Definitely Progress!

Today was a GREAT day!!  I wrote the last post yesterday, during the 630-730pm shift change break.  At 730pm when we're allowed back in the NICU, I walked into her room and the first thing I saw was her heart beat up at 212 :(  Her nurse and the nurse practicioner were standing there talking about and contemplating putting her back on the ventilator.  They were talking about all the stress she'd been under and how she was doing off the vent.  Before they made the final decision to put her back on it, they ordered an x-ray of her lungs so they could see how they were looking, and they also ordered a blood gas.  Her blood gas was perfect, they said that it was actually so much better than when she was on the ventilator....that meant her body was doing what it should in terms of exchanging the gases.  That was the main reason why they still had her off the ventilator.....they said if her blood gases were off even a little bit, they would probably have put her back on.  In the x-ray they took, they saw quite a bit of fluid in her lungs.  They said that could be the issue of the high heart rate, so they decided to give her a drug called lasics, which takes all the fluid from the lungs and then she pees it out.  Because they saw so much fluid in her lungs, they decided to lower her feedings to 22ml from 23ml every 3 hours.  1ml doesn't sound like anything, but it's actually a lot to her considering how small she is.  They also expanded the time she's getting her food from 30 minutes to an hour....that meant they set the machine to pump 22mls of milk into her stomach over an hour period of time.  The reason for that change was to see if allowing a little more time for her to digest her food instead of dumping it all in at once would give her more room to expand her lungs and breathe better.

I really am grateful for the staff at the NICU, they are amazing and I honestly feel that they love and care about my baby girl, and it's just as important for them to see her progress as it is for me and Ova.  They're constantly meeting together just to discuss her progress and to decide what changes need to be made to help her progress even more and even faster.  They are amazing and I'm so grateful for them!

One of her primary nurses Meredith, we love her!  was taking care of her last night.  She told me that she asked the NNP if I could hold her....she thought she needed some mama time, some physical stimulation. She was so stiff and tight that Meredith thought that since she does so well when I hold her, that she just needed me to hold and love her, and she would calm down and relax.  I was super excited because I LOVE every chance I get to hold her...and at the same time I was surprised because I just held her a couple days ago on Sunday.....I was told at her age and size that she should only be held once a week.  This would be the 7th time I've held her in 6 weeks!  The NNP agreed and said it was ok, it was worth a shot to try and calm her down....and hopefully her heart-rate would stabilize.

See how tight she is holding on to her binki....she needed to relax!

Like I mentioned earlier, her heart rate when I came back from the break was up at 212.  As soon as the nurses transferred her to my chest, her heart rate went down to the high 160's, low 170's.  It hadn't been that low all day!  She immediately relaxed and calmed down and she finally went to sleep.  I just sat there holding her, looking down at her little head as I was rubbing her back.  I love those moments I get to hold her, it really is amazing what a Mother's touch can do.  I held her for almost 2 hours....she was doing so good that Meredith let me keep holding her.  Her Fi02 (oxygen the machine was giving her ) was in the high 40's-50's all day, but the entire time I was holding her she was able to go down to 33%.  She did so good with me for almost 2 hours, and then she had a small ABD, which she self-resolved....but Meredith took that as a sign that she'd had enough physical stimulation.  We put her back in her incubator and not to long after that her heart beat went up again. :(

The lasics they gave her caused her to pee a lot, and when we changed her, her diaper weighed 50ml, which is a whole lot!  30ml is 1oz, so she peed almost 2oz....double the amount of breastmilk she gets every 3 hours......after that she started stabilizing and doing great!  Just like the nurses keep saying, every baby is different and the trick of taking care of them is finding out exactly what their little bodies want and need.  They have to figure out what, out of all the many possibilities, are slowing their progress and change it.  It takes a lot of brainstorming, monitoring, trial and errors....but we think they finally figured it out!  The dose of lasics along with spreading her feedings over a longer period of time, and being held by her mama seemed to have done the trick.  She was calm, her heart rate stabilized in the 170's and she finally got some rest in her incubator.

This was what she looked like when I left last night, nice and calm and sleeping!

