Easter Sunday

Archer laid some rotten eggs and Mom and Dad found them. He managed to spew up on Dad once and pee on him twice. He was fighting gas in his tummy throughout the day which has become routine. Archer's weight is up to 5 pounds 13 ounces. His oxygen level made it back down to 24% and has not required a regular bump up in his oxygen during feedings or throughout the day for quite some time. He is still on 1.0 liter flow.

Archer fed by bottle really well for Mom and Dad today. Of five bottles he finished one, drank more than required for two, and had just a smidge left on two. It takes work and patience, but Archer is showing us that he is able to feed by bottle. Mom and Dad will find out more about any feeding problems he may have via a swallow study tomorrow morning.

Seventeen Weeks Old

Archer received his second vaccine, the Hib vaccine. He has taken his two vaccinations really well. Just one more to go.

Archer seems to be pacing much better during his feedings. Mom and Dad do not have to pull the bottle down or away from him as much to help him pace. He needs to work on keeping up his stamina so he can one day drink all the milk he needs to stay healthy.

Archer had another visit by his eye doctor. The prognosis was that his left eye is still in stage 2 ROP and a part of his right eye has entered stage 3 ROP. The eye doctor will come back in a week to see if his eye has worsened or if corrective laser surgery may be necessary. He has vessels growing abnormally in the back of his right eye and laser surgery can get the vessels growing back on the right track.

Archer's weight is up to 5 pounds 11 ounces.

Backed Up

Archer had three out of five good feedings today where he drank the whole bottle. He paced himself well. He was pretty tired through the other two feedings and he was trying to get out some poops during the entire day. He was still unsuccessful when Mom and Dad left for the evening.
A swallow study is scheduled for Monday. This test looks for any milk that is leaking into the lungs during feedings. If there is a small amount of leakage then it is possible for milk thickeners to help with the situation. If there is a large leak then surgery may be required to help him take feedings. Mom and Dad are trying to find out if there are any physical reasons why Archer cannot take full feeds yet, other than having premature lungs.

Little Pookie

Archer's bottle feeds haven't progressed much in the last 24 hours. He has taken all of some bottles and more than half of others. He still paces himself about half the time. Mom and Dad spoke with a surgical nurse today who observed Archer's hernia and talked about surgeries for his hernia, G-tubes, G-buttons, and a Nissen surgery in case he is having bad reflux. He will definitely need to have a hernia surgery. It's a matter of having it done soon, along with possible other surgeries, or having it done in a few months if other surgeries can be avoided. When he has surgery he will need to be transferred to a different hospital and will have to be re-intubated (put on a ventilator). Mom and Dad are weighing their options and are still hoping that Archer pulls through the tough time he is having with bottle feeding.
Archer received his first vaccination today, Pediarix. This is the first of three vaccines he will receive before going home.
Archer received a new Kate's Kart book: Night-Night, Little Pookie.

Adjusting

Archer did not drink as much volume from a bottle as he did yesterday, but Mom said he paced himself much better. He was very sleepy through a few feedings. His volume per feeding increased from 51 ml to 54 ml. It will be a challenge for Archer to keep up with the amount of milk he needs to drink based on his weight gain. His medications were also weight adjusted.

Due Date

Today was Archer's due date, though this date varies based on the doctor you talk to (March 25th, 26th, or 28th). He is almost four months old already, but he doesn't have the same abilities as a four month old who was born near the due date. Sometimes Mom and Dad will have to go by his "adjusted age" which begins today. He will eventually catch up to others his age in a couple of years, and it will take a lot of work from his family and therapists to help get him up to speed.
Archer's bottle feeding adventure continued by drinking all of six bottles of his last eight feedings. He slept through one feeding and drank all but 11 ml of another. This isn't to say that his feeding technique is excellent. About half the time he will pace himself and the other half the feeder has to pace for him. He is on the right track and has shown good progress in just a couple of days. The staff is becoming a little more optimistic of his potential.
Archer's oxygen level has been around 25% to 28%.

More Bottles

Since Mom, Dad and the NICU staff had a discussion about bottle feeding yesterday, Archer has attempted to bottle feed for every feeding. During some feedings he has taken all of the bottle without a problem, and during others he has taken more than half, and he has also had a few bradys. This is all expected as he learns to pace himself, and Mom and Dad learn how to help pace him. Another discussion about this process was had today with a speech therapist, another doctor, and nurse practitioner. The speech therapist recommended trying a different type of bottle. The first try with this bottle was very successful. Archer paced himself and the flow was a little slower. This bottle will be tested more for the next two days. The current plan is to put bottle feedings as the number one priority and see how he progresses throughout the week, and give Archer a chance to show everyone what he is able to do. If he is not taking every milliliter needed by bottle by the end of the week then another discussion will have to take place. Some of the staff is very optimistic about Archer's potential and his progress so far and others are not so optimistic.
A physical therapist showed Mom and Dad different ways to position Archer throughout different times of the day to help with muscle development. Archer enjoyed sitting upright on his boppy and looking at his surroundings after a good feeding.
Archer's weight has increased to 5 pounds 7 ounces and his length is 16 1/2 inches. He received another Kate's Kart book: Chester.

Ugh

Mom and Dad arrived at the hospital and found some new information that they had to process and contemplate. A discussion was had with a doctor and nurse about the plans for Archer moving forward. It was mentioned that he may need a "G-tube" (or a G-button) if he doesn't catch on with 100% bottle feeding, or if he is taking bottles well but doesn't gain any weight. This new tube would require surgery. If he has such a surgery then Archer has the possibility of coming home earlier. If not, then it could be four to six more weeks before coming home, and even then he still has the possibility of requiring a G-tube. This is all based on whether or not he learns how to take a bottle for every feeding, and is cueing for one. Archer's feeding order has only been on "whenever he is cueing" for about the last four days. Mom and Dad feel that this has not given him proper time to prove himself with bottle feeding, plus he started a few weeks later at bottle feeding than most preemies, mainly because he was on a ventilator for so long. Dad took this discussion and made it a mission to make bottle feeding a number one priority. Mom gave him a bottle at 8:00am and Archer drank all but 10 ml. At 11:00am Dad fed him and Archer drank all of it. At 2:00pm Dad fed him and Archer drank all of it. At 5:00pm Dad fed him and Archer drank all of it (with a short brady at the end). At 8:00pm Dad fed him and Archer drank half of it. Dad wanted to prove with correct timing and giving him the opportunity, Archer can take a bottle. Dad hopes that the nursing staff will take note of this and try just as hard, without pushing Archer over his limits. The hospital setting also makes it difficult for Archer to get good, uninterrupted, and much-needed sleep sometimes, resulting in fatigue by feeding time. Mom and Dad, along with the nurses, will try to ensure Archer is able to rest while still offerring him many opportunities to practice bottle feeding.

Sixteen Weeks Old

Archer had another stable day. He took a few feedings by bottle and a few through his tube. When it comes to bottle feeding, he tends to gulp too much at the start, then he needs time to recover. In the middle of feeding he tends to bear down and poop. This throws off any type of groove he was getting into. A diaper change will temporarily wake him up in the middle of feeding. Near the end of feeding he does better and paces himself, though by this time it's difficult for him to finish the whole bottle, and he gets tired.
A nurse practitioner stated it typically takes a preemie about 5 days to get back into the groove they were in when caffeine doses were given. Archer's oxygen has slowly risen because he is having to work harder without caffeine. His oxygen level today reached 29%.

Stable

Archer took some feeds from his bottle and some through his tube today. His feedings were increased from 49 ml to 51 ml per feeding. Archer had another eye exam and it was best to feed him through his tube after such a stressful test. The results were the same as previous tests and his eyes are considered stable. He had a couple of apneic episodes which could be from having to work harder since being off caffeine. His oxygen level floated around 24% and 26%.

Three in a Row

Archer's bottle feeding orders have changed from every other feeding to any feeding that he is cueing for a bottle. He drank three bottles, in three feedings, in a row for the first time and drank almost every milliliter of all of them. Even without caffeine he was awake for the majority of the day, and he had the stamina for his feedings. Mom and Dad hope he keeps up his stamina but also takes more time to rest in between feedings.
Archer's weight today was 5 pounds 4 ounces. His oxygen level has been at 24%. He received a Kate's Kart book: Goodnight Gorilla.

No More Caffeine

After the results of yesterday's kidney test (VCUG) it was decided that Archer will stay on Amoxicillin until a follow-up renal ultrasound in three months, unless he has another UTI. The doctors are being cautious about the possibility of having hydronephrosis, which can cause further kidney damage.
Archer did well with his bottle feedings today. He drank one full bottle after 25 minutes and still seemed hungry. His feeds were increased from 47 ml to 49 ml per feeding.
Archer has been receiving doses of caffeine since he was born. Because his lungs were so immature, he needed to work extra just to keep the air sacs in his lungs open. The caffeine helped to give him the extra energy he required to breathe. This will be discontinued and he will be monitored closely to see how he does without the doses.
Archer enjoyed his play mat and swing today and has been revealing his desire to be held more and more lately.

39 Weeks

Archer had an adventurous day. He made his first trip from the third floor of the NICU to the first floor for a kidney dye test. The doctors are wanting to see if there was a physiological reason for having a urinary tract infection a few weeks ago. He required a catheter for this procedure and he did not like it one bit. He was put on a portable oxygen tank at 100% oxygen to make the trip from floor to floor. The doctors were looking for a backup or reflux of the kidneys but they did not find such evidence. This was one of many tests Archer will have before discharge and Mom and Dad are happy that this test showed good results. He will need another renal ultrasound before going home to check again for hydronephrosis.
Archer's bottle feedings continued with Mom trying to find the type of bottle that Archer can work with when he is home. After a few tries she believes she found a kind that Archer can suckle on properly. He finished the whole bottle at his 5 o'clock feeding without an increase in oxygen. He also had his first try at nutritive breast feeding with the help of a lactation consultant, who believes Archer will eventually do well. Mom and Archer get to practice once a day for the time being. He has had some practice with non-nutritive breast feeding (basically just suckling after Mom pumps) in the past month.
Archer officially made it to 5 pounds (5 pounds 1 ounce)! His latest measurement is 16 & 1/4 inches long. He is currently on 25% oxygen.

Snug as a Bug

Archer made it back down to 1.0 lpm cannula flow. He spent most of the day on 28% oxygen. The staff hopes he will stay on this level of flow and get his oxygen down to room air consistently while he is trying to learn bottle feeding. Archer's bradycardia issues have not been present in the last few days.
The test on Archer's eye goo came back and it is an infection. This is a common infection that most babies have and many doctors won't bother treating it. He will receive eye drops four times a day for the next five days to help remedy the infection.
The speech therapist paid Archer another visit and fed him a bottle to see how he was doing with feeds. She was happy with his progress and recommended to increase his bottle feedings to every other feed (four times a day), and only if he is cueing for a bottle.
Archer received a Kate's Kart book: Snug as a Bug.

21%

Archer tried making his own schedule today. He started out the morning by drinking a full bottle, took a short nap, then he was wide awake for a few hours. The nurse put him in a swing to help him relax. After Mom and Dad arrived he slept throughout the afternoon and through two feedings. He seemed to get back on schedule after his 5:00 pm bottle, of which he drank half.
The night nurse weaned Archer down to room oxygen level, 21%, for the first time. He was on 21% for four hours. Since then his oxygen was between 24% to 30%.
Archer was getting some goo around one of his eyes and it is being tested for infection. He weighs 4 pounds 15 ounces.

Fifteen Weeks Old

Archer did very well practicing his bottle feeding. He drank all of bottle number one and all but 12 ml of bottle number two. He is getting better at taking time to take breaths while drinking. Sometimes he is too tired to drink a bottle and Mom and Dad must recognize when he is alert and ready. 

Archer was very fussy and he was fighting air bubbles stuck in his system since the morning hours. He received some gas drops during the day. At 5:00 pm they finally left his system and he immediately acted happy and calm. 

Archer's weight is now 4 pounds 14 ounces.

Three Bottles

Archer's bottle feedings were increased to three from two. The speech therapist has observed Mom feeding Archer and she was impressed with their progress. He is getting better at breathing while sucking and he did not require additional oxygen during feedings today. The therapist is not concerned about the amount that he drinks, but the way that he is drinking. Archer drank more than half of all three bottles today. Archer's tummy troubles seem to be decreasing ever since the calorie fortifier was decreased to 22 and off formula.
Archer's seizure medication was discontinued. The staff will keep a close eye on him to check for any signs of a seizure. He only had one seizure a few weeks after he was born and has been on medication since. He has not had any tests to see if there are any causes for seizure activity. He will most likely have an EEG fairly soon to look for any signs of seizures.
Archer received a Kate's Kart book: Kiss Me Goodnight.

Turn It Up

Archer had his feeds increased from 44 ml to 47 ml per feeding. He drank all of his bottle this morning within 35 minutes, and only took about 10 ml of his bottle at night. He was fairly tired after a bath and a cannula change, among other assessment activities.
The doctor said Archer will stay on 1.5 liter flow until his oxygen level is lower and steady. The nurses have had to turn it up during feedings, hiccups, and other breathing incidents.

