Tuesday, June 26, 2012

Benjamin's Life: Oinker!

Whatever it was that was supposed to click has apparently clicked. It helps, I think that they started him on Prevacid (I always want to say percocet...but it's definitely not) to treat him for reflux. Apparently reflux makes babies absolutely miserable. When the partially digested milk starts going back up the esophagus and into the throat it annoys a nerve that affects the heart. In preemies, the heart burn that reflux cause can make the infant go into bradycardia. Since Benjamin was having so many bradys the doctors decided to do a trial of Prevacid, which doesn't cure reflux but treats the heart burn, to see if that would help stop the bradys and help him want to nurse a little bit more. They started the Prevacid on Friday, June 22nd.

On Saturday, June 23rd, Benjamin ate 51 mL in one feeding! It was his first time ever nursing enough to get 100% of his feeding without supplementing with the NG tube. In fact, he over-nursed since a full feeding for him was only 48 mL. Everyone was very proud of him and he did such a good job that the following day we were asked to try for three feedings.

June 24
He did alright with three feedings on Sunday, getting around 30 mL each feeding but to advance to the next stage he needed to consistently be eating at least 75% of his feedings. It was such a pain to get him to eat three times a day on Sunday because he was so sleepy; we kept having to lie him on the scale so he'd wake up and root around and he just did not want to work that hard. Apparently it was good for him, though, because on Monday he was eager to nurse all three times we came in.

Last night he quaffed so long and hard that he had a pretty scary brady. He was just gulping and gulping and gulping but something didn't feel quite right. "I don't think he's breathing," I said to Andrew.

"Oh, he's breathing," Andrew said. "Look at the monitor—see?"

The monitor said his respiratory rate was 24 or something like that, which is low but not too low.

"But I just don't think..." I managed to say before his respiratory rate flat-lined and his heart rate dropped below 80 and his alarms started blaring and his monitor started flashing red. Red is the worst light to see flashing; orange is bothersome but not panic-inducing; white usually just means you have to check his probes to make sure they're all connected correctly.

Anyway, he was still gulping milk while he was dying in my arms! It was so freaky!

Preemies don't adhere to the usual suck-swallow-breathe pattern that full-term babies adopt. Instead they have periods of vigorous sucking followed by periods of vigorous breathing so it's not uncommon for their breathing and heart rates to get a little wonky when they're eating. They shouldn't get as wonky as Benjamin's were though!

I quickly unlatched him and repositioned him so he was kind of sitting up and I rubbed my hand on his back like I was burping him to help convince him to run his most basic bodily functions. Andrew, meanwhile, grabbed the blow-by oxygen and shoved it in his face—we didn't even have it ready because he went on room air on Sunday night and hadn't needed his blow-by at all for the past couple of feedings.

It seemed like forever before he got his stats to the right levels.

And then we kind of just held him really still with the oxygen blowing in his face until we were brave enough to move him to the scale. The boy ate 63 mL! No wonder his heart stopped! He could've died and gone to milky heaven right then and there and would have been the happiest boy on earth.

Gives a whole new meaning to "milk coma," doesn't it?

Well, this morning we went in to feed him and he did just fine. He ate, kept his rates up, and didn't freak out afterwards. We weighed him and found he had drunk 70 mL! What an oinker!

June 25
We just got the call from the nurse practitioner. She said that Benjamin is responding so well to the Pervacid that she's going to just write him a long-term(ish) prescription without waiting for the fifth day of his five-day trial. And he's doing so awesome that they want to start him on four feedings a day, starting today!

I was a little nervous about this because the feedings have to be evenly spaced throughout the day, which means that one of his feedings will have to be the 4 AM feeding. Going into the hospital three times a day is exhausting enough...plus, I'm already getting up to pump in the middle of the night! The idea of getting ready, going to the hospital, being there for the feeding, coming home, and going back to bed only to get up a few hours later to pump and then get ready to go to the hospital again was a bit overwhelming.

However, they want to send Benjamin home taking two bottles of fortified milk per day (the rest of his feedings will just be nursing) so that they can make sure he's getting extra calories and proteins and things that he would've gotten in the womb but won't be getting through breast milk. So, the nurses will just teach him how to use a bottle at 4 AM and I won't have to be there. I'm totally fine with that idea because I've never been successful in teaching my children to drink from a bottle and this way Benjamin will learn to drink from a bottle and won't connect the idea of mommy with the idea of bottle so there's a chance he'll take a bottle from someone else and will still want to nurse from me. I'm kind of nervous about bottles because I've never used them and much prefer nursing to pumping...but I think it will be okay.

They'll also be cutting back on his NG tube feedings so that he'll be hungrier for nursing/bottle sessions. Four feedings per day is half of his feedings and we'll be alternating an oral feeding with a tubal feeding so he'll be getting enough food over the course of the day.

We're really excited. We seemed to be making no progress or slow progress and now we're just zooming along! Four feedings a day means he'll be ready for his car seat test soon and then his requests... I imagine we'll still have another week or so in the NICU. We'll see how things go...

7 comments:

  1. Hey Nancy, I just wanted to thank you for your comment and well wishing. Especially in your current stretched thin state, it means a lot. Tessa was in the NICU-level 2 nursery at the AF hospital for five days (which is nothing near what you're experiencing) but I just wanted to reassure you that it's going to get better. Soon the cords and beeping will be a distant memory, and you and your baby will be fine. Benjamin won't even remember it, which I stressed about for a long time - that Tessa would blame me in some way for her horrible early start. She didn't, and neither will Benjamin :).

    It sounds like he's going to be home soon! I am so happy for him! Keep pigging out little man!

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  2. Awesome! It sounds like he is doing great! Do they have a place that you can stay overnight. Aylin had this really horrible couch I could sleep on. So not restful but it was nice to have a place to sleep :)

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    1. When we do the 24-hour request there's a "sleep room" I can use. But they only have a couple so they usually reserve them only for the 24-hour test; other than that we just have to commute. But our commute is not so bad as others!

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  3. Awesome! I hope he continues to do as well as he is. That's really scary that he stopped breathing. I think I would have stopped too. What a panicky experience for the parents. :( You guys are such awesome parents and I'm so glad that Benjamin has you two and two fabulous older sisters!

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  4. I will have you know that I practiced suck-breathe-swallow as I read that part. And, that was weird. Because normally I think I suck-swallow-breathe. Yes, that's what I decided. I just tried it again.

    I like those pictures. He looks like a cute, growing newborn to me! I'm glad he didn't go into milk-coma.....really.

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    1. Diana—I think you're right. It is suck-swallow-breathe. Either way...Benjamin struggles with it. :)

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  5. I cannot get over how adorable he is! I LOVE every photo of him looking so content!! Sounds like he is learning a lot! Some he'll be home t snuggle every day!

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