So Long, NICU

After 125 days at the NICU, we're finally saying goodbye...Thomas left Stamford hospital July 5th and joined his sisters at home. We marvel at these precious lives which our merciful God has not merely sustained but has blessed with flourishing that beats all odds. Our journey has been a long one in many ways already, but we are so aware of God's provision and grace for each day, and we begin this next phase-- the real journey-- with great excitement and gratitude (even amidst a 1am feed currently taking place!). The "Daily NICU" portion of this blog is officially complete, but we'll start populating the main blog with the real craziness that is only just beginning. 

Thomas in the rearview mirror, leaving the NICU behind...

Change of Plans

Thomas is leaving Stamford Hospital on Tuesday, but he's not going back to Columbia for a ligation surgery. No. Instead, he's coming home! 

He is seriously a different baby than he was just a week earlier. He had an echocardiogram today, so it will be interesting to hear the cardiologists assessment of it tomorrow, but the fact of the matter is that he doesn't seem to be too bothered by his PDA anymore, regardless of size. Here's hoping and praying that it is on its way to closing fully on its own. He had a chest X-ray today, which showed the chronic lung disease he's been dealing with from the beginning, but it apparently looked pretty good on a relative scale. Thomas has been on diuretics to help clear out fluid from him lungs, and he'll continue on those at home but hopefully just grow out of the dosage amount over time. Speaking of size, he's around 8lb 5oz at this stage. Huge. 

The girls are doing well and actually have their 4 month appointment with the pediatrician next Thursday. Thomas will come along for that and will simultaneously be checked out as a new baby and a 4 month old baby. So strange. It's surprisingly complicated to field one of the most basic questions a mom can receive about a newborn: how old? They are almost 4 months, but they are also just a few weeks from a gestational point of view. The former age is used for immunizations, school enrollment, etc. But the latter age is more suitable for assessing developmental milestones. That said, they seem more advanced to me than normal newborns (and obviously less advanced than typical 4 month olds). They're all enrolled (automatically as micro preemies) in a birth to 3 program that will evaluate them initially and track their progress, so we shall see.

We are daily taken aback by these little miracles and how incredibly well they are doing, especially considering their start as 25 week quads. Praise be to God! Thank you for supporting us all throughout this NICU journey. Our NICU days might be drawing to a close, but the real adventures are just getting started :)

Long Time

It's been over a week since my last real post. I've been to the NICU each day to visit Thomas, but my usual windows for writing a quick post have been filled by the girls at home. I can't really multitask like that while giving a bottle, at least not at this point of my learning curve. All that said, the girls seem to be doing quite well, and we look forward to their brother joining the fray. 

Speaking of, everyone has been praying for Thomas to turn a corner on his own (without ligation surgery) this week, right? Well, the Stamford neonatologist is still planning to check in with Colombia Presbyterian on Monday re: transferring him for surgery, but this past week has been huge for our little man in my mind. Earlier this week, he decided to remove all of his tubes (nasal cannula and feeding tubes). No real surprise here; I'd be sick of the tubes too if I were him! The shock is that he hasn't been on any sort of respiratory support since then, and he's doing beautifully! What's more is that without the prongs in his nose and the pressure in his airway that goes along with it, he takes his bottle better than ever. Win-win. They have him taking 3 of his 8 feeds per day by bottle, but that should increase sometime soon. He sucks it down faster than Charlotte does here at home, and he's been more alert the past couple of days than either of his sisters. Now, who knows what an echocardiogram would show with respect to his PDA, but I am so grateful for this progress and attribute it fully to answered prayers. Thank you!!

That's all for now, but more to come prior to another week passing!

Sisters

This pretty much sums it up...

:)

And Then There Were Two

Charlotte is slated to join her sisters here at home tomorrow! She's been progressing well with her bottle feeds and continues to be pretty strong and stable from a respiratory perspective. She still seems slightly more delicate (albeit larger) than Audrey but not so much so that it's scary to be bringing her home. That said, I have a feeling that it's going to be more than twice as hard as this past week has been... She is significantly slower with a bottle and has also seemed thus far to be a bit feistier than her siblings. We'll still be traveling back and forth to the NICU to see Thomas too. Thankfully, my parents arrived today (just in time for Hannah's 2nd birthday!).

