Tipping the Scale

Archer has gained a lot of ounces over the past couple of days. He has been weighed by the nurses several times to try to make sure that the readings were accurate. Yesterday the scale said he had reached 3 pounds 13 ounces. Today's reading was 3 pounds 15 ounces! Because of this weight gain his feedings were increased from 32 ml to 35 ml during his 30 minute feedings.
Archer is now receiving his breathing treatment only as needed, instead of a twelve hour schedule. His heart rate increased dramatically for a short time period. That could have been a sign to cut down on the treatments. He has been doing well on the 2.5 lpm cannula setting with an oxygen level around 29%.
Archer received a Kate's Kart book today: Splash!

Acrobatic

Archer was able to wean down on his cannula flow today fom 3.0 lpm to 2.5 lpm, though he required a little more oxygen (30%). He was paid another visit by the eye doctor today. Archer's eyes looked about the same as before, between levels 1 and 2 ROP. The doctor was still very pleased that the eyes did not get any worse and he was optimistic that his eyes would turn out okay.
Archer has managed to move around his incubator in recent days. He will arch his back and fuss and move around until he gets comfortable. He enjoys busting out of a good swaddle. Mom found him pressed up against the side of the incubator wall today.
Archer received another Kate's Kart book: The Berenstein Bears and a Job Well Done.

36 Weeks

Archer did not have any changes today. He's had four bradys in the past 24 hours. Some of these can be attributed to working on some poops. The nurse practitioner said that if his brady count stays the same or improves, then she will wean him off more liter flow tomorrow.
Archer has been waking up grumpy about 30 minutes before feeding times. He is demanding and wanting attention, a pacifier, food, and moved to a different position. Mom and Dad are glad that he is feisty and is showing them that he is in charge.

Fast Food

Archer's nurse last night attempted to wean down Archer's feeding times last night from 45 minutes to 40 minutes. He did well with this adjustment so the staff weaned him down some more during the day today to 30 minute feedings. This will most likely be the shortest time that he will take in his feedings. When he starts to take feedings by bottle then they may adjust any tube feeding timings based on how long it takes him to take in a bottle of feedings. Because of these feeding changes the staff did not want to make any cannula adjustments and put more stress or work on Archer.

Steady Sunday

Archer was able to wean down on his cannula liter flow today from 3.5 to 3.0 liters per minute and has been on 24% oxygen. The nurses took off his cannula to change it out and retape it. While the cannula was off he was breathing really well on his own, though it would have been too much work for him to do this continuously. His reflux issues were not as noticeable today. The doctor mentioned that growing and gaining weight can help with these issues. Archer's weight for the evening was 3 pounds 9 ounces.

Twelve Weeks Old

Archer had an easy going day that involved kangarooing with Dad and swaddling with both Mom and Dad. His oxygen level was at 26% for most of the day. The nurse had tried 22% for 90 minutes the other night but Archer did not do very well at this low level. He seemed to have some issues with reflux today. His reflux issues seem to be reappearing as his feeding times are decreasing. This also seems to correlate with low breathing levels at times.

Still Seeing

Archer had a chest x-ray this morning to check for any tummy problems and everything looked okay. He had a good day with his oxygen and cannula levels staying the same as yesterday. His feedings were increased from 30 ml to 32 ml for 45 minute time periods.
Archer's eye doctor made his weekly visit today. The doctor was pleased that Archer's vessels had not grown erratically since the last visit. His eyes appeared to be the same as before, which is a good sign. The doctor mentioned that weaning him down to room level oxygen (21%) would be best for his eyes. Unfortunately Archer can't handle this low percentage of oxygen right now, but he has been in the mid twenties.

Not Ready

Archer started out the day with a good oxygen level (24%) and his breathing was steady. The doctor decided to try to wean him down some more on his liter flow from 3.5 to 3, and he also adjusted his feeding schedule to 30 minute feedings every 3 hours. Archer tried out these new settings for a few hours. His breathing was up and down during this time and was having a slightly difficult time adjusting to these changes. When Dad arrived he was able to swaddle Archer for a few minutes until Archer "clamped down" and stopped breathing. A couple of nurses came in and he was placed back into his incubator. It took him a while to recover from this apneic episode. The decision was made to put him back on 3.5 liter flow and 45 minute feedings. He had only been on these settings for just over 24 hours and he was doing well with them. A chest x-ray was taken that showed his tummy was backed up with stool. He was given a suppository to help with this situation. He will get another x-ray in the morning to look for improvement or signs of infection. Since the episode, he has been doing well with good breathing and oxygen levels. Mom read him his new Kate's Kart book today: Does a Kangaroo have a Mother, Too?

Tachypnea

When Mom arrived to see Archer he seemed hot and frustrated. Mom decided to swaddle him and he calmed down and gazed at the room around him. He even found his mouth with his thumb a couple of times. 
Archer's feeding time was decreased again from 60 minute to 45 minute feedings every 3 hours. His liter flow on his cannula was also decreased from 4 to 3.5. This was changed because his blood gas tests have been good and he has been steady on lower oxygen levels. This was also changed in spite of the fact that he has had tachypnea, which is a series of quick respirations in a short amount of time. The doctor said that this will likely continue until he is 3 to 5 years of age. 
Archer's weight this evening was 3 pounds 7 ounces.

35 Weeks

Archer's feeding times were decreased again today to prepare him for bottle feeds. He is now receiving 30 ml in a 60 minute time period every 3 hours through his feeding tube. His oxygen level has made it down to 27% and his breathing levels have been fairly steady. His bowel movements have been great as well.

Swaddling

Archer had another good day today. His lab tests for the day came back with good results. He is reticking his own blood at a faster pace. He has not needed a blood transfusion in a long time and with better reticking the staff shouldn't need to give him a transfusion. His antibiotics ended today and an I.V. line was removed.
Archer's feedings were increased from 28 ml to 30 ml for a 90 minute time period every 3 hours. His weight for today was still 3 pounds 8 ounces.
Mom and Dad kangarooed today and they received the okay to interact with him more outside of the incubator. They can now attempt to swaddle him after assessments in hopes that it will reduce any fussiness.

Fifteen Inches

Archer had another restful day with no changes to his schedule, feedings, or oxygen. He required a suppository because he had not had a stool for 30 hours. This was most likely due to being off feedings for 24 hours a couple days ago. The suppository worked right away. Archer also managed to aim his squirt gun right through the open portal of the incubator during a diaper change and hit dad in the hand and chest! The weigh-in for the evening was 3 pounds 8 ounces. He also measured in at 15 inches long.

Eleven Weeks Old

Archer's x-ray this morning looked much better than yesterday's! The doctor believes the spot they saw was just some stool, and not a sign of NEC. Archer was put back on a feeding schedule today. He is receiving feedings on a 2 hour basis. If he does well with this then he will go back to a 1 1/2 hour schedule tomorrow. His feeding tube was moved and now flows through his booger preserve. This will allow him to achieve full suction on his pacifier, preparing him for bottle feeding.
Archer had his second ROP exam (eye test) today. The doctor found that one eye has stage 1 ROP, and the other has stage 2 ROP. These stages can be described as (link): 1) Mildly abnormal growth of retinal vessels. Usually gets better without any treatment and has no long-term effects. 2) Growth of retinal vessels is moderately abnormal. Usually gets better without any treatment and has no long-term effects. The eye doctor will pay a visit weekly to look for improvement.
Archer seemed fairly calm today and he rested well with Mom. His oxygen level made it all the way down to 26%! He is still on 4 liters of flow. His latest weigh-in was 3 pounds 5 ounces. He also moved up a diaper size.

