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.