Oh, and Charlotte is still colonized with MRSA, so there's that. But all hospital protocol sort of goes out the window at discharge. Clearly, we don't plan to keep her in an isolette and wear a gown and gloves every time we go near her. However, should she ever be hospitalized in the future, she will be back on contact isolation (unless/until she has three negative cultures). 

Then there's Thomas; he might actually be going back to Children's Hospital of New York. Although all three of the kiddos still have PDAs, Thomas is being markedly affected by his, and the perspective of the neonatologist at Stamford is that he needs to have a ligation (surgical procedure to cut the PDA). Stamford isn't equipped to do the procedure, so back he goes. That said, the NICU there is packed beyond capacity, so we'll have to wait and see when a bed opens up for him. The procedure isn't insignificant (risk of hitting a nerve related to the vocal chord, need to collapse a lung to get to the heart, etc.),  but it sounds like it's needed. The miracle would be for him to make huge advancements during this waiting period that negate that need. Here's a picture of him getting his most recent echocardiogram at the bedside in Stamford. 

Thomas is still in need of respiratory support because of his large PDA that is basically sending too much blood to his lungs and causing his heart to work harder than it should.  

Audrey is Home!

This is a much delayed post, but Audrey came home on Sunday as planned and has been a dream! She reminds us a lot of her older sister Hannah, both in appearance and in the fact that she is a super easy baby. I think we are being spoiled/fooled in these early days with just one baby at home, but we're all enjoying it.

Hannah is obsessed with all things baby these days. She spends countless hours strapping her dolls and stuffed animals into the new infant car seats and is constantly pretending to change their diapers as well. She was excited to welcome her little sister home, and aside from calling her Charlotte half the time (maybe more!), Hannah has shown nothing but love for baby Audrey. 

More news to come, but I'll leave it at that (and the below picture) for this post...

Due Date

Today, June 10, is my due date. It's day 0 for these little ones from a gestation and development standpoint, but it's also 14 weeks and 2 days post birth. As it turns out, that's equivalent to 100 days of life, which also means 100 days in the NICU. It's a big day, for all of those reasons but also because we found out that Audrey is slated to come home with us on Sunday!

Audrey is the only one who is smaller now than Hannah was at birth (6.5lbs). She is about 1oz shy of 6lbs, but I think she'll almost certainly hit that threshold by Sunday. She and Thomas both transitioned into cribs yesterday afternoon, so the only real hurdle remaining was feeding. She must have known because she took the liberty of removing her feeding tube a couple of nights ago, as if to tell us all that she is definitely ready to go home. She's been taking her bottles like a champ and has even had a bit of success with initial attempts at nursing. I'm blown away with how well she is doing and am so grateful that I'm not terrified about bringing her home. She's still a preemie, of course, but she seems amazingly close to a full term newborn. 

All three had their eye exams a couple of days ago. Charlotte and Thomas are still in the clear with no sign of ROP in either eye. Yay! Audrey, however, still has mild stage 2 ROP, but the vessels are more developed, and the doctor believes that it will regress as it has for the others. Here's hoping and praying. She'll have her next exam as an outpatient in a couple of weeks.

Charlotte is still in an isolette because her cultures came back positive for MRSA. Surprise, surprise: she's still colonized. ID (infectious disease) is going to assess the situation and make a decision on whether or not they will attempt to decolonize her. There is no other MRSA (of which they are aware) in the Stamford NICU, so perhaps there would be better likelihood of success in that environment. We will see. I taped some black and white animal flash cards to her isolette to try to add a bit of excitement to her confinement. I understand the reason behind all of the contact isolation, but it's still a bit funny since it will all go out the window once she's discharged and at home with us and the others. 

