Aside from a few emotional meltdowns on my part, our first 2.5 weeks in the NICU have been amazingly uneventful! I knew there was the roughly 24 hour 'honeymoon' period following their birth, so I knew that just because they were breathing room air with only the assistance of the CPAP, had good weights, and were crying and very active, didn't mean that it would be smooth sailing from here forward. But so far, we couldn't possibly ask for more from these little guys. Surely Jude, their sweet angel brother must be keeping a close eye on them, and everyone's prayers including our own are being answered.
Before my milk came in the boys were ready for feeds, so the NICU was mixing my few drops of colostrum with human donor milk from the city's milk bank. This is one of the most amazing organizations!! I can't describe that feeling, knowing that even though I couldn't provide the very best nutrition for my babies at that time, they were getting the 2nd best thing. I am forever thankful to the donating mamas at the milk bank. I hope that one day I might be able to contribute, too!
There really has not been much action (thankfully) for these boys this far. Their time here has really just been focused on maintaining their heart rates, oxygen saturation, breathing, temperature, feeding and growing, and the regular stuff like diaper changes, linen changes, isolette changes, circuit changes, line changes, and the occasional mouth/eye wipe to clear away the gunk that builds up when you don't really blink or swallow...or bathe.
They both have had cranial ultrasounds and echocardiograms to ensure that their brains and hearts are functioning properly with no damage, whether caused by TTTS or their prematurity. So far everything is normal and they are perfect little guys! Their ductus' have also closed which is fantastic! In many premature cases they need medication or sometimes surgery to close this artery in their heart, which in a full term baby happens naturally within the first couple of days following birth.
We were so very lucky that both Nash and Lincoln started off in the same boat, needing the same things. One wasn't sicker than the other. Since their birth, they've taken slightly different paths but have generally remained on course with one another - though Lincoln seems to be the slightly more competitive of the two!
Nash
Breathing: He started off on room air with a CPAP machine (continuous positive airway pressure) which helps to keep his lung cells open, conserving energy for other things besides trying to remember to breath AND inflating his lungs with each breath at the same time. He is taking his own breaths with the help of this amazing machine. He seems to be pretty popular at times with the A's and B's though (apnea - forgetting to breath, and bradycardia - lowered heart rate) and lower oxygen saturation levels, so they moved him onto SiPAP instead. This way they can puff little breaths into his lungs at timed intervals to help him along - he started at 10x/min, was bumped up to 30x/min and has since been lowered to 20x/min. He is usually just getting puffs of normal room air, but occasionally he'll get a bit of extra oxygen if he's sitting at low levels too long, again just to help him along. This is all very normal preemie stuff.
Feeding: He started with, and is still using an orogastric (OG) tube (a feeding tube placed through his mouth). He will need this kind of help to eat until he's able to take my milk via bottle and/or breast. He was on track with Lincoln for feeds the first few days, but one day he'd been having lots of bradycardia
episodes and green aspirit (undigested food that they pull up through the feeding tube - but it's not supposed to be green). This can sometimes signal that an infection is brewing, so they stopped feeds, started antibiotics to be safe, and drew blood work. His blood culture came back negative, so all was fine and they started his feeds from scratch. They found that his feeding tube was placed quite low down into his belly, so this could have been why they'd pulled up some green goo in the first place. They regularly check for aspirits on both boys. If just a little food comes up, they push it back in to continue digestion. If almost a whole feed comes back up, they will hold the next feed and monitor them closely. If the aspirit is green, that's when they start to worry. Initially they were giving my milk through the tube via gravity - it's almost like a shot of milk, it goes in super quick. As they increased the amount of milk they gave Nash at each feeding, he started to have a harder time tolerating his feeds - lots of oxygen desats and bradycardia. So they placed his feed on a pump to be delivered over 30 minutes time instead. He was tolerating feeds much better, but the more they increased the amount the more he started up with the same episodes. The thought right now is that he may have a bit of reflux - another totally normal preemie thing. His little tummy needs more time to digest, so now they've got his feed on a pump over an hour, and he seems to be responding well. He's currently getting about 130ml of breast milk a day. They have started fortifying my milk with protein powder - which makes me a little nervous for their sensitive tummies - but I know they do this for good reason. They're really good at getting babies fat quickly here, if they're tolerating all this stuff. Shortly after delivery they placed an umbilical line into Nash's belly button where they could supplement with more vitamins and fats and nutrients (TPN - total parenteral nutrition) and any necessary medications (like antibiotics) on top of my milk. After his umbilical line dried up, they gave him a PICC line (like an IV in his arm but travels all the way to the top of his heart) which essentially does the same thing but is more long term, especially when compared to an IV which can sometimes only last a few hours in these tiny babies. He is actually doing so well on his feeds now that they removed his PICC line today! Once these preemies are tolerating enough breast milk for their weights, they take them off of the supplemental nutrition and eat breast milk alone. This is awesome news for obvious reasons, but mainly because the less stuff he's got poked into him, the less chance there is for infection.
Weight: Our little man was born at 2lbs1oz. He now weighs 2lbs8oz!
Bathrooming: He has been doing great with his poop and pee, and today i got to change his diaper! Occasionally they give him a glycerine suppository if he seems to be struggling to get poop out.
