One Month Update

*Note: I am sure my explanations for things that have happened throughout my pregnancy and Nick's time in the NICU, like a subchorionic hematoma or the placental abruption, are not completely medically accurate. I am obviously not a doctor, so don't take everything I write as exact definitions or explanations of these conditions. Just wanted to clarify :)

Nick is already one month old today! It is so hard to believe I should only be 34 weeks pregnant at this point, and his due date is still 6 weeks away. Each month, my plan is to give updates about how Nick is progressing in different areas, especially while he is in the hospital.

Weight:
Nick was born weighing right at 4 pounds, and was 17 inches long. He lost a pound throughout the first week of his life, like most newborns do, but gained it back over the course of this month. He is now up to a healthy (for his age) 5 pounds, and is 18 inches long. Fun fact about preemies: at our hospital, the only minimum weight babies must weigh before discharge is 4 pounds, because that is the lowest weight that can safely ride in carseats. The doctors are thrilled with Nick's progress once he started on formula (more below) and he seems to be  moving in right direction.

Eating:
This has been the biggest area of difficulty with Nick so far this month. Babies do not develop the ability to coordinate breathing, sucking, and swallowing until the 36th week of pregnancy, and since Nick was born at 30 weeks, he doesn't, and can't be expected to, know how to eat on his own, so he has been on a feeding tube since day one. For the first two weeks of his life, Nick was fed donor breast milk from his feeding tube. I have never breast fed because of a medicine I take daily that passes through breast milk and has the potential to be harmful for the baby, but, at 30 weeks, even formula that is designed specifically for preemies would have been too hard on his stomach. From early on, Nick has struggled with reflux issues, much like Graham did as a newborn. During his feedings, Nick would begin to arch his back and act like he had a bad taste in his mouth, but would never actually spit up. While he was doing this, he would stop breathing, and then, to make up for the oxygen he wasn't getting, would begin to basically hyperventilate, which would cause his heart rate to drop and would set off one of his alarms. This is known as a a bradychardia, or a  brady for short (again, not the most perfect medical explanation, but it's what I understand it to be.) At first, this was causing his weight gain to slow, so at three weeks he switched to alimentum formula. This seemed to improve his reflux, but his brady's continued. The doctors and nurses weren't and still aren't overly concerned about his brady's, because they aren't happening enough to signal an infection or to cause him to go back on oxygen, and are simply a side effect of his prematurity. Yesterday, he switched to preemie formula, which he will most likely continue eating once he goes home.

Milestones:
1. The first huge milestone Nick reached was his ability to go off oxygen and breathe on his own. Most likely because of the two rounds of steroids Nick received throughout my pregnancy to help speed up his lung development, he only needed oxygen for the first few days of his life, which is virtually unheard of for 30 weekers.
2. No more closed isolette! The isolette is basically a closed in crib that preemies sleep in because they are attached to so many different machines and monitors. The reason they have a closed lid is because preemies like Nick haven't yet developed the ability to regulate their body temperature, so they stay in a closed crib where the temperature is adjusted for them and keeps them toasty warm. On day 23 (so when I should have been 33 weeks pregnant,) the nurses took off the lid of his isolette and he was able to keep a stable temperature on his own. This is a happy milestone because I can now maneuver him in and out of the isolette on his own without asking a nurse for help, and I can change his diaper and clothes more easily.
3. Another huge and impressive milestone Nick reached that the doctors were not expecting him to at this age is the ability to drink from a bottle. Nick is fed every three hours exactly, and the nurses and occupational therapists that work with Nick began watching for signs that Nick was ready to start a bottle, such as rooting, sucking on his fingers, and waking up around the time he was due to be fed during this time. This past Saturday, when he was still only three weeks old, the nurses gave him his first bottle, and he was able to drink 1/4 of it. I was a little crushed that I wasn't the first one to feed him a bottle, but I was able to later that night when I got to the hospital. The process of getting him to drink from a bottle is incredibly complex and delicate-since he hasn't developed enough to know how to breathe, suck, and swallow on his own, he will begin drinking from the bottle and won't stop on his own, which causes him to stop breathing, which triggers a brady. To help him learn to breathe while eating, I let him suck 3-5 times on the bottle, and then tilt in downward so the formula no longer flows through the nipple. Since he still isn't breathing while he eats, this lets him catch his breath before we begin again. The risk of beginning him on a bottle is it could cause his brady's to become more regular, in which case the doctors would call off the bottle feeding for a few days. It is a careful process of wanting him to move closer to being off his feeding tube, but runs the risk of him taking a few steps backwards. It is hard to see him struggle with something that Annabelle and Graham were able to do immediately after birth, but it really is such a blessing that he is able to eat from a bottle at all at this point.

Coming up this month:
The big focus of this month will continue to be getting him to eat from a bottle with ease, and getting his brady's to stop, which will hopefully come with maturity. He must go two days with no feeding tube and eating exclusively from a bottle, and five consecutive days with no brady's before he is allowed to go home. I would love if he is home by Easter, but that is probably not a realistic goal. The doctors told us to be prepared for him to be in the NICU until his due date (April 23), and that anything earlier than that is a bonus. Overall, just like in my pregnancy, we have gotten incredibly lucky that Nick is as healthy and strong as he is. There are babies that spend months in the NICU. There are babies that need repeated surgeries, and babies that have lifelong disabilities as a result of their prematurity. I have seen a baby being prepped to be airlifted to a nearby hospital that is more equipped to handle sicker babies who require  more complex surgeries. The nurses told us that they do not usually see babies born as prematurely as Nick, so the fact that we have dodged so many potential bullets is truly incredible. The doctors have warned us that he still has a long way to go before we can begin talking about discharge, but every day he seems to be getting a few steps closer to being home :)