Charlotte is 6lbs 11oz and growing. She's got the breathing thing down pat at this stage, but feeding has been a challenge. She's not coordinated enough to handle a normal flow bottle, but she is impossibly slow with the slow flow preemie nipple. As a result, she tends to tucker out partway thru a feed. But that's better than going quickly and gagging, so we're just keeping a slow and steady pace to win the race. She'll get there. She's had a couple of attempts at breastfeeding as well, and I think she'll end up being good at it. All that said, she's had an ongoing issue of being preoccupied with trying to poop during feeding time, so we also need to work on multitasking :) 

Thomas has had his first bottle attempts the past couple of days and has done reasonably well, but the focus for him is still breathing. He's mostly on bubble CPAP (like he was at CHoNY), but they're weaning him off for a few hours each shift to nasal cannula. Generally speaking, his oxygen saturations are consistently good (high 90s). The issue for him (from the beginning) is with his respiratory rate. When he's off CPAP, he tends to get tachypneic. They're attempting feedings while he's on cannula instead of CPAP, which makes sense, but it means that he's being asked to work hard in multiple ways at the same time. He's not fully ready for it, but I think he'll be off to the races with feeding once he's in a better place from a respiratory standpoint. Who knows, maybe he'll end up beating Charlotte home. I'm not even sure if I mentioned it before, but the nasty wound on his foot (from an IV infiltration back at CHoNY) is healing well. Oh, and Thomas is absolutely huge; he is 7lbs 4oz. All of a sudden my joke about him being 8lbs before learning how to breathe on his own doesn't sound that extreme. 

I had been wondering how in the world I was going to handle having Audrey at home (plus Hannah) and Thomas and Charlotte in the hospital, but then I found out that I'm allowed to bring Audrey back to the NICU with me each day. Game. Changer. They even said that they might be able to leave her current crib set aside for her to use when she comes. Not only is the Stamford NICU a much shorter commute, but it is also able to be more accommodating to me/us in this transitional phase because of its size. I'm so, so grateful to be there. For the first time, the reality of them coming home at different times seems like a blessing...one of so many blessings.

Isolettes for 48 Hours

Same story with somehow failing to hit "publish" yesterday....

Even though they were all in cribs in NYC, the babes have to be in isolettes for their first 48 hours in CT. I can't wait to have them back in cribs, but they seem to be happy enough and settling in to their new, temporary home at Stamford Hospital :)

Audrey

Thomas

Charlotte

Moving Day

It's a big day for the Haughey babies. No, they are not coming home today. But they are all moving to Stamford Hospital! In fact, Thomas has already arrived. There's only one ambulance available, so it's a bit of an all day affair to get them transferred individually, but it's underway! It feels like Audrey is close to coming home, and it will be SO much easier to deal with one at home and two at the hospital with a 20 minute commute instead of 50 minutes. We're so grateful that insurance approved the transfer so quickly and that three beds became available almost immediately as well. 

Prior to the transfer, the babies all had echocardiograms to assess their PDAs. The cardiac team seemed a bit concerned about Thomas because he still has a large PDA and he's still on CPAP, so there's a thought that the latter is due to the former. However, when I spoke to the attending physician, she reiterated that her strategy is simply to continue to wait and watch and not to rush into surgery (PDA ligation) since it's not an insignificant procedure. Therefore, moving him to Stamford doesn't really change anything; worst case scenario is that he doesn't progress and we need to move him back to Columbia for the procedure, but she seemed to think that he would grow out of it on his own (we're certainly praying that that is the case). As for the girls, PDA or not, the cardiac team isn't too concerned because they are both doing so well breathing on their own. 

Thomas and Audrey were due for an eye exam today, but that got canceled because of the transfer. Someone at Stamford Hospital should be able to administer the exam later this week. As of the most recent exams, Audrey is the only one with any ROP. We're praying that this next exam shows her clear of it as well. What a blessing that would be. These little ones have come so far in 14 weeks; I'm so humbled when I think about how smooth their path has been. My gratitude for all of the prayers is immense. They have been lifted up and supported each moment of this journey. Our joy is great, and it's only the beginning of our adventures with them. 

Weight check: Thomas is 7lbs!!! Charlotte is around 6.5lbs (Hannah's weight at birth). And Audrey is a few ounces away from hitting 6lbs herself. It's crazy how big they seem to us but also unbelievable to think that Hannah was once that small! Life is such a miracle. 

