Brick Wall

Mom and Dad walked into the NICU to find that Archer had a rough night with taking in full bottles and his feeding tube was placed back in. He continued to have trouble throughout the day with Mom and Dad feeding him. He did finish one full bottle during the day that a nurse had fed him, though he struggled through it. The nurses spoke of a notorious "brick wall" that several preemies run into just after they have accomplished full feedings. This brick wall period consists of refusing to eat, or not doing well with feedings, for a day or two. Mom had an inkling about the milk and started questioning which batch of milk was used. The staff had been consistently using recently produced milk. Last night a nurse pulled out a batch that was made over three months ago. Archer was given several feedings last night and throughout today with this batch of milk. Mom and a nurse did a smell test and this older batch had a funky, metallic-like, smell to it. Archer was then given fresh milk in the evening. He struggled with one bottle, but then he finished the next without any problems. The hope is this was just a minor set-back to going home and that he bulldozed the brick wall with this last feeding.
Archer had a change in medication to help with fluid in his lungs. This was changed to a type that is easily accessible at pharmacies for Mom and Dad to pick up when Archer is home.

Eighteen Weeks Old

Archer had a fun and easy-going day with no changes. He kept his feeding tube out by taking all of his bottles. He received a nice tub bath and had story time, as he does almost every night. Though there has been no official date yet, Archer should be on his way home soon. Below are some pictures of Archer's room where he will receive a warm welcome home.

Lego nameplate designed by Dad.

Refurbished bassonett by Grandpa Long.

Toy photography taken by Dad, with assistance from Ottoville students (hot wheels cars).

Toy photography taken by Dad, with assistance from Ottoