10 Grams

Archer gained just 10 grams in weight today, which is better than losing weight. He is looking bigger everyday, as well as getting more squirmy. Archer had very little change in oxygen today. Archer also kangarooed with Mom. He received another Kate's Kart book: Where the Wild Things Are.

Change of Routines

Archer has had a schedule change regarding some of his daily routines. Since he has been born, he has had at least one chest x-ray and one blood gas test drawn every day, if not multiple times in a day. He will now undergo these tests on Mondays, Wednesdays, and Fridays only, unless they are needed otherwise.
Archer's NAVA ventilator settings were turned down from 2.2 to 2.0, and his oxygen level has been around 29%.
Archer gained another ounce, bringing him up to 2 pounds 10 ounces. His milk intake has also increased from 180 ml to 187.2 ml per day (6.3 oz.).

32 Weeks

Archer was acting a little squirmy throughout the day today. He also gained back two ounces, bringing him back up to 2 pounds 9 ounces. Dad calmed Archer down by kangarooing with him. Archer slept the majority of the time. When it was time to go back into his incubator he went right back to being squirmy. He was sure eyeing his tube before Mom and Dad left, and the nurses are keeping an eye on his hands in case he pulls his breathing tube out.

The Waiting Game

Archer's status has not changed much since yesterday, and the staff doesn't expect much change until he tries a CPAP again. Archer is playing the waiting game and is hoping to gain some weight in the process. He has been sitting at 2 pounds 7 ounces for two days now.
Archer's latest Kate's Kart books that he received were It's Time To Sleep, My Love and My Daddy and Me.

No Humidity

Archer had a good day of rest and relaxation with Mom and Dad today. He kangarooed with Mom while dad changed his diaper a few times and played with him while he was in the incubator.
Archer's NAVA settings went from 2.5 to 2.2, and his oxygen level was lowered to 30 percent. His feedings were increased from 168 ml to 180 ml (6 oz) per day.
Archer no longer requires humidity in his incubator, only heat. His incubator was also switched in hopes that it will deter any future body temperature increases.

Eight Weeks Old

Archer's time on the nasal cannula was cut short. He was pausing too much in between breaths and the cannula does not have the technology to back him up. It was good for him to be off the ventilator and to start taking small steps to breathing on his own. The staff may give him another try in a week. They would like to give him time to grow more and take in more calories. His milk intake was increased from 156 ml to 168 ml per day, with a 25 calorie fortifier. Archer's oxygen levels for the ventilator are back in the thirties and his NAVA setting is back to 2.5. He recovered fairly quickly from all of the excitement he had yesterday. Another positive result of the excitement was that he was able to move to the largest available breathing tube. This will help reduce any air leaks that could occur.
Archer had another short period of high body temperature. His temperature reached 100 degrees. Mom and Dad helped cool him down and calm him by opening the incubator doors and kept him from squirming about. It's speculated that the incubator heating probe may be faulty.

Nosey

Archer's blood gas test today showed that he still had too much acid in his body (acidotic). He had an I.V. line put in so he could be given more sodium bicarbonate to help combat these issues.  The staff also ran a test on his poo because acidosis can also lead to tummy problems. The test came out negative, though they are giving him formula with his feedings, half and half, instead of the concentrated fortifier, to see if that will help.
Archer went down another NAVA setting overnight last night to 2.2 because his CO2 had looked good. But he ended up taking a lot more steps than just weaning down a ventilator setting...
The nurse practitioner decided it was time for him to try to move off the ventilator and onto a CPAP. This is a nasal oxygen system that gives pressure to the lungs and helps inflate them. As expected, he did not like this big change. Archer was on this for a brief moment shortly after he was born. After about an hour of fussiness the staff decided to try something else...
Archer then moved up from a CPAP to a nasal cannula. The cannula is much smaller, and more flexible, than the CPAP. Though the cannula supplies oxygen, it does not help inflate the lungs. Archer tolerated this much better and eventually settled down.  After a short time a nurse tried closing Archer's mouth to see if he would do better and keep so much oxygen from escaping.  His breathing statistics did go back up, so other methods were taken to help keep his mouth closed. He received a wrap around his head.  His oxygen level was brought down to 75%.
Throughout all of this, Archer's voice could barely be heard. His vocal chords were most likely swollen from the endotracheal tube, and they are also not fully developed. He will most likely bounce back and forth from the cannula to the ventilator until he gets used to breathing through his nose and his lungs get healthier. Even if it's just a few hours, it's good for him to be off the ventilator, as it can give his lungs and vocal chords a beating. His upper lip has also taken a beating from all the tubes being forced into his mouth. We were assured that this will eventually grow back into a normal form.