Good News

Thomas was looking a LOT better today, according to the nurses. I didn't actually see him yesterday, but I thought he looked pretty comfortable today. He was back on bubble CPAP at room air (21% oxygen) as of 7am and was putting up good numbers on his monitor. They decided against another x-ray and/or dose of Lasix because he didn't seem to need it. Yay. He'll continue on his antibiotics until the cultures come back negative after 48 hours; thus far, we have every reason to believe that they will indeed come back negative. We're not really sure what caused his temperature drop and apnea episodes, but he seems to be back to his normal self, or at least close to it. Thanks for your prayers! Oh, and he is 1 ounce shy of his older sister Hannah's weight at birth (6lbs 8oz). He'll probably surpass it tomorrow. 

Charlotte is getting a bottle at every other feed (they are all on a 3 hours feeding schedule) and is doing okay with it. She took the full amount at 11am today but has often been taking only half of it before tiring out. When that happens, they just finish the feed thru her tube. She still needs a lot of pacing help; meaning, she would suck and suck and forget to breathe if we/they let her and still needs more time and practice to learn the coordinated suck-swallow-breathe pattern. That said, she continues to grow like a champ and is just barely shy of 6lbs!! The biggest news for her, though, is that her ROP has regressed; she currently has no ROP in either eye! What an answer to prayer! We pray that it stays that way for both her and Thomas.

Audrey has had mild stage 2 for the last two exams, so we'll see how she looks this coming Tuesday at her next exam. She is basically 5lbs at this stage. Although she's the smallest, she still seems to have the lead in the race to discharge. She's eating well, finishing her bottle at every other feed, and will likely start to take even more of her milk via a bottle before long. She still has a bit of tachycardia on occasion, but for the most part, all of her statistics (heart rate, oxygen saturation, respiratory rate...) are stable and good. It will be so strange to NOT have a monitor on these babies at home. 

Some of the biggest news of the day is that our insurance approved a transfer of the babies to Stamford Hospital, which is significantly closer to where we live. Everyone seemed surprised with how easily/quickly they approved the request. I'm guessing our Connecticut based insurance gets a much better deal at Connecticut hospitals... Regardless, it's exciting news. The NICU at Stamford has 16 beds (I think), so we'd represent a decent percentage of it (unlike our current setup in which we are 3 of ~80 babies!). They're anticipating some discharges over the weekend, so they might have room as early as Monday. Crazy. I'd love for Thomas to join his sisters in a stable state off of CPAP prior to the move, but I suppose there's no really important reason that that needs to occur. We will see how they all progress and what the hospitals have to say early next week. 

Audrey enjoying her Wubbanub pacifier while getting one of her feeds thru her tube. Here's hoping she's learning to associate sucking with feeding and feeling full!

Initial Results

Whoops! I just realized that this didn't actually post-- it's from later yesterday afternoon...

All of the initial labs for Thomas look good. His white blood cell count is good/normal as is his CRP (C-reactive protein). An elevated level of either of those would be a marker for infection. The test they did to detect a virus came back negative as well. They did another chest x-ray and noticed a bit of a change from yesterday; there's a bit of white cloudiness (potentially fluid) in an area on the left side. They decided to give him a dose of Lasix thru his IV to help flush out extra fluids. They'll probably repeat the x-ray again tomorrow and will continue to look for potential growth (sign of bacterial infection) in the blood they sent to the lab for culture. 

Temperature

The babies' temperatures are taken every three hours. In part, the nurses use the temperatures to gauge how well the babies are maintaining body temperature and whether or not they need more or fewer blankets. However, an abnormally high or low temperature is a marker of potential sickness/infection. This morning, Thomas had an abnormally low temperature. He was also experiencing some significant episodes of apnea. He had times of fast breathing yesterday, so perhaps that was an early indication of whatever it is that is bothering him. He's now on a different type of CPAP (not bubble CPAP) that actually forces air into his lungs in case he forgets to breathe, and he has heat lamps over him to warm him up. They sent things off to the lab to be tested but went ahead and started him on antibiotics as a precautionary treatment while they gather more information. The first set of results (white blood count and a couple of other things that are markers of infection) should be had within a few hours. The cultures that they try to grow to determine if there is infection in the blood stream or urine (and if so, what kind of infection) take 1-2 days. We're praying that it's nothing serious and that the antibiotics help knock it out right away. The nurses said that he looks a lot better already, so hopefully he's comfortable. 