Kangarooing: This is by far one of the coolest things I've ever done. Who knew you could hold your tiny 28 weeker skin to skin? Not only is it fantastic for regulating their heart rate, breathing and oxygen levels, but it also shares the bountiful flora of good bacteria that mommy and daddy have on their skin with their babies, who don't have any of this good bacteria of their own (in fact, our good skin bacteria fights our baby's bad skin bacteria and wins). Man our bodies are incredible. Nash loves to be cuddled and sung gently to. I've been rotating 3 songs with both boys: You are my sunshine, Make you feel my love, and Hey Jude :) He also loves to have his hands played with. He seems to dislike it when I talk loudly while holding him, or when I'm holding Lincoln. He will often protest by showing off with a bradycardia episode, hehe. I hear this happens often with multiples in the NICU!
Personality: Nash seems to be pretty calm and content most of the time. He loves to sleep on his tummy the most, and I think prefers to be a little swaddled. He's got a really gentle, sweet temperament and so far seems to sleep or rest more than Lincoln does.
Other: Last week they thought they'd heard a murmur in Nash's heart, and were concerned that maybe his ductus opened back up again (PDA). They did an echocardiogram and it was normal and they no longer heard the murmur! They really stay on top of things here.
Lincoln
Breathing: He also started off on room air with a CPAP, regulating his breathing on his own. Though he definitely does have episodes of bradycardia and apnea, they are not as frequent as Nash has them. Still, this is all normal stuff and it doesn't really mean much that one is having more than the other, except that Lincoln so far hasn't had to use the SiPAP (the machine that gives a puff of air in timed intervals) and very seldom needs a boost of extra oxygen to increase his saturation levels if he's hanging out too low for a while.
Feeding: Lincoln also started with and is still using an OG tube for feeding, and he'll also need it until he's able to coordinate his suck/swallow/breath reflexes. He's been a champion eater pretty much from the start. On occasion he'd aspirit and they would hold a feed, but in general he's been great. As the volume of his feeds became quite a bit larger, he did aspirit more often and had more frequent A's and B's (which is common after a feeding that they don't tolerate well) and so they also put his feed on a pump dispenser so that he gets it over 30 minutes instead of all at once. This has helped him greatly! He's currently getting between 140-150ml of fortified breast milk daily. After delivery they also placed an umbilical line into Lincoln's belly button to receive extra nutrition through on top of my milk. At the point that it was drying up (about a week ago) Lincoln was taking his feeds really well and was close to not needing the extra nutrition at all, so they gave him an IV instead of a PICC line as they knew he would very soon not need an IV at all anymore. Sure enough within a couple of days, Lincoln's IV went and they didn't need to replace it because he was eating and tolerating enough breast milk alone for his weight! And that was that, no more IV for Lincoln! It's awesome that the only thing still poking into both boys is their feeding tube (and their CPAP masks if you count that).
Weight: Sweet Linc was born at 2lbs3oz, and now weighs 2lbs11oz!
Bathrooming: Lincoln is in the same boat as Nash on this front. They've both been great poopers and pee-ers, with the occasional need for assistance via a glycerine suppository. I changed my first poopy diaper yesterday for Lincoln. He'd had a big yellow seedy one, and as I was wiping his tiny bum clean, he pooped again but thankfully right onto the wipe! What a thoughtful little boy. These preemies don't have that super liquid poop that full-term babies do - it's quite chunky (maybe due to the protein fortification?) and probably why they sometimes have a hard time getting it out on their own.
Kangarooing: Can I just say again how satisfying it is to have these guys on my bare chest? Lincoln loves skin to skin time, too, of course. He also loves to be sung to, and also doesn't like it if I'm talking too much or too loudly. He loves to have the top of his head stroked very gently and slowly in circular motion. He's also really commonly wide awake during skin to skin, with his googly eyes looking out and blinking at the blurry world he can't really see.
Personality: Lincoln is a goofball. There is something about him that makes you laugh, not sure what it is. He catches me off guard with how often his eyes are WIDE open. And of course they aren't coordinated for real seeing yet, so they're rolling around and looking in every direction and just so sweet. One time though, I swear he caught my eye and was looking straight at me for a good couple of minutes. I'm not sure what he was seeing, but he could certainly feel me there looking straight at him. He used to prefer being on his back with limbs stretched out everywhere, but that seems to be changing.
Other: The is nothing interesting to report here, which is fabulous!
Jude
I would just like to take a moment to thank so many people for asking about Jude in conversation, though I understand that for many it might feel uncomfortable or that you might worry you'll upset me. I am a very proud mama of my triplet boys, and I beam when people ask me about our little angel (albeit most times I cry, too - but I smile through the tears!). It's a heavy weight on my heart, but it feels so good to talk about him and recognize that he is a part of all of this and always will be. I will always refer to our boys as triplets, and will include Jude in conversation whenever it feels appropriate. He has taken such a careful watch over Nash and Lincoln, and I am so thankful for everything that he is.
I am very much hoping to update more often so that these bad boys aren't so darn long. We are hopeful, praying, and keeping our fingers crossed that things continue to remain 'boring' - in NICU terms anyway. We are so, so blessed :)
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