X-rays

Archer's kidney ultrasound results came in today. It showed that he has mild hydronephrosis, which is fluid around the kidneys and is apparently normal in preemies and newborns. This typically causes urinary tract infections. They usually grow out of this. Until then he will receive doses of Amoxicillin. Archer had an array of other tests completed to see if anything else has been going on. He had a few bradys and required a higher oxygen level in the forties. Blood culture results came back not showing much change since the staff checked it for signs of infection a few days ago. He had a chest x-ray as well. This showed a small spot that could be stool, or it could be a sign of NEC. NEC is an infection of the intestines that can become a serious health concern. The doctors in the NICU are leaning more toward the spot being just stool because he has been taking feedings just fine and his bowel movements have been great. To be cautious the doctors stopped feeding him for the next 24 hours and will give another x-ray in the morning to see if the spot was just stool. Late in the evening his oxygen made it back down to 30%.

Valentine

Archer's feeding schedule was changed again to help get him ready for bottle feeding. He is now receiving feedings for an hour and a half at a time instead of two hours. His weight also increased another ounce, bringing him to 3 pounds 4 ounces.
Archer seemed irritable today. His poo engine was running on high, he had a few bradys, and an hour long kidney ultrasound added to his rough day. The results of the ultrasound should be in soon. Dad kangarooed with him for a few hours as well.
Archer made Mom and Dad a Valentines card with red footprints made into the shape of a heart. He also received a new Kate's Kart book: I Know My Mommy Loves Me.

Coasting

Archer's second urinary culture test came back negative, but he will still be on antibiotics for a few more days. He will undergo a renal ultrasound of the kidneys tomorrow to look for any causes of the UTI.
Archer had a "coasting" day where the status quo was maintained. His weight, feedings, and oxygen flows all remained the same as yesterday.

34 Weeks

Archer started on his journey toward taking his feedings by bottle. This might be a somewhat slow process, but it's a good start. Archer has been giving cues of being hungry. He has been receiving his feedings continuously, at a slow pace, every 24 hours. With this pace, his stomach may have always felt like it never got a full meal. His cues of being wide-eyed, sucking, fussiness, and fighting sleep, led the staff to change his feeding schedule to 28 ml for 2 hours at a time. He will get 1 hour breaks in between feedings. In this manner, he will be taking in feedings in a shorter amount of time, allowing to get more of a "full" feeling. Depending how Archer is doing with this system, they will try to wean him down more to a naturally timed feeding, such as feeding for 30 minutes, after every 3 hour break. The staff would then slowly transition  him to a bottle. Feeding is one of the most difficult things an infant can learn how to do, and Mom and Dad are glad that Archer has been "asking" to be fed.
Archer weaned off more flow from his cannula, going from 5 liters to 4 liters of flow. His oxygen level is still in the thirties.
Archer will no longer receive chest x-rays unless the staff believes one is necessary. His latest weigh-in was 3 pounds 3 ounces. He was weighed 3 times to make sure the weight was accurate.

Testing

Archer had a round of tests completed today, which has been a common theme on Mondays. His billiruben level is the best it has ever been. The blood culture test for infection (CRP & CBC) is the same since a few days ago, just a little off. His urine test identified the type of bacteria he has, so the staff cancelled one of two antibiotics he was receiving.
Archer weaned down to five liters of flow on his cannula and his oxygen level is in the low thirties. His weight has been around three pounds. He received a Kate's Kart book today: Trucks.

Needy

Archer is becoming the average baby more and more everyday. He's been getting fussy every few hours. He'll let out some cries and get fussy if he needs to poop, has a dirty diaper, needs a pacifier, needs turned over, or wants to be held. The cries are music to Mom and Dad's ears because his vocal chords are sounding healthy.
Archer's urinary test showed that he has a type of urinary tract infection. His schedule tomorrow will consist of several lab tests for his medication levels, as well as a kidney ultrasound sometime this week to see if anything abnormal is going on.
Archer went back down to a six liter flow cannula from a seven. His oxygen level reached the low thirties. He has only had one bad spell with a low heart rate (brady) in the last 24 hours.