Today when I got to the hospital, her heart-rate was back down in the 150's and her Fi02 was down at 29%!  Another one of her charge nurses, Annica  (we love  her too) was taking care of her today.  She told me she'd been doing so great all day.  Her heart rate was where it needed to be and was stable, her oxygen needs were down and she was very restful.  I was so excited to hear that news....and to know that my baby girl was finally feeling better enough to get some rest!  They figured out last night what her little body needed and it worked!  And she was still off the ventilator.....on day 5, which was a HUGE accomplishment!  I asked Annica if she had had any ABD episodes and she told me she only had 1 the night before at 11pm, and hadn't had any at all all day long.  (They only count the ones they have to actually get into her incubator and wake her up to remind her to breathe....she did have a few that she self-resolved, which is normal for preemies....and that was ok!)  She didn't even require very much sedation or morphine......she was having a great day, and I was so happy!

Since she's 6 weeks old now, she had to get her eye exam done today.  I had been told by several nurses that I could be in the room to watch her get it done if I wanted to, but that it was pretty invasive and they recommended that I not......they explained to me what it entails...first they would give her drops that would numb her little eyes, then they would hold her eyes open with forcepts, dialate her eyes, pop them a little out of the socket and shine a bright light on them so the optical doctor could see the veins and blood vessels behind her eyes to see how well her eyes are developing and if there are any signs of ROP (retinal problems cause by high oxygen levels)  I opted to listen to the nurses advice, especially since I'm such a cry baby.  I thought I'd spare myself that pain.  I went into the breastfeeding room and pumped while they did it.  When I came back into the room, she was still calm...even after all that, she did get aggitated.....which meant she was comfortable (Annica did give her a dose of morphine before the procedure just to help her out)  The results of the exam were excellent.  She's at a stage 2, with no signs of ROP.....almost at a stage 3.  Stage 3 means her eyes are fully developed, and she was almost there!  :)  The optimologist did mention that polynesian babies' eyes tend to mature a lot better and quicker than other races....I was so grateful for the good news!

The rest of the day was pretty uneventful.  I just sat by her incubator for a few hours staring at her and thanking my Heavenly Father for a great day!  It was exactly what both her and I needed after 3 not so good days!  It's the good days that come around that keep us sane, give us hope and keep us going!

The NNP came back in tonight and right when she walked in, she said "I'm so proud of her"....I said "so am I"  we talked a little about how great she did today and how their plans were to just watch her and make sure she stayed stable.  She did mention that they wanted to try and wein her breaths because she was still getting the 40 breaths from the machine.  They wanted to go down to 35 breaths.  Immediately Annica stepped in and suggested that they only wein her by 2 or 3 breaths....just because when they made huge adjustments before, when trying to get her off the vent....she didn't respond too well to it.....when they made slow adjustments, she was able to tolerate it.  The NNP agreed with Annica and the plan was to go down to 37 breaths.  That's why I'm grateful for primary nurses (a post about them coming soon!) because they work with baby Katea often and know what she likes and doesn't like and what will work for her.  And I'm grateful for an NNP that listens and respects what the nurses have to say.

Tonight before I left the hospital they weined her rate by the 3 breaths they had discussed.  She wasn't handling it too well.  Her heart-rate went up a little and she was requiring a higher Fi02...up to 52%.  They were just going to watch her for a little while to see if it was that she needed the 3 breaths back or if it was just the fact that she was getting her feeding and had just had her dose of caffiene.  I had to leave to get the van to Ova so he could go to work....so I didn't stay to see if she stabilized again.  Either way, she had a great day today and I'm so happy for that!  If they did have to give her those breaths back again, it's ok.  They'll just try to wein her again in a couple days.....it's all about timing and when her lungs have grown a little more and are ready, it'll work!  Glad they decided to only wein the 3 breaths, because if they would have done the 5 they originally planned, she probably would have failed hard.

Today I'm so grateful for small miracles, for good days and for my baby's doctors and nurses who are doing everything they can every single day to help my little girl progress!!

Baby Katea right before I left today....with puffy eyes from the eye exam and the nasal IMV in her nose!  Love you baby girl!