Hard Work

Archer drank almost all of his two bottles today; he had about 7ml left at 8pm after he tired out.  During feedings he has required a higher oxygen level in the forties to help prevent any bradys and to help him not work as hard.  He has been multi-tasking during feedings and trying to make up for some constipation while eating, combining two challenging activities.  Otherwise his oxygen level has been around 30%. No other changes were made today.  Archer lost some grams due to a record-breaking diaper but remained at 4lbs. 13oz.  Mom and Archer also talked with the occupational therapist, who suggested some new positions and a version of infant massage to try.

38 Weeks

Archer's speech therapist stopped by to see how he was taking the feedings. She said that he did very well with his bottle but needed more practice at breathing while feeding. He drank 37 ml of his bottle during the day. He will now start taking two bottles a day, twelve hours apart (or whenever he's awake), to help him practice more. He then drank all of his bottle during the night shift. He's back on a 22 calorie fortifier instead of formula. This means that he will be taking in more milk. This may increase reflux issues but decrease tummy troubles as the milk will be thinner. He will also gain weight in smaller increments. Today he weighed 4 pounds 13 ounces.

Brady Night

Archer had a rough night last night and had a total of four bradycardias. These could be attributed to pushing out some stool and/or reflux, but he required stimulation from the nurse to help get him back to normal. The doctor raised his liter flow back to 2.0. Later in the day it was moved down to 1.5. The occupational therapist came in and said it may be good for his breathing to continue to have kangaroo care once a day, instead of always swaddling.
Archer took about the same amount of his bottle as he has done the past couple of days (27 ml).
His eye doctor also paid another visit. Archer's eyes have not changed (still between 1 and 2 ROP), though the doctor did confirm that he does not have Plus disease.
Archer measured in at 17 inches long today and 4 pounds 12 ounces. He received a new Kate's Kart book: The Very Busy Spider.

100th Day

The staff at the NICU decided it was time to go ahead and try out an open crib with Archer. The bed is rather large and looks like a cage (it is also used for toddlers). Last night the nurse had turned the incubator temperature down even closer to room temperature. Archer's gestational age, the fact that he has started bottle feeding, his incubator temperature, and his occasionally warm body temperature was convincing enough to move him to an open crib. He seemed to look at his surrounding in amazement today when he was lying in his new crib. It will now be easier for the nurses, doctors, and Mom and Dad to handle Archer when he needs attention. He will be wearing out a lot of onesies, sleep sacks, and swaddlers to help regulate his body temperature.
Archer's feedings were increased from 42 ml to 44 ml per feeding. Dad gave it a shot at feeding Archer for the first time today and they both did very well. Archer drank all but 16 ml of his bottle before he got tired.
Archer also made another milestone and reached 1.0 liter flow on his cannula. His oxygen level was floating around 35%. The next most likely step will be taking oxygen off a valve that feeds 100% oxygen at smaller liter flow increments.

Fourteen Weeks Old

Archer took in all but 15 ml of his 42 ml bottle today. He is still practicing the process of sucking, swallowing and breathing while he is taking a bottle. The nurse has to pause often during feeding to give him time to breathe and burp, though he did do well without pauses for a good period during his bottle feeding today.
Archer gained weight today and he now weighs 4 pounds 11 ounces.
Archer has been getting warm more often and his incubator temperature has been turned down, almost to room temperature. When he starts taking in more bottle feeds per day he will move to an open crib. He seems to be more calm regulating his own temperature in sleep sacks while he is resting.

Quiver

Archer weaned down on cannula flow from 2.0 lpm to 1.5 lpm. He got excited and celebrated this milestone by peeing on Mom!
Archer's feedings were increased from 40 ml to 42 ml per feeding. He drank about 3/4 of his one bottle feeding today. He lost weight, weighing in at 4 pounds 8 ounces.

Goodnight Moon

Archer drank all but 10 ml of his bottle today. His weight has increased to 4 pounds 9 ounces. The staff is talking about decreasing his calorie fortifier because he has been gaining a healthy amount of weight. Decreasing his fortifier may help out some tummy issues and bowel movements. Sometimes going number two can be tough for him.
Archer's oxygen level has been around 26%. The staff is cautious about making more changes while he is trying to get a handle on bottle feeding.
Archer has been in the NICU for so long that he is starting to receive the same Kate's Kart books! Goodnight Moon!

