This has been baby Katea's home for the past 2 months. A humidified incubator that had to be covered because bright light and loud noises were too much for her little eyes and ears...
She's still on the nasal IMV, but she was getting way too hot in the incubator, so they figured it was time to get her out of it. When she's too hot, it makes her heart rate skyrocket up in the 200's, which in turn affects her breathing and so it's all around a bad thing. Usually they just keep them in the incubator until either they're on a nasal canula, or they weigh 1800 grams. She hadn't quite reached either one of those goals yet, but it was time! The nurses were joking that she was the smallest baby they've ever seen in an open crib. haha...But that's just another example that she's the boss, and she'll do things when she wants and not when we want her too! The crib is about half the size of a regular crib, and she looks so tiny in it....but at the same time, she looks like such a big girl! This was a huge step and we're so proud of her! :) Besides moving to a big girl bed, another important 'first' happened on Wednesday. That was the first time her daddy held her! It was such a precious moment that I'm not gonna go into detail about it in this post....it deserves a post of it's own! :)
Daddy so happy to see me in my big girl bed
She's been doing so well with her respiratory status. They'd been able to wein her breaths like they'd planned, and she was tolerating it. They started out slow at first, because they didn't want to overwhelm her....but she was doing so awesome that they picked it up a bit. At first they were just taking 1 breath away every 12 hours....then they up'd it to three breaths a day, two during the day and one at night. She did so well with that that they started taking away 2 breaths every 12 hours. She was tolerating it so well, that the NNP and nurses were so impressed. They decided on Friday at their rounds to start taking away 3 breaths every 12 hours, starting that night.....and when she got down to 0 (meaning the machine wasn't giving her any breaths at all...she was doing all the work on her own) they would take her off the nasal IMV and move her to the high flow nasal canula. They also decided that since she'd been able to consistantly keep her Fi02 under 30% for the past couple days, they would drop her PEEP(pressure) by 1. A PEEP of 5 is the lowest they go, and they went from a 7 to a 6. She was doing amazing and we all (me, Ova, the nurses and NNP's) were so proud of her! On Friday her rate (breaths the machine was giving her) was down to 15. Saturday morning, down to 12. If she would have continued with the plan, she would have been to a 0 by Monday morning.....which means she would have been able to go to the nasal canula by Monday night....but she had a little set back last night. :(
She hadn't had any ABD episodes at all since she was extubated....and it had already been 8 days! I was hoping that meant she was clear of them....that the awesome progress she had made meant she was good. But last night she started having ABD episodes....she had 3 within 10 minutes. I got scared all over again. I was holding her when she had them, and I noticed she wasn't coming out of it...I was rubbing her chest and patting her bum trying to get her to start breathing again. It wasn't working. Ova was sleeping in the chair right across from me and I tried so hard to get his attention, but he was just too tired, and wouldn't wake up....I was panicking so bad. The NNP was doing her rounds and she walked in the room in the middle of it. I was crying. She went straight to the machine and pushed a button to give her a few breaths....that helped and she finally came out of it. It only lasted like 30 seconds, but it scared me to death and felt like it lasted forever. The nurse came in and took her from me and put her back in her crib...where she continued to have a few more episodes. The NNP immediatly ordered a chest x-ray and blood work to be drawn to test a CBC and a Blood gas. She wanted to make sure baby's lungs weren't collapsing, and that she wasn't developing any infections....She also moved her rate back up to 15 breaths per minute and increased her PEEP from a 6 back up to a 7. All those steps forward.....and now steps back again. :( Rollercoaster. She finally stabilized and calmed down. I was trying so hard to fight my tears. My poor baby girl. The chest x-ray came back and the NNP said it didn't look bad...but she wanted to keep the rate increased to give her a little break. Maybe they had too much confidence in her and they were trying to wein her too fast. We didn't know. Her blood gases came back perfect again....and her CBC showed no signs of infection. Why all the sudden after she had been doing so good for so long, without showing any signs of distress.....why all the sudden now, is she back to having ABD episodes?
Ova and I sat by her bedside for a little bit after she had settled down.....then after she fell asleep, we left.
I kept thinking about her all night last night, wondering what was going on....hoping she was ok. I got here today around 4pm and she was sound asleep in her crib. The machine was set at 20 breaths. 5 more than what they went up to last night. When her nurse Stacey walked in, I asked what happened. She said that last night they had to go all the way back up to 25 breaths. She just kept having those episodes. Then, they asked the RT to come and do prong cares (clean out the prongs that were down her nose) and they found tons and tons of boogers, mucus....and one of the prongs were completely plugged up with a big booger. That was the reason she was having so many episodes.....she wasn't getting any oxygen at all through one side, because it was blocked. Stacey told me as soon as they cleaned the prongs and suctioned her out, she didn't have any more episodes and was stable.
She turned 2 months old yesterday too.....can you believe it? I can't believe two months have already passed.....thankfully, the time just flew right by! Because she hit 2 months, she had to get her 2 month shots (just because she's a preemie and super tiny doesn't exempt her from getting her immunizations) They were giving her a total of 5, combining some of them she would only have to get 3 shots.....and they'd do it over 2 days just to give her little body a break. Yesterday she got 2 of her shots, and today she got the last one. The NNP and nurses were thinking that her episodes were a combination of all the boogers and the shots.....it was just a lot on her.
Today at rounds, because she did so much better after cleaning her prongs, they put in her chart that she needs to be cleaned every 6 hours instead of every 12....just because she's more boogery than most other babies. And the NNP told them to wein her breaths down 3 every 3 hours at cares...until they get her to the 12 breaths she was at last night. Then they would reasses her and go from there.
She had an awesome day all day long! They weined her breaths throughout the day with every cares, and at her 8pm cares, she should have been back down to the 12 she was at yesterday. But around 6pm she had a couple more episodes :( the RT came in and suctioned A LOT of boogers out of her....they're thinking that and her other immunizations she got today is causing it again. So they're gonna hold where they're at right now instead of continuing to wein......give her a day to recover from the shots. Tomorrow they'll talk about how she did tonight and decide what to do to continue. Aaarruugghh.....2 steps forward, 1 step back! She's still making progress though, and I'm so proud of her!
Since they've been fortifying her milk to 27 calories....and adding the protein, she's been gaining weight like crazy! On Thursday she weighed 1680 grams.....Friday she was 1700 grams.....yesterday (Saturday) she jumped to 1790 grams....that equals 3lbs. 15 1/2 oz!! Only 1/2 oz. more and she'll be 4 pounds! Can't believe it! At her cares tonight, since it's Sunday we'll get to see how much her head has grown and how long she is....and I'm sure she'll break the 4 pound mark! Good job baby....grow, grow, grow!