Ten Weeks Old

Archer has seemed to recover since yesterday's spells of apnea. He only stopped breathing once in the last 24 hours. The blood culture test came back negative for infection and Mom and Dad are still waiting on the urine test results. He is still receiving antibiotics and further tests will help determine how long to keep him on these.
Archer is no longer receiving the chest treatments (CPT). His schedule of receiving inhaled steroids and breathing treatments has moved back from every 4 hours to every 6 hours.
Dad kangarooed with Archer today. It took a little while for him to get settled in and to figure out that his breathing was better with his legs stretched out, and not up to his stomach. Archer has really taken to using a pacifier. Mom, Dad, and the nurses often have to hold it for him for a half hour or so to get him to fall asleep after his assessments every 4 hours.

Antibiotics... Again

Archer had a slightly bad day today. He went apnaeic quite a few times and needed help to get him to start breathing again. For precautions his liter flow on the cannula was changed from 6 to 7. A culture and urine test was also taken to see if he had been getting sick again. A couple numbers were a little off and the staff will have more specific results in the morning. He had an I.V. put in and is back on antibiotics. A late phone call by Dad to his nurse revealed that he seemed more alert the last few hours and did not have any apnaeic spells. The antibiotics could be helping already. His weigh-in for the evening was 3 pounds.

Alarmed

Archer's second day on a nasal cannula went well. His oxygen level made it down to 35%. There are different liter sizes of cannulas, he is on a six. The doctor said today that he will need to wean down a few more sizes, and try timed feedings again, before thinking about starting to bottle feed.
Archer had a few apnaeic spells today. This alarm is different than other beeps we are used to from all the monitors that he is hooked up to. When his breaths per minute drops and is  accompanied by a large drop in his heart rate (called a bradycardia or "brady"), nurses come running in to check on him! He has been recovering just fine from these forgetful spells. He is no longer on the NAVA system. It did not seem to serve much purpose since he was transferred to a cannula. This means he has one less tube down his throat. He is down to just having a feeding tube.
Mom kangarooed with Archer today. The process of transferring him from the incubator to her arms was much easier with the cannula.. She needed assistance from only one nurse.
Archer's latest weight is 2 pounds 15 ounces. He received another Kate's Kart book: When Will It Snow?

What's Next?

When Mom walked into the NICU this morning she was surprised to see Archer did not have his CPAP equipment on. Instead, Archer had on a nasal cannula! The machine used to send the air to the cannula is known as Vapotherm. The cannula is on high flow, is sending six liters of oxygen, with an oxygen level around 45%. Some reasons for the big change include: having a good blood gas test, there was a large leak around the CPAP prongs (larger prongs would not fit), and he did well breathing on the CPAP but was very fussy when he was awake.
The cannula is smaller, flexible, and more comfortable. It should be less irritating for Archer to wear. It will make kangarooing with Archer much easier for Mom and Dad. Archer can still use the NAVA system to monitor his breathing, though it cannot be used to help backup his breaths. He will no longer require the CPAP, or ventilator, unless he has a rough spell. It is common to have to go back to these technologies for a short time to give the preemies a break from working too hard. Archer's breathing has been heavy at times, but fairly normal when he is resting. He has had very few, if any, apnaeic spells since he moved to the CPAP and cannula. Archer will most likely be on some sort of cannula for the rest of his stay in the NICU, if not when he makes the trip home as well. He has chronic lung disease. His lungs were not made to work this early in life. The future is uncertain regarding his lung strength, but he has made great strides in helping them heal and grow.
Archer's feedings were increased from 204 ml to 223.2 ml per day. His medications were changed due to his weight changes. However, the last weigh-in may have been off, or he may just have been working off a lot of calories, because this evening's weigh-in stated 2 pounds 12 ounces. His vocal chords are sounding a little better too.

33 Weeks

Archer has now lasted more than 24 hours on the CPAP. His oxygen level has dropped to the mid 30s. He is tolerating it a little more than yesterday with a little help from Tylenol every six hours. His grunts and cries have become slightly louder. The staff is already talking about possibly moving him to a nasal cannula near the end of the week if he continues to do well. This would be more comfortable for him. The CPAP prongs put a lot of pressure on his nostrils and there is pressure on his head from holding it in place. He has become pretty skilled at wiggling the prongs out of his nose.
Archer also gained a few more ounces, passing the 3 pound mark to 3 pounds 1 ounce. Some of this weight may be attributed to the CPAP equipment.