Audrey is doing well and is now taking a bottle every other feed. If I were to bet, I'd say she'll be the first one home....potentially soon. Eek!

Charlotte is doing well too, but she often seems to be too tired to take her full feed from the bottle. I suppose we can't rush these things. She'll let us know when she's good and ready.  

I'm reminded again of how precarious things still are with these little ones. Life is a gift each day for all of us. If you've been praying along with us, thank you for your loving support. Please continue to pray for grace for each day, and especially for little Thomas. 

Normal Baby Things

With each week that goes by, my time at the NICU becomes increasingly similar in substance to what it would be with full term newborns at home. Granted, we still have a ways to go, but bottles and diaper blowouts are here to stay for a LONG time. 

Thomas is still on room air CPAP, but he is basically 6lbs! As I've said before, that boy is going to be 8lbs by the time he decides to breathe on his own :) He finished up his course of antibiotics for his salivary gland infection today, so the IV should be able to come out within 24 hours. With time on his side, he just might come out of the gates running when it comes to feeding. 

Audrey and Charlotte are both getting one bottle feed per day, and I'm typically the one to give it. They're behaving like "textbook preemies" according to the feeding specialist; when they are in the right side-lying position and I help pace them (pull out the bottle if I can tell they're forgetting to breathe) and watch for their cues, they're able to take the full feed amount within the allotted 30 minutes without having any episodes. I'm in no rush to push them to do more than that at this stage. Charlotte is 5lbs 4oz and Audrey is 4lbs 7oz, so they're continuing to grow well. Now it's just a race to learn how to suck all their food so that they can come home. I'm placing my money on one of the girls, but you never know how Thomas might surprise us all. I certainly wouldn't have guessed that Charlotte would weigh almost a pound more than her sister at this stage. 

Charlotte, snoozing. Her Wubbanub pacifier helps give a bit of perspective on size. 

News to Me

Audrey and Thomas had their routine eye exams today. They both handled the medicine drops and actual exam well; they seemed more annoyed than anything. Thomas especially had puffy red eyes for most of the day. That said, he now has no ROP. Yay! His vessels are still immature though, so they will continue to monitor. Audrey, on the other hand, has mild stage 2 ROP. Last I knew, she and Thomas both had mild stage 1, but apparently, this is Audrey's second exam with stage 2. News to me.  

Charlotte was tested for the presence of MRSA (a nasty strain of staph bacteria) yesterday, and it came back positive. Apparently, she's been positive this whole time (not infected but just "colonized" with the bacteria). They gave her medicine of sorts and a special bath to try to "decolonize" her, but I guess it didn't work. All of this is news to me. We had been told that all the cultures had come back negative. And we had not been told anything about the "decolonization" attempt. I guess if you don't know to ask the question, you won't get the answer. Awesome.  

While I'm on a bit of a rant...Charlotte had a major brady and desat during a bottle feed over the weekend, which made everyone hold on giving her bottles at all. The feeding specialist and I had been working with Charlotte with a specific position, particular slow flow nipple, and methodical pacing for her feeding. If I had to bet, I'd say that those details were probably not heavily considered (if at all) for the feeding in which she had her episode. The feeding specialist had a similar reaction. I guess we'll never know, but I do know that she has taken a bottle well with me since then. She took most of her afternoon feed today and never dipped below 94% oxygen, and even that was only a brief dip. 

My hospital frustrations aside, the babies are all doing well overall, and they are actually receiving a high level of care. If you stick around anywhere or with anyone long enough, you're bound to notice the warts, I suppose. 

Oh, and Audrey has joined her sister in the 4lb territory! Charlotte, however, won't stay there much longer, and Thomas is eying 6lbs. It's amazing how far they've come. I failed to mention it earlier, but last Friday marked "full term" (37 weeks) gestational age. My due date of June 10 is fast approaching. Homecoming we be here before we know it!

Bottles

Wow, there are so many updates to share. I hardly know where to begin. 

Yesterday, Audrey's godmother came for a visit and we were able to try to give Audrey a bottle for the first time. It's an exciting milestone, but my expectations were low. I've heard a fair amount about the whole suck-swallow-breathe pattern being a difficult one for preemies to learn. Apparently, they forget that last step (breathing), which obviously doesn't work out too well for long. They also get tired pretty easily and don't often make it thru their full feed amount. They're not used to having to work for it. So it was a total shock to everyone when Audrey powered her way thru her entire bottle!! It actually freaked me out a bit because I started to think that it's possible that one (or more) of these kiddos might come home a lot sooner than we've been expecting (around my due date of June 10). The "Discharge Readiness" checklist that was placed on the girls' cribs probably had a little something to do with that panic attack as well. All that said, it wasn't a perfect feeding session (more on that later), and I don't think her path will be perfectly linear. So I can breathe again while waiting for these kiddos to consistently do the same. 

Later that afternoon, a feeding specialist came to help me try to give Charlotte her first bottle. Charlotte had no issue with sucking and swallowing (she likes her milk!), but she didn't bother to breathe while the bottle was in her mouth. I had to pull it out entirely after every couple of sips or else she would brady and desat. As you might imagine, this laborious process tired out all of us, especially Charlotte, so we opted to swaddle her back up and give her the rest via her tube. 

When I arrived this morning, Thomas had been off CPAP for about 2 hours and was doing well with it. To my complete shock and delight, he was still off CPAP when I left around 5pm. He had a few self-limiting bradies and desats but nothing major, so we will see... Since he's so new at breathing on his own, we didn't try a bottle with him but instead did some "nonnutritive sucking" work. Basically, we dipped his wubba nub pacifier in a bit of milk repeatedly just before a feed (via his tube) so that he would associate milk and sucking with then feeling full. According to the feeding specialist, he behaved in perfect textbook fashion. He was wide awake, exhibiting a strong rooting reflex, properly pausing for a break between bursts of sucking, and demonstrating that his muscles for sucking are pretty strong. Attaboy Thomas! This all bodes well for his first attempt, whenever that might be. 

We then moved to Audrey. Today, she showed that she still is a preemie after all. She didn't properly pause to take breaths and had some almost brady moments. The only reason she didn't move to a full brady is because we pulled the bottle in time for her to recover. She also seemed sleepier today than she was yesterday, so the timing could have been part of the challenge. We might try a different flow rate nipple tomorrow, and maybe a different holding position as well.

Speaking of, we moved Charlotte to a side-lying position today and also transitioned to a preemie, slow flow nipple. Apparently, she liked those changes because she showed that she is actually capable of rocking the suck-swallow-breathe pattern when she wants to do so. She took over half of her feed without dropping below 96% O2 saturation. However, it took a fair amount of energy and time to get the milk out of that slow flow nipple, so after that time (about 20-25 minutes), we opted to let her rest and get the remainder via her tube. 

Okay, heading to bed, but I'll do a weight check here before signing off: Audrey is 3lbs 14.5oz; Charlotte is 4lbs 10.5oz; and Thomas is 5lbs 4oz!

Our tiny one, Audrey; you can get a better sense for size when you see her little legs. 

Big Boy

I'll post more actual updates tomorrow, but for tonight, here's a relatively recent photo of our now 5lb 4oz boy! He's been gaining an ounce or more each day, so I'm guessing that he'll be bigger than Hannah was at birth by the time he comes home. 

Vision & Weight

Charlotte had another eye exam today. The eye drop medication seemed to bother her (as they warn it might) enough to put her back on CPAP for the day. She went off again around 9pm and has been good thus far. As for her eyes, she still has Stage 2 ROP in both eyes (praise the Lord that it hasn't progressed) and will received a follow up exam in another 2 weeks. Thomas and Audrey have their next exam in 1 week.  

Audrey is still off CPAP and seems to be doing better again, after her 24 hours or so of strange desats. She still has tachycardia (high heart rate) somewhat regularly; it seems like she just gets hot or annoyed easily, but what do I know?! She's still the slightest of the three, by far, but she's at least been gaining these past few days and is almost at 4lbs. There's talk of her starting to try bottle feeding sometime soon! 

