Major Progress for Nathan!!

Nathan made a major step today (09-28)! We were there to help move him into the "Baby Steps" section!

Now that all of Nathan's intravenous lines are out, we can bathe him as well. When his lines were still in, he got sponge baths.

Nathan's First Tub Bath

The NICU has 2 main sections. The part they call the NICU, which is where Nathan has been for the past month, and the other half called Baby Steps. Nathan now has a new address in Baby Steps! Although Nathan slept through the move, this is a Major step towards coming home. The qualifications for Baby Steps are somewhat flexible, but primarily the baby needs to be off of any intravenous medications and treatments, not on assisted respiration like the ventilator or CPAP, and able to digest his full feedings. He is still in his incubator to maintain his temperature and he is still on his nasal cannula to assist with oxygen flow when needed.

In Baby Steps, Nathan will learn how to take feedings through a bottle and learn how to suck, swallow, and breath all at the same time. Us parents will be formally learning all kinds of things as well.

We are happy to be moved into the Baby Steps section, but very sad to leave some of the NICU nurses that we have become so close to. We loved sitting with Nathan and visiting with the nurses. Nathan also had to leave one of his preemie friends Katlyn behind in the NICU as well. We were sad that Katlyn and her parents couldn't move with us yet, but hopefully we'll see them in the Baby Steps section soon.

Nathan - 1 Month

Nathan has been in the NICU just over 4 weeks now and he is doing fantastic. He is up to 3 pounds 5 ounces. That's up from his 2 pound 4 ounce birth weight. When he's awake, he is very alert and animated and he looks great.

Nathan has been on a 24 hour a day continuous feed for a while now. He can't suck, swallow and breath all at the same time yet so the breast milk is pumped directly into his stomach. At the moment he is getting 6.5 milliliters per hour (every hour) and he is digesting virtually all of it. They are increasing that rate every day. His target rate is around 9 milliliters an hour, but as he gains weight, his target feed rate will also increase. The feed tube now goes through his nose. It is more comfortable through the nose and it stays in better. They can't put it through the nose when he is on the CPAP respiratory assistance because the nose must be open for that. But now that he is completely off the CPAP his nose is open for the feed tube.

Did you know that your intestine attaches to your stomach on the right side? As a result, preemie babies digest best while laying on their right side or stomach, but they also get rotated onto their left side and back and must keep digesting in those positions as well.

Yesterday they started fortifying the milk with extra calories. It's like a preemie protein shake! With the extra fortification and increasing feed rates, he'll be getting big soon!

He is still on the nasal cannula to provide extra oxygen when needed. His oxygen is set on room air levels most of the time, but occasionally he needs some brief assistance. He gives the nurses a regular challenge by ripping the cannula out of his nose. You'll see in one of the pictures how they have put a lot of extra tape on it as an attempt to keep it in place. He seems to tear through the tape pretty fast. Don't worry, it's a baby skin sensitive medical tape. Luckily his breathing is progressing very well because the cannula is somewhere other than his nose a lot of the time!

Nathan is also now on "cycled lighting". They open the blankets on his incubator during the day in order to get him used to day / night cycles. This is one of the many steps they take to get him ready for the real world.

Nathan recently got moved to a new spot in the NICU that has unusual lighting and not much space to move around. A new baby needed Nathan's old spot more than he did. The new location makes taking pictures difficult! Preemie babies don't like camera flashes, so many of the previous and new pictures were without a flash. We have a feeling he will be getting moved to the big kid section within a couple of weeks!

That's pretty much all the news for now!

Mommy holding Nathan
Baby Stop Sign
Kangaroo Time(Nathan is tucked down in my shirt)
Nathan in his incubator

Nathan - Day 17

Nathan is 17 days old now (Wednesday 09-13) and is doing great.

He is up to around 2 pounds 10 ounces depending on his diaper load. He has also graduated into a fully enclosed isolet / incubator. That's the clear box with the arm holes in it that most people have seen for preemie babies. The incubator maintains the temperature, humidity, silence, and darkness better than the open crib he was in before. New arrivals are typically kept in open cribs because they are handled more frequently and need to be easily accessible to monitor and maintain their feed lines and sensors. Early preemies also need to be accessible in open cribs so the nurses can wake them up from their apnea and bradycardia spells!