CPAP

Archer made the big step today and moved onto a CPAP! He doesn't like it very much. The nasal prongs are fairly large and probably annoying. He was very fussy, though his breathing levels were doing just fine. The CPAP works with the NAVA system, which monitors his breaths and gives him backup breaths if he needs it. It works better if his mouth is closed, otherwise about 90% of the air is leaked out through his mouth. Mom spent a long time today helping keep his mouth closed by giving him a pacifier so he could breathe easier and trying to calm him down by "containing" his arms and legs. His NAVA levels are the same as when he was on the ventilator, though his oxygen level increased in the range of 40%.
The staff is unsure how long he will last on the CPAP, but they hope it lasts long enough to make a smooth transition to a nasal cannula. Archer was very fussy and upset with the CPAP when he was awake, but when he was sleeping he was doing very well. He was given Tylenol to help calm him down and ease any pain he may have felt. His vocal chords are still swollen. Mom was told that the air flow of the CPAP can sometimes help heal the vocal chords.

Nine Weeks and a Day Old

Archer was kangarooed by Mom and Dad for the first time in a single day. He was a little restless in his incubator when Mom and Dad arrived, and Mom and Dad are anticipating not being able to hold him as much when he is on a CPAP. Archer quickly settled in when kangarooing and behaved for both of them.

Archer had a ventilator setting change that does not allow him to go below 15 breaths per minute, it was previously set to 20. Mom and Dad are hoping that Archer spent his last day on the ventilator today, but it will ultimately be the doctor's decision on when to transition him to a CPAP. 

Archer's milk intake was also increased from 192 ml to 204 ml (6.9 oz.) per day. This was increased because he gained a whole 2 ounces overnight! He now weighs 2 pounds 14 ounces.

Preparation

Archer had an eventful day today. Early in the morning Archer had his first ROP exam (eye test). The doctor dilated his eyes and a quick check revealed that he has premature vessels. This is common in 95% of premature babies, as their eyes are still premature. The doctor will come back and do another check in two weeks to see if there is any improvement. 

Archer then kangarooed with Mom for a few hours. He was a little squirmy, but overall he did fairly well.

Archer's NAVA ventilator settings were turned down from 1.8 to 1.7, and his oxygen level is floating around 25%. Room level oxygen, like a normal baby or person would breathe without any assistance, is 21%. His breaths per minute rate is not allowed to fall below 20. Another setting was also changed that will pick up even his smallest breaths, so the backup system won't kick in as much. These settings are being lowered to help prepare him for a smooth transfer to a CPAP or nasal cannula sometime next week in hopes that he will permanently stay off the ventilator. 

Mom and Dad were on double diaper duty before bath time. He had not gone number two for the majority of the day. As soon as Dad took his diaper off to give him a bath, he let it all out, getting some on Mom's finger, and sprayed like a fountain on Dad's hand, and all over his sheets. Even after all this, Archer gained 70 grams since yesterday, which brings him up to 2 pounds 12 ounces.

Grabby Hands

Archer was able to wean down on his NAVA settings today from 2.0 to 1.8. He's had some episodes of needing the backup mode to give him breaths, and this was expected to help get him used to the new settings.
Archer's milk intake was increased from 187.2 ml to 192 ml per day. Archer lost 20 grams today. His CPT treatments were decreased to just twice a day.
Archer has had several episodes of having an increased body temperature that goes along with a faster heart rate, and an unhappy face that he moves from side to side and lifts off his pillow. We are starting to think that these short tantrums are related to his poo mechanisms. It takes a period of time to help cool him down afterward. Today Archer had another one of these tantrums, only he improvised a little more. Mom witnessed him moving his head back and forth, loosening his breathing tube, and pulling his tape that holds the tube off the side of his face with his hand. Mom and the nurse stopped him in time before he did any more damage. It is common for preemies to take out the breathing tubes themselves, which makes it easier to convince the staff to attempt to transition them to CPAPs.