Yarrr!

Archer's breathing seemed to improve a little today. He did not need the backup mode on the ventilator very often. The NAVA ventilator setting was decreased again. Since he has been back on the NAVA setup, the settings have decreased from 2.5 to 2.3. The staff would like to see this number around 1.5 before they try out a nasal ventilation system.
Archer's blood gas test showed that he needed sodium bicarbonate. The calorie fortifier he has been taking typically leads to having too much acid in the body.
He may also need another blood transfusion soon, though a recent test showed that he has been making red blood cells on his own. It has been quite awhile since he has needed more blood due to the staff's blood draws.
Archer dropped back to 2 pounds 8 ounces this evening.

Heating Up

Archer's chest x-ray this morning was said to be much better than previous x-rays. Archer was able to wean off a couple of ventilator settings. His allowed apnea time was moved back to every six seconds. His oxygen levels are back in the high thirties. Archer's CPT treatment was moved to every eight hours. This way he will not be bothered during his resting times.
Archer had a temperature scare during the day today. Mom noticed his head was constantly moving, he looked uncomfortable, red, and his heart rate was up. The nurse took his temperture and it reached 101. The nurse opened his incubator and turned down the heater in his bed. A blood test was also administered to see if another infection was brewing. These results came back negative. It took about 45 minutes, and two poops, for his temperature to get back to a normal level.  It was thought to be a malfunctioning temperature probe that caused his temperature to rise; it has been fine since. Archer had his last round of antibiotics today from his last infection scare.
Archer has increased his milk intake from 144 ml to 156 ml per day, with a 24-cal fortifier. He has made it to 2 pounds 9 ounces.
Mom and Dad are currently testing out the kangaroo care system. We have moved to an every other day schedule for the time being.  Archer's status on the weekends has not been as good as during the week. Some doctors and nurses attribute this to being too tired and over worked. However, other nurses and doctors say that kangaroo care can be the best thing that a parent can do for him. We are trying to find the best schedule that benefits his health.

31 Weeks

Archer's feeding intake was increased from 132 ml to 144 ml per day. A calories fortifier was also increased from 22 to 24-Cal. Archer is no longer on fluids. This means that he is on full feedings! He has an I.V. line in so he can receive his antibiotics for any sickness he might have. The testing of the infection from the lab showed the infection did not grow to become anything severe.
Archer has been receiving a CPT treatment a few times a day. This is basically a vibrator that they use on his back, sides, or stomach to help remove fluid in his lungs. Sometimes he tolerates this and sometimes he does not. He will now receive this treatment every six hours.
The staff tried to wean Archer off a ventilator setting but it did not go very well today. They will keep trying. Archer is now not allowed to go more than three seconds without taking a breath. The ventilator was set on six seconds.

Forgetful

Archer had a restful day today. The sensors that run to his diaphragm for the ventilator system were replaced. When Archer is breathing, his breathing statistics are excellent. However, he will forget to breathe on occasion and the backup system will kick in. It will take some time for his brain and his lungs to learn to work together. Once he figures this out then he will be in better shape. Growth will also help his lung development. He reached 2 pounds 6 ounces today.
Archer received another Kate's Kart book: Lullaby Moon.

Bouncing

Archer's experience in bouncing back to the older ventilator settings was short lived. He needed these older settings for a short amount of time to help give him some breaths and give him some rest and relaxation from working hard on breathing on his own. He is now back to the sensory ventilator settings, referred to as NAVA. The staff turned up some settings on the ventilator since he has been back on the NAVA system.
Archer's milk intake was increased from 120 ml to 132 ml per day. He is currently floating around 2 pounds 4 ounces. He has been on the pattern of gaining a few ounces, and then losing a couple. His intestines have been hard at work, and they have been working well. Archer has also grown some more, he is up to 14 1/4 inches.
Archer also gave Mom and Dad some keepsakes by having his feet marked in ink to make footprints. Dad then had his first experience in giving Archer a bath.

Seven Weeks Old

When Mom and Dad walked into the NICU this morning they caught the doctor turning down some pressure settings on Archer's ventilator. It is a fun cat and mouse game to watch, as a doctor will sneak in the room to change settings without the nurses knowing. This particular doctor likes to call the other nurses "chickens" for not being more aggressive.