He is still learning how to digest the milk that is getting pushed into his stomach. He is getting better and consumes more milk volume every day. As soon as he figures out how to digest it fast enough he is expected to start gaining weight fast.

That's pretty much all the news for now!
Nathan's Incubator
Nathan - Wide Awake
Family Portrait
Daddy holding Nathan and looking at him in the mirror.

Nathan - Day 10

Today is day 10 (Wednesday 09-06) and Nathan is doing fantastic.

Nathan's apnea spells (where he temporarily stops breathing) have reduced significantly. It now happens once or twice a day instead of 10 - 12 times a day. The doctors expect it to continue for a few more weeks. He gets straight medical caffeine injected through his feed line to keep him alert which helps him to remember to breath. They also determined that the preemie passifier and sleeping on his stomach are too relaxing for him as they both increase his apnea spells. A mix of caffeine and good observation has made a big difference.

Saturday, 9-2, he was moved off of the CPAP and onto a nasal cannula. He is on 21% oxygen just like you and I, and the cannula provides a very slight flow of air to help him breath. It is not intended to keep his lungs inflated like the pressurized air from the CPAP was. The nasal cannula is the final step before they remove all respiratory assistance and let him breath completely on his own.

He is now getting breast milk injected directly into his stomach. It goes through the orange tube that is in his mouth. The nurses are increasing his milk dosage to as fast as he can digest it. His stomach and intestines are still growing and learning how to handle "solid" food. Once they get his milk digestion rate high enough they will stop the nutrient feeds through the umbilical cord line.

He is also starting to open his eyes and look around. I think the caffeine has him pretty strung out. When he opens his eyes he just looks so exhausted. He looks like he's been up for days and just can't sleep! Oh well, breathing is a few steps above sleeping on the priority list.

Randy also changed his first diaper ever. That was fairly entertaining. He ended up having to do it twice since he accidentally got some of Nathan's monitor wires inside the diaper on his first attempt.

Daddy's first diaper change.

Daddy holding Nathan for the first time.

Mommy looking and feeling much better since she has been released from the hospital.

Nathan strung out on caffeine.

Nathan - Day 5

Nathan has had great progress over the past 24 hours.

Nathan's endotracheal ventilator tube was removed Thursday. He has returned to assisted breathing with the CPAP (Continuous Positive Airway Pressure) which puts slightly pressurized air into his nose. The CPAP requires him to take his own breaths and the pressurized air keeps his lung capillaries slightly inflated so they don't collapse. The oxygen push through the CPAP has been reduced to 21%, which is what you and I breath through regular air.

He occasionally has "apnea of prematurity" which is where he temporarily stops breathing. They are giving him caffeine as a stimulant to help him remember to breath. The "stops breathing" description sounds worse than it really is. It usually lasts only a few seconds and he typically recovers on his own or with a touch or tap from the nurse. Virtually all babies born prior to 34 weeks gestation have this condition and it typically resolves itself as he progresses.

His bloodwork tests are trending positively so they have removed his arterial line that was put into his umbilical cord artery. They drew the blood for all of his blood tests through that line. Future blood tests will be less frequent and will be taken from his foot.

Due to that line tap in his umbilical artery, holding him caused a risk of damaging the line causing bleeding. With the artery line removed I was finally able to hold him, 5 days after delivery.

Thursday he took a test of taking breast milk that was injected through a tube directly into his stomach. He had decent digestive rates of the milk, so Friday he was put on a continuous feed that is currently pushing 2cc of milk per hour. Over the next 7 - 10 days he is expected to learn how to fully digest and get all of his nutrition from the milk. At that point they will remove the other line that is in his umbilical cord. That other line is in an umbilical vein that sends nutrients to him just like the umbilical cord did. As he develops later he will be put on a feeding schedule instead of a continuous feed.

We appreciate everyones thoughts and prayers. We still have a long way to go, but things are progressing very well at this time.

Nathan's Aunt Samantha came to visit him in the NICU.

Nathan trying to sleep.

Mommy's first diaper change.

First time I got to hold Nathan. He was so light, it just felt like I was holding a blanket.

Mommy and Daddy visiting Nathan.