The Emma Report

Emma had another good day (well, apart from a big spell following her afternoon feed).

She’s now 33 weeks gestational age and has been in the NICU for 9 weeks (63 days, 5 hours, and 24 minutes, but who’s counting), longer than many of the babies there.

She was able to go for more than 10 consecutive hours off CPAP and nasal canula today. She’s up to about 16 hours on the nasal prongs (most of that time in room air/requiring no additional oxygen) and 8 hours on CPAP each day now. Her next goal is to be weaned off CPAP entirely, which will hopefully happen in the next couple of weeks.

As the pictures show, Emma was very alert this afternoon and was awake for more than 15 minutes after her 3:00 p.m. care/feed. That was a first time I’ve seen her stay awake that long and we were able to capture the event…. Another photo for Miss Emma’s Book of Love (Thank you for the beautiful scrapbook, Pepper!)

Not much new to report around here

Emma now weighs in at a whopping 2lbs 12oz. Whoo Hoo!! Maybe she’ll break the 3 pound barrier next week!

She had another eye exam to monitor for ROP (retinopathy of prematurity) today. She didn’t like getting the eye drops beforehand (who does?), nor the actual exam, and promptly had a “spell” in protest. Emma also barfed up some of her feed afterwards (which is very unusual for her), but her nurse decided it was simply because she was righteously annoyed and so wasn’t too worried by it. While there was no significant evidence of ROP on today’s exam, we’ve been told it can progress very rapidly and so the neonatal ophthalmologist will see Emma again next week.

Otherwise, apart from a few big desats today, Emma is doing well…

Emma is officially 2 months old today. Some days, it is hard to believe she’s been in the NICU for two months, already. Other days, it seems like it has been two years.

Emma “celebrated” by getting her 2 month immunizations today. She handled the needles well (even without pain medication, which “they” no longer give preemies before the shots) and didn’t seem at all affected by them. She successfully did 2 long trials off CPAP again today and is handling her gradually-increasing feedings well.

The best news is that she was her fiesty self again! She was much more active and alert today, stayed wide awake during her nursing care and feeds, and was squirming and wriggling around her isolette. It was great to see our “wild woman” back again

Emma continues to do very well

She was off both CPAP and nasal canula for 8 hours early today, breathing room air entirely on her own. It was such a nice surprise to walk into the NICU and see her beautiful face completely tube and tape free! She started to desat by mid-afternoon so they put her back on CPAP for a few hours, but this evening she was back to breathing on her own again.

In spite of how well Emma is doing, I’ve noticed that she isn’t as feisty and active as she was late last week. I mentioned this to her nurse this afternoon and she conceded that she too was a bit concerned as Emma seemed pale and listless to her as well. Emma perked up abit after her noon feeding, so the nurses think she is just getting very tired due to a combination of her efforts to breathe unassisted and her low hemoglobin. As she gains weight, she’ll get stronger and this should improve.

I don’t think we’ll ever get bored by saying that Emma had another quiet day, but there’s not much new to report

She had a couple of spells over the last 24 hours but these “desats” (lowering of the percentage of oxygen in her blood, which is associated with bradycardia and apnea) generally happened just after she had been fed (she’s up to 7 cc every 3 hours). She was able to pull out of them all by herself (without needing more oxygen), so the team isn’t concerned by them.

Emma’s hemoglobin is quite low, but for now the docs aren’t going to do anything about it as they want her bone marrow to “kick in” and start making red blood cells. If her levels continue to drop, though, she may need yet another blood transfusion.

Emma had another uneventful day

She was off CPAP, breathing on her own, for 10 hours again today and required very little supplemental oxygen.

Emma also seems to be tolerating the re-introduction of breast milk well. Although she (not surprisingly) didn’t gain weight while her feeds were being withheld last week, she’s been gaining well over the weekend and is up to 1192 grams (2 pounds, 10 ounces). Her nurses will be increasing her intake by 1 cc every 24 hours so it will take a while before she is at “full feeds.” As of tomorrow she’ll be getting 5 cc every 3 hours and she’ll need to be taking approx. 24 cc every 3 hours before she’s off the intravenous drip entirely. The docs are being very conservative with her intake because they don’t want to over-stress her tummy after the problems Emma had last week. At the same time, getting off of the IV fluids sooner is better because the IV line is a great entry point for all manner of infections that we’d like to keep far, far away from Emma.

Emma is going to have her first ’round of immunizations this week as it is recommended that preemies receive their shots at the same schedule as full-term babies (i.e., they’re given according to chronological age rather than corrected age)* So, even though she is still 8 weeks away from her “due date”, in this case, Emma is considered to be 2 months old).

She’s also going to have her second eye examination this week. The docs are monitoring Emma carefully for any indication of ROP (retinopathy of prematurity)– see: http://retinopathy of prematurity for more information. Our hope is that if the docs see any evidence of problems, they’ll be able to start treatment early.

*An ‘adjusted or corrected age’ for a premature baby is the amount of time since the baby was supposed to be born (the due date). This is different from the baby’s ‘chronological age’ — the amount of time since the baby was actually born). For example: If baby was born 10 months ago, but was 4 months premature, her ‘adjusted or corrected age’ would be 6 months.

That’s how Emma is doing!

I wasn’t able to speak with the neonatologists today about her xray (because they were busy with some very sick babies who just arrived in the NICU), but it must have looked good because her antibiotics have been discontinued and she’s been restarted on breastmilk (a tiny amount – 3 cc every 3 hours, but it’s a start). The docs will reassess her tomorrow and may gradually start increasing the amount she receives then.

Emma was off CPAP and on nasal canula (with only a very tiny bit of oxygen) for 10 hours today. The team is very impressed with how well she is doing, and we couldn’t be happier with her progress.

Emma celebrated her 8-week birthday by have a quiet, restful day. She was off CPAP (breathing on her own) for 4 hours this afternoon! She’s doing better on the nasal canula than anyone anticipated given her BPD (bronchopulmonary dysplasia – damage to her lungs and the airways in the lungs as a result of being on a respirator for a lengthy period of time). The team will gradually increase the time that she spends on nasal prongs each day… the respiratory tech mentioned today that Emma will likely be on canula all day (and CPAP at night) by the end of next week.

Emma will have another xray of her tummy tomorrow morning… If things continue to look good, her antibiotics will be discontinued and she’ll be started back on milk by mid-day.