Thomas' infected salivary gland seems to be almost healed at this stage. I'm not sure how much longer he'll be on antibiotics, but it will be nice when the IV can come out of his arm. He's pretty dependent upon his CPAP still (mostly set at 21% oxygen), but he certainly has no trouble putting on weight. I held him (and Audrey) today and could hardly believe how big he was, especially in comparison. My thoughts were just confirmed when the night nurse gave me his weight from tonight: 5lbs 2oz! Insane. It's actually plausible that Audrey would come home prior to reaching that same weight. I guess they each have their own journey...and they always will be unique. We're grateful that we get to be a part of them all and watch them unfold. 

All Three Held at Once!

Will and I visited today with Audrey's godfather, so we were able to hold all of the babies at the same time! They seemed happy about it, and I know we loved it. If only we could get them all in the same room, preferably one with a view (window).

Audrey and Charlotte are both still off CPAP; it's wonderful to see their little faces free of velcro tape and tubing. That said, Audrey was having some desats that seem to have come out of nowhere. We're hoping and praying that it's just a short blip and that she'll be able to remain off CPAP and thrive. Her feeding has been increased over the past couple of days, and she's in a crib now too, so maybe it's just too much all at once...? She lost 5 grams yesterday, so her weight gain is a continued prayer request as well.

Charlotte, on the other hand, is still putting on the pounds like crazy; it almost seems plausible for her to catch up with Thomas at some point. Who would have thought?!

I say that, but Thomas is also continuing to grow well. ENT came by again today and said that his salivary gland infection is improving; they actually decided to stop one of the antibiotics he's been getting. I think he'll get the full 7 day course of the other, but all seems well. He's breathing room air on CPAP, so the nurse was thinking that they'd either try to get him off CPAP or bottle feeding this week, one or the other. Perhaps the girls will be able to start bottle feeding soon as well.

I'm pretty sure we get a new attending physician tomorrow (for the next three weeks), so I guess we'll just have to wait to see what he/she thinks. Until then...

Salivary Gland

As it turns out, the redness and swelling just below Thomas' chin line is due to an infected salivary gland, something that they don't see too often in the NICU. The ENT (ear, nose & throat) doctors took a look at him yesterday and noticed that fluid from the swollen area was actually draining into his mouth, confirming the diagnosis. They took a sample of that fluid and sent it to the lab to assess for bacterial infection, and they prescribed warm compress, massage and potentially lemon juice drops in his mouth as treatment. The idea behind the lemon juice is that it would cause him to salivate more and thereby help flush out the infected gland, but the attending physician hasn't yet decided whether or not to go ahead with that part of the treatment since he's so small. All that said, the ENT folks noticed progress when they examined him again today, so that's great news. The poor guy has probably been in a fair amount of pain; no wonder he was fussing and crying more than usual when we were there yesterday! Nothing has grown yet in the blood sample that was sent off to the lab, so it looks like he probably does not have an infection in his blood stream; we're cautiously optimistic there. He's also been acting pretty normal and healthy otherwise, so that's a good sign too. Thanks for the prayers; we feel them and know that Thomas and his sisters (and all of us) are safe in His hands. 

Infection

I got back from the hospital around 6:30pm today and got a call from one of the fellows in the NICU at about 6:45pm. Thomas' nurse noticed a red spot with a bit of swelling below his chin; it looks like a skin infection of some sort. They immediately started him on antibiotics and sent off samples to the lab to assess what the bacteria is and whether or not it has entered his bloodstream. We're praying that it's not MRSA and that it's not in his bloodstream. He seems to be behaving normally (for him) but has definitely required more oxygen these past few days. Hopefully, that's not a sign of anything worse. They're going to do an ultrasound tomorrow, and we should also get an initial read on the lab work. 

Otherwise, everyone seems to be doing well. Audrey gained 15 grams (about .5oz), so that's at least something. Charlotte is eligible to trial off CPAP again, so I bet that will happen in the next day or so. She and Thomas are both still rocking their cribs and are growing well.