34 weeks. In addition, their lungs would be developed enough to breath without a respirator. The babies did not quite make this milestone.

Bedrest was extremely challenging for Laura. Grammy Evans came out to take care of her for over 1 month. Without her, the babies would not have stayed inside as long as they did. The story to come would have been a lot more painful. Grammy also prepared the nursery after Aunt Lynn painted the jungle. Many thanks to Dianne for keeping Laura well fed and helping keep the house and the baby preparation manageable during this very stressful time.

Grandma Brown also came out early during Laura's bedrest to let me to celebrate Grandpa Brown's 70th birthday heli-skiing in Canada. She was also a key to keeping the babies inside.