Weight

They all had their echo scans done again today. We don't have the results, but the assumption is that they all still have large PDAs. The side effects of the medicine they all took for it seem to be almost gone at this stage.

Audrey and Thomas are both being bumped up to 2 cc of milk every 3 hours, but Charlotte is staying at 1 cc for now. Charlotte and Thomas have been doing well breathing on bubble CPAP like their sister Audrey. The doctor noticed a slight graze on Charlotte where the CPAP prongs enter her nose, so she's watching it and trying to ease pressure and abrasion to avoid hurting her fragile skin and nose.

Not much else is new, but we did manage to get weights for all of them. Charlotte is by far the smallest, but her number is also a few days old and so even lower than it otherwise would be. Here goes: 

Audrey is 810 grams or ~1lb 12.5oz

Thomas is 890 grams or ~1lb 15.5oz

Charlotte was 630 grams or ~1lb 6.5oz

It will be exciting when they are all over 2lbs! 

Antibiotics

Hannah has an ear infection, amidst a generally nasty cold, and started antibiotics yesterday. I apparently have walking pneumonia and started on a z-pack today. Here's hoping we're both better by the weekend and that Will doesn't get sick again. 

Audrey's nurse described her as a "rock star." She's tolerating her food and breathing well. She's still having some self-limiting desaturations  (I think they all are) but nothing concerning to them. 

Thomas went off NAVA today and is breathing well on normal bubble CPAP. Yippee! He too is tolerating his feeds. 

Charlotte moved to bubble CPAP today AND started to get colostrum / milk. Praise the Lord! She's tolerating the feeds and breathing well. 

We are grateful. Thanks for all the prayers!! 

Monday Meet and Greet

We met the new attending physician for the next three weeks. She was lovely. And she went to medical school at the University of Auckland in New Zealand, so there's that too.*

As for time at the NICU, my visit was via FaceTime, which might be (probably is) against the rules, but a sick momma has to do what she has to do to see her babies and hear the updates.

Audrey and Thomas both completed their courses of medicine to try to close their PDAs. Unfortunately, it didn't work. At this stage, I think the plan is to wait and see if they close on their own over time since they don't seem to be presenting significant clinical problems. They might be to blame for some of the apnoeas and braddies, but those seem to be infrequent and self-limiting (the babies correct themselves without outside assistance) and therefore not a major concern at this stage. That said, it's certainly disconcerting to be there when one of those episodes occurs, helplessly watching your child's oxygen levels and heart rate decline. 

Charlotte did not like the PDA medicine at all, even at a lower dose, so they stopped giving it, and the plan to wait it out is likely the same for her. Also, we learned that she has actually been on ventilator CPAP as opposed to bubble CPAP like her siblings. Basically, she's been getting a bit more help to ease the transition from intubation. The nurse thought she might be transitioned to bubble CPAP tomorrow since she's been doing so well. And there's even a chance that she might start to get milk tomorrow! 

Audrey has already started back on milk, but they start back at 1 cc and move up by 0.5 cc every 12 hours, so it'll take a while for her to get back up to 3 cc and beyond. Thomas hasn't started back on milk yet but should soon.

That's all I've got. We're back to visit first thing in the morning before my parents fly back to FL...

* Will was born in New Zealand and is not even a US citizen. His dad, a surgeon, is currently teaching a course at the University of Auckland. Small world. 

Not Much to Report

It sounds like Audrey and Thomas have both received their last doses of medicine for their PDAs. Apparently, Charlotte has as well, but I think that might not be correct; yesterday, they had said she was on a lower dose for a longer period of time. Regardless, they'll do echos again sometime soon to see how effective it was for each of them. 

Otherwise, they're all doing well and will hopefully start back on food soon. Maybe I'll find out more and add to this post later this evening... 

Update Call

Hannah is sick too. We're all at home. Maybe it's a gift...forcing a bit of rest on us. 

We've called into the NICU a couple of times for updates, and all seems well.

Charlotte's "just hanging out" according to the nurses. She's been at 23% oxygen (21% is room air) on CPAP and has had oxygen saturations in the in the high 90s (which is great). As a result, they're lowering her CPAP to 21% (which is as low as it goes). She's breathing well on her own, actually seeming to surpass her brother in this area. She's been active, as always. Hopefully, she doesn't use up too much energy since she won't start on milk for a few days still. She received her next (lower) dose of the medicine for her PDA, and it looks like she is tolerating it well. 

Thomas is steady. He started his first (higher) dose of the medicine for his PDA. So far, so good. Hopefully, he tolerates it and can be thru with the treatment by sometime tomorrow. 

Audrey is receiving a blood transfusion (she didn't get one yesterday), so she'll start her first (higher) dose of the medicine for her PDA once that is finished. 

Short updates tend to be good updates. Short and sweet. We are grateful. 