Sleepy

Archer attempted to take a bottle today but he acted too tired and did not seem very interested. If he seems awake and alert later on tonight then the night nurse may give it a try.
Archer had another eye exam today and the results were the same as before. His eyes are between levels 1 and 2 ROP, and it is good that they have not gotten any worse.
Archer gained two more ounces and his weight is now 4 pounds 8 ounces.

Pictures of Archer's Room

Archer's picture board and schedule. Schedule shows his nurse for the shift, assessment schedule, feeding amounts, and weight.

A shelf for Archer's Kate's Kart books and gifts.

A work area for Mom and Dad.

A reclining chair for kangarooing and swaddling, and a small couch to relax on.

His Vapotherm machine that feeds him oxygen. Set at 2.0 liters per minute, 28% oxygen,  and a humidified oxygen temperature of 35 degrees celsius.

A larger view of the Vapotherm stand that holds other equipment needed and liquids.

A monitor that shows the statistics of the leads that he wears. The green number is his heart rate (beats per minute),  the blue number is his oxygen saturation number (ideal number is between 88 and 98), and the white number is his breaths per minute. The box below this monitor shows his incubator temperature (27 degrees celsius), and it has other options to weigh him and such.

A refrigerator to keep milk, a food warmer, a scale to weigh dirty diapers, and a sink to help Mom and Dad stay clean when they handle Archer.

Archer is in here somewhere in his incubator. There are valves along the wall. At some point when he is off Vapotherm (when he can handle small amounts of liter flow) he will be receiving 100% oxygen "off the wall" from one of these valves.

Where Mom has stayed everyday since December 1st.

37 Weeks

Archer continued his one-a-day bottle feeding again today. His milk intake was increased from 37 ml to 40 ml and he has increased his weight to 4 pounds 6 ounces. Archer was quite fussy for about 45 minutes before his bottle feeding. He then downed just more than half of his bottle and got worn out. The rest was sent through his feeding tube. Mom observed the nurse feed him again because it is a difficult task to tackle.

Bottoms Up

Archer had his first try at feeding through a bottle for one of his feedings today. The nurse taught Mom how to hold the bottle, to take it out slightly when Archer forgets to breathe, and to allow him time to burp. So Mom observed while Archer downed all 37 ml of milk like a champ in less than 30 minutes! He was very good at burping too! It took a lot of work for him to do this and he was worn out when he had finished. He had a brady about an hour afterward which was expected after this difficult task. The staff will most likely continue to give him one bottle a day, and then gradually add more bottle feedings until he is taking a bottle every three hours. Until then he will still take most feedings through his feeding tube. Archer's oxygen has been around 30% and the nursed raised it to 35% only while he was feeding. The nurses mentioned that he did much better with a bottle than they had expected.
Archer received a new Kate's Kart book today: The Grouchy Ladybug.

Tugging

Archer started his day out today by giving his nurse a run for her money. He pulled his feeding tube out... twice! This was the first time that he has accomplished this task. His breathing was also fairly periodic (up and down). He is most likely getting used to the 2.0 liter flow setting that was changed yesterday.
Archer also put on 20 more grams, bringing him to 4 pounds 3 ounces. His reflux medication was increased because of this weight change, and also to help with his reflux issues he has at the end of feedings. His meals were increased from 35 ml to 37 ml.
Archer has received quite a haul as far as gifts, cards, and love and support from family members and friends. Mom and Dad would like to thank everyone who has showered Archer with their gifts and support, and those who have followed this blog. Archer still has a long road ahead, but your support makes the road much easier to travel for the Kumfer family.

Thirteen Weeks Old

Mom and Dad arrived this morning to find Archer dressed in a onesie for the first time! He has been maintaining his own temperature more and more as the incubator's heating level has been turned down. His weight for the evening was 4 pounds 2 ounces. The more weight he gains the less work he has to do to keep his temperature steady.
Archer was able to wean down from 2.5 lpm to 2.0 lpm on his cannula liter flow. His oxygen level has been in the high twenties. He will have a brady once or twice a day, usually near the end of feeding or right after. This is most likely attributed to reflux issues.

Swinging

Archer maintained his weight today, in fact he jumped up 20 grams (still at 3 pounds 15 ounces). He also made it into a baby swing for the first time today. He has been maintaining his temperature just fine on his own when he is swaddled, and he is usually calm as well. One of the main steps to weaning out of a closed incubator is taking in half of the feeds from a bottle. Archer is not really close to this step, so he will still stay in his closed incubator the majority of the time (unless the staff decides to make an exception).