The ABC's of Preemies

Emma's older sister Eden is so excited that she's learned her ABC's.  She sings them all the time and ecourages Britne and myself, and frankly anyone else who is around her, to sing with her.  She's so proud of herself for learning them, and we must say that we are proud of her as well.  Emma, being a preemie, is working on a different kind.  Instead of the ABC's, it's just the A's and B's.  That stands for apnea (when the baby stops breathing) and bradycardia (a decreased heart rate), which is very, very common in premature babies.  In fact, 80% of babies born before 30 weeks of gestation have this problem.  In most cases it gradually becomes better and resolves itself prior to 36 to 38 weeks gestational age.  It's considered mild if the following criteria are met:  the baby doesn't stop breathing for 20 seconds (try holding your breath for 20 seconds and see how tough that is), her heart rate doesn't dip below 60 beats per minute, she resolves it on her own by beginning to breathe again, and she has fewer than 10 to 12 a day.  So far, Emma meets all the criteria for mild A's and B's.  She's having about 4 to 6 episodes a day and each time she's resolved it on her own without any intervention.

It is very nerve wracking to be in the NICU spending time with her and look up at the beeping monitor and realize that her respiratory rate is 0 and her heart rate is dropping.  You're looking around wondering why all the nurses are just sitting at their computers charting or doing whatever it is they're doing instead of rushing to help your child come out of one of these episodes.  But the reason they have that job and the parents don't is because they have years and years of not only training, but dealing with this on a daily basis.  One such occurrence happened to me this afternoon when I went to visit Emma.  I was just standing there watching her when all of a sudden one of the alarms on her monitor started to beep.  I looked up to realize that she had stopped breathing and her heart rate was dropping...117, 102, 85.  Finally, 2 nurses who were covering for Emma's nurse, who happened to be on her lunch break at the time, came casually walking over, one of them saying to the other "She's bradying."  The second they made it over to Emma's isolette, she resolved this herself and started breathing again, and I watched as her heart rate climbed back up to its normal 140 to 150 rate (yes, that does seem high as the normal adult heart rate is about 60 - 90 beats per minute, I believe, but it's totally normal for young babies).  The nurses wait to intervene not only because they realize better than the parents when it's time to be alarmed, but because it's good for the baby to learn how to come out of these episodes on their own.

About 5 minutes later, the doctors were making their rounds and were so excited to report that since the increase in her caffeine the day before she'd had no more bradies.  I was a little disappointed to have to tell them that she'd just had one.  But that was the first one she'd had all day, and the first she'd had since 4pm the day before.  She did have a few more after that a little later in the afternoon, but she was still under the 10 per day that raises an alarm from the doctors.  Britne was with her later in the afternoon and said her heart rate didn't even drop below 100 on any of the ones she observed.  So Emma is still going along as expected.

Dr. Price, the chief in charge of the NICU, was one of the doctors who was making rounds when I was there this afternoon.  After he'd gotten the full update from the nurse practitioner on Emma's overall condition, he turned to me and said "We are still cautiously optimistic.  As you know things can change in an instant in premature babies, but up to this point, she's done exceedingly well."  That was a big boost for me, and it put a smile on my face about as wide as I can possibly imagine!  Still, he prefaced everything by saying that he and the entire team remain cautiously optimistic.  Emma's Mother and I share that same stance.  We know that at the drop of a hat anything can happen, but we cherish each and every good report we get from the doctors.  We know that we haven't had our last bad report, but that doesn't make the good ones any less enjoyable.

As I mentioned last night, they increased Emma from 1ml of milk every 3 hours to 2ml.  Well this morning they increased her again to 2.5ml.  She tolerated that increase very well, and the plan, as it was told to Britne, was to increase her again this evening at her 8pm feeding to 3ml.  I called for an update at around 8:45 and her nurse told me that they had indeed increased her feeds again, but it was to 3.5ml, even more than they'd told Britne they would give her. 

They weigh Emma every night, sometimes they weigh her prior to her 8pm feeding, sometimes prior to her 11pm feeding.  It all depends on which nurse she has that night.  Last night when they weighed her she was up to 710 grams, up 40 grams from the day before.  That's a little over an ounce gained, and more importantly, it's 2 grams more than her birth weight of 708 grams.  There are approximately 450 grams in a pound, so there's about 28 grams in an ounce.  So a gain of 40 grams is nearly an ounce and a half.  At this point they want the babies to average a weight gain of around an ounce a day, because that's the average gain they would have in Mommy's womb at this gestational age.  So they have a protocol they follow for increasing her milk intake that coincides with their goals of increasing her weight.  In the next few days, definitely before the weekend is out, they will begin fortifying her milk with a supplement to add a few calories to it.  They've told us that Mommy's milk usually averages 20 calories per ounce (again, an ounce is 30 ml, so Emma's still well shy of that volume every feeding) and the substance they add to it will increase that count to 24 to 26 calories per ounce.  This will all aid Emma in adding some weight to her tiny little frame.  It's completely normal, they do it in all babies in the NICU.  They reassured Brit and myself of that yesterday afternoon.

I know that was a lot of information for one post, but the hospital gave us a book yesterday called "Preemies:  The Essential Guide for Parents of Premature Babies."  It's basically an encyclopedia of everything that can happen during a stay in the NICU.  They have encouraged us to read only the parts of the book that pertain to our current situation.  It's got a lot of information in it, and much like googling stuff, if you look up everything, you're going to find stuff that scares the daylights out of you.  But since Emma's been having some episodes of apnea and bradycardia, I looked that up in this book tonight, hence the extraordinarily long post.  All in all, it was another positive day for Emma.  We remain, as they tell us to, cautiously optimistic.  Taking this experience one day at a time is the only way to do it.  I sometimes find myself thinking ahead, then I have to remind myself not to do that.  We never know what's just around the corner.  But so far we're 9 days in, and we're very, very proud of the strides Emma has made.  Keep fighting little girl!!  Your strength is what is keeping us going.  We love you!