Archer's chest x-ray looked much better this morning, according to the doctor. The test on the infection has so far come back negative, as it has not grown into anything worse. He will continue to receive antibiotics for the next six days.
Archer's PICC line in his left arm was officially removed. They will use temporary I.V. lines for the rest of the week to give Archer his fluids, until he is on full feedings. His feeding intake went up from 96 ml to 120 ml per day.
Dad got to cuddle with Archer for the second time. Archer did much better this time around. He would forget to breathe once in a while and let the ventilator back him up, but he would also do this in the incubator.
Later at night, Archer's breathing started going a little downhill. He was having trouble breathing on his own and the ventilator was doing all of the work for him. The staff decided to take him off the setup of the sensory breathing, where Archer had more control over his breaths per minute. The line with the sensors in his stomach was taken out. He was then switched over to the older ventilator settings where the ventilator gives him breaths, whether he needs them or not. The staff set it to 45 breaths per minute and he was doing much better on this system.

Calories

Archer has now gained a few more ounces, bringing him up to 2 pounds, 5 ounces. A calories fortifier was added to his milk intake for the first time today, and this will continue to be added for quite awhile.
Archer's PICC line in his left arm went bad today. The staff removed the line and a temporary IV line has been added to his foot.. They will only need a line for another week to give him his antibiotics and fluids until he is up to a full feeding schedule. Other medications will be given by mouth.
Archer has continued to cuddle with Mom using kangaroo care. His oxygen levels have remained in the thirties. Recent attempts at lowering his ventilator settings have not been successful, but the staff will continue to try wean him to lower settings.

Fighting

Archer's chest x-ray today looked a little more hazy, so the staff ran a check of the fluid in his breathing tube to see if he had an infection of some sort. This test came back positive for an infection. It will take a little time to see what type of infection it is, though they are treating it as if it were pneumonia. Archer will be on antibiotics for at least one week to try to fight off whatever the infection may be.
Archer's feedings increased yet again from 72 ml to 96 ml per day. He also took his last dose of nutrients (TPN) today! This is one less bag in the room, and one less fluid type running into his body. Starting tomorrow, Archer will have a calories fortifier added to his milk intake. Archer has also grown another one half an inch. He is up to 13 3/4 inches.

Not Today

Archer has gained back a couple of ounces and is at 2 pounds, 2 ounces again. His feedings have increased from 62.4 ml to 72 ml per day. His reflux issues have become minimal.
The staff tried to wean him off a ventilator setting by a half a step, but he did not do very well. They will try to decrease his settings in smaller increments.
Archer received another Kate's Kart book: Guess How Much I Love You.

30 Weeks

Archer was able to resume kangaroo care with Mom today. He has been doing pretty well with his new ventilator settings. His oxygen levels averaged in the mid 30s today. It took about an hour for him to settle in with Mom, but then he was calm for about another three hours. The doctor mentioned today that the plan is to slowly wean Archer off the ventilator.
Archer's feedings was increased from 57.6 ml to 62.4 ml daily. He has been having some trouble with reflux. They may start adding calories to his milk soon, as well as medication to help keep his food down.

Something New

When Mom and Dad visited Archer this morning a new plan was put in place to help his up and down breathing. The nurse practitioner and doctor advised that adding another tube in his stomach, the same size as his feeding tube, could be beneficial. This new tube has sensors on it that reach down to his diaphragm. The sensors detect when the brain sends a signal to the diaphragm to take a breath. The ventilator can use the signal to either help give Archer breaths or to let Archer breathe on his own. Archer is now in the driver's seat when it comes to taking breaths. The ventilator will no longer force feed him breaths when he doesn't need them. Now, whenever Archer sighs, yawns, or has the hiccups, the ventilator knows not to keep sending breaths his way. The breaths per minute settings is no longer a huge factor because Archer determines how many breaths per minute he will take. Though he is not allowed to fall below 30 breaths per minute, nor go 6 seconds without taking a breath. If either of these happen, the ventilator will kick in a breath for him. This new breathing system can help Archer transition to a nasal-type respiratory system. He will learn to breathe more on his own, and he can use this same system when he does take his oxygen through the nasal cavity.
Archer did very well soon after he received this new technology. In a short amount of time his required oxygen went from 52% to 38%! This new technology also helps compensate for the leak around the end of his tube.
Archer's feedings were also increased from 48ml to 57.6ml, continuously, every 24 hours. He has recently lost a little bit of weight. This could be related to the medicine he was taking to help drain his fluids.  Dad also changed a couple of heavy and dirty diapers. His weight is floating around 2 pounds.