Extubation

So I'm sick. Bummer. I can't go into the NICU to see the babies until I'm better. Major bummer (even if totally understandable). The silver lining is that all of the babies are going to get antibodies for whatever I have through my milk. How cool is that?!

I had canceled my trip to the hospital this morning to try to get rest and recover as quickly as possible. I called to check in on the babies and all was well, so I took a nap. Then the NICU called and the fellow told me that they had changed the plan and wanted to extubate Charlotte in an hour or two. Will and I packed up and drove to the hospital with my parents, praying and texting family and friends to do the same as we drove. We arrived and waited for about 40 minutes in the lobby while the doctors did the procedure. After what seemed like an eternity, the fellow walked through the doors with her thumbs up! Praise the Lord! Charlotte has joined her brother and sister, breathing on her own with the help of CPAP. We pray that she would continue to breathe well on her own with minimal help. They gave her some caffeine to help her remember to breathe. Seriously. Not-so-NEAT via IV :)

Charlotte started medicine for her PDA yesterday. She tolerated it okay but not perfectly, so they decided to reduce the dose and spread out the treatment over a longer period of time. They're just waiting for her sodium levels to go back to normal. 

The echos yesterday confirmed that both Audrey and Thomas also have large PDAs. They will begin treatment as well, initially at the higher dose level. They don't eat while they're on the medicine, so the higher dose / shorter duration is best if they can tolerate it. We will see. It will be many days still before Charlotte is going to be able to receive any milk, but we are so grateful for progress towards that. Oh, and they're all getting blood transfusions today; they've all had them before and will all have them again since they have blood drawn for labs and are unable to produce more at this stage. 

That's all for now. Praise God for yet another good day for these precious little ones! 

False Alarm

Will and I went to the hospital first thing this morning to be there for Charlotte's extubation. But that didn't happen (more on that later). We did however get to sit in on morning rounds for all three of the babies, so here goes... 

Charlotte had her echo   yesterday, and results confirmed a Patent Ductus Arteriosis (PDA), an open connection between the pulmonary artery and aorta that typically closes after birth in a full term infant, and a large one at that. It's common in preemies, but it can cause issues, so we decided to try to treat it with medicine prior to extubating. She will be given three doses over 36 hours, and hopefully that will do the trick of closing it without any side effects. She will stay intubated and on the ventilator during this time for stability and will likely be extubated this weekend. She's still on room air and all of her other numbers look good, so she seems to be in a stable place going into this treatment. But it also feels like one more bump in the road to getting her started on milk. One day at a time. 

 Thomas got a clear report on his brain ultrasound and is up to 2 cc of milk every 3 hours. He had his echo today, so we don't have the results yet. However, the doctors anticipate a PDA with him as well given the murmur that they can hear, so he will likely begin the same medicine treatment in the next day or so. He's been on his stomach or side the past couple of days and seems very comfortable. 

Audrey is up to 3 cc of milk every 3 hours, and all of her numbers continue to be strong. Her brain ultrasound showed a smudge of brightness similar to her first ultrasounds, but none of the doctors seem to be worried about it at all. It's not a bleed, but there's a tiny chance it could be an indication of Periventricular leukomalacia (PVL). Obviously, we pray that that is not the case; the doctors don't think that it is. All three babies will continue to receive regular brain ultrasounds, so they'll be tracking this for her each time. She too has been sleeping on her stomach lately, which is super cute. She's had her legs pulled up underneath her, which is the same way Hannah loves to sleep. Sisters. 

Audrey sleeping soundly and looking a lot like Hannah

Morning Rounds

Audrey continues to "fly." She is now getting 2 cc of milk every 3 hours. She's breathing "room air" with the help of CPAP, as she has been almost right from the start. The nurses don't talk much about her because she's just doing everything right at this stage. She got her 7 day brain ultrasound today, so we're praying for a clear report. Bleeds in the brain are an incredibly common issue with preemie babies, and they typically occur within the first 7 days of life, so a clear report now is a big deal. 

Thomas is also breathing "room air" with the help of CPAP, but he is also being assisted by NAVA (a sensor on his diaphragm that informs how much help he will get from the machine such that every breath is different-- amazing). He's up to 1.5 cc of milk every 3 hours and now seems to be taking food well. He also got his 7 day brain ultrasound today.

Charlotte is the only one still intubated. She had a scary episode yesterday when they tried to extubate her (chest compressions and everything). I received the call from the NICU within moments of walking out of the chapel following Joseph's memorial service. Apparently, she has thick secretions (similar to the mucus we all have), and that was blocking her ability to breathe on her own. They're planning to fully suction her tomorrow morning and try again. We're praying for a successful transition to CPAP. Once that occurs, they will likely wait a day or so and then start to feed her as well (beginning with 0.5 cc every 6 hours). She's the smallest, by far, so the beginning of nutrition would be a huge milestone. Finally, she had her brain ultrasound yesterday, and it came back clear :)