New Schedule

Archer was still quite fussy over the last 24 hours. He also experienced some reflux. A decision was made to change the way he takes in his feedings and change the slope of his bed to help with this issue. Instead of taking in milk every three hours, Archer will be on a continuous feeding schedule through his feeding tube. It adds up to about 2 ml every hour. His feedings were increased by 8 ml per day based on this new feeding schedule and his increasing weight. The staff is hoping that he won't have to work or fuss as much with this new schedule. Archer is also receiving a double dose of medicine today to help drain fluids around his lungs. This will also increase his diaper deposits, which Dad experienced changing today. Archer floated around 2 pounds, 2 ounces today, depending if it was before or after a diaper change.

Mom had her first opportunity to give Archer a bath! She soaked some wipes with soap and water while Archer soaked and stained his bed.

Six Weeks Old

Overnight, Archer went backward a step, moving from 40 to 45 breaths per minute. Archer was also quite fussy throughout the day today. His breathing was heavy at times and his breathing tube has been quite loose down in his throat, providing a leak. If Archer, or the tube, slightly moves, it causes his breathing to be not very good at times. His tube was retaped today, but it seemed to help very little.

Despite his fussiness, Archer decided to try to celebrate his sixth week in the world with Dad! Dad learned how to properly take Archer out of his incubator and keep him comfortable on his chest. Archer spent almost two hours with Dad, but his breathing had been heavy and offbeat almost the entire time. He was also pretty drooly before it was decided to put him back in his incubator. Afterward, Archer was still a little fussy and was given a sedative to help calm his breathing.

Archer's intestines looked just fine today on his chest x-ray. His milk consumption was increased from 4 ml to 5 ml, every three hours. 

Getting Longer

Archer improved more on his ventilator settings today, moving from 45 to 40 breaths per minute. He also gained another ounce, which brings him to a total of 2 pounds, 1 ounce. Since his birth, Archer has grown a full two inches and a quarter, making him 13 1/4 inches long!
The nurses are keeping a close eye on his intestines, making sure that he is tolerating the feedings. After viewing the morning chest x-ray, there was possibly an overgrowth of one intestine. But a second x-ray in the afternoon looked a little better. Preemies have a high rate of having NEC, an intestinal infection that can grow and harm his insides. It usually occurs after receiving feedings. He has not shown any other signs of having NEC. Other signs may include bubbles on the intestines, leftover food that has turned green, or odd-colored poo. The overgrowth could just have been some food that did not make it's way down yet. NEC will hopefully not be a factor since he has been tolerating the feedings really well.
They are also keeping a close eye on his long fingers! He tends to use them to try to pull off his taped tube. The staff has ordered a special nasal tube for him in case he decides to use those fingers to pull out his tube, taking himself off the ventilator, and moving to a CPAP.

Number Two

Archer has officially made it to two pounds! His milk feedings have been increased yet again. He went from taking in 3 ml to 4 ml, every 3 hours. He has been accepting the milk just fine, but having a little trouble going number two. An alternative measure has been necessary the last couple of days to help him go.
Archer has gone down on his breaths per minute on the ventilator. He went from 50 to 45 breaths per minute. His oxygen level has been floating in the 50s.
Archer received a new Kate's Kart book: The Little Red Caboose.

Warming Up

Archer increased his weight a little more by adding an ounce - he is up to 1 pound, 15 ounces.
His feedings have also been increased. He went from 2 ml to 3 ml, every 3 hours.
Archer weaned a little more off the breaths per minute settings on the ventilator, which has changed from 55 to 50.
Mom and Archer participated in kangaroo care again today. After Mom had put Archer back in the incubator, Archer's temperature was very warm, but the nurses got it back down to a normal level.
Archer received a new Kate's Kart book: The Little Engine that Could.

29 Weeks

Archer was able to wean down on some breaths per minute on the ventilator today. He went from 65 to 55. His breathing was much more stable throughout the day today.

Archer has also been taking steps to breaking out of his incubator. After he was born, the humidity was set to 90% - he is now at 37%. Aside from the humidity, there are a few other steps that need to be taken as well before leaving the incubator, such as taking half of his feedings from a bottle. He is currently taking his feedings through a feeding tube.

Archer's milk intake was also increased. His schedule changed from 1 ml to 2 ml, every 3 hours.

Archer and Mom were able to participate in kangaroo care for the second time today. Archer did very well, beside the fact that he tried tugging on his breathing tube several times.

After kangaroo care, Archer seemed to be in a very happy mood. Even though his cheeks are taped close together, and you can't hear him make sounds due to his breathing tube, he looked as though he was smiling and giggling at Mom and Dad!

One Ounce at a Time

Archer had another day of up and down breathing levels. He never seemed to get settled in, so a nurse gave him a sedative to help calm him. This seemed to help just a little. He required a little more oxygen today.
Archer's latest weigh-in was 1 pound, 14 ounces.
Archer's new feeding schedule should help him gain a little more weight and grow. It was increased from 1 ml of milk every 6 hours, to every 3 hours.

Whew!

Over the last 24 hours, Archer's breathing had been up and down. The nurses tried to retape his breathing tube three different times, but this did not seem to curb his behavior. His blood gas tests were not very good this morning either. After looking at a chest x-ray, it was determined that his right lung was collapsed and not expanding correctly.
The first move was to lay Archer on his left side, so his right lung would have more room to expand. Next, the nurses changed his TPN (nutrients) to a different mixture, hoping this would improve his blood gas. After a few more hours, a few more blood gas tests, and another x-ray, the NICU staff was successful at getting his right lung to expand correctly again!

Since this was corrected, Archer has been doing fantastic (according to the night nurse). Archer was given a bath, peed while getting a bath (ha ha), was given new sheets (the camouflage sheets appeared to make his skin blue and purple), and has been very calm.

Now if we could just get him to keep his thumb out of his nose...

Five Weeks Old

Archer had his diaper changed by Dad for the first time today! Thankfully, it was not a stinky one, and they both had fun during this experience.
Archer received a new Kate's Kart book: A Silly Snow Day.
Archer did not take part in Kangaroo Care today. His breathing numbers have been a little jumpy ever since his first experience with Mom. This is a common occurrence in between caring times, and the Kangaroo Care system usually begins with an every-other-day timetable.
Archer's oxygen levels are still floating around 45%, but he was able to go down a pressure setting over night.

Kangaroo Care

Archer's day was full of excitement. His blood pressure line (his second so far) quit working, so it was taken out. The nurses will rely on the blood pressure cuff again to check his levels.

Archer then had a new I.V. line put in. The nurses had a rough time finding a good spot in a vein to accomplish this task. He got a little bruised up on his right arm during this process. Mom was a little frustrated, but the nurses made up for it later in the day.

The nurses decided that it would be a good day to start "Kangaroo Care" because Archer has been doing so well the past few days. Kangaroo Care is a technique for preemies and parents that allows skin-to-skin contact, on the chest, with quiet time, for a few hours at a time. In short, After four weeks and six days, Mom got to hold Archer for the first time for almost three hours!

It was quite the process in watching four nurses prepare for this event. Several wires and lines had to be untangled, detached, and reattached. Mom learned how to properly pick him up, and then she stepped back with him into a reclining chair. Archer did very well with Mom. It was a very peaceful experience for both of them. 

While Mom was taking care of Archer, the nurses switched out his incubator for the first time. He had made quite the mess in it today! So when Mom was done with Kangaroo Care, Archer snuggled into his new bed (with camouflage blankets).

Dad let Archer grasp his finger while he was in Mom's arms. Don't worry Archer, Dad's turn is coming soon!

Gaining Momentum

Archer seems to be taking in the latest rounds of milk just fine. He is having good bowel sounds and movements. He is still on the 1 ml, every six hours, schedule.
Archer's latest weigh-in number is 1 pound, 13 ounces. Some of this weight could be attributed to all of the lines and padding he has on his arms.
Archer was able to wean a little more off his oxygen and seems to be heading in the right direction. He is currently floating around 45%, the lowest it has been since he's been back on the ventilator. We hope this trend continues. The next best thing would be to wean down on the ventilator's pressure settings. The goal is to get his lungs to be able to expand on their own, and the ventilator is helping him practice this task, along with the inhaled steroids.

Milk. Round 2.

Mom got to change Archer's diaper for the first time today! Eww. He left a nice one for her to change for the first time!
Archer started to receive milk again, since he is now off the blood pressure medication. His current schedule is 1 ml of milk every six hours. The six hour difference is based on giving him time to rest in between feedings.
Archer was also able to wean a little more off high oxygen levels. He had a good day while Mom read all of his Kate's Kart books to him.

Two Eyes Are Better Than One

Archer made it to the 28 week mark today and he waited until New Year's Day to fully open his left eye. Mom and Dad think it is pretty cool that he opened each eye in a different year!
Archer rested well today. He recovered from some high oxygen levels and he was not as squirmy as he had been. He received a new blood pressure/blood draw line in his left arm, the same arm that still has the PICC line. His blood pressure levels have still been good. If this continues then milk feedings should start again tomorrow.
Archer received another Kate's Kart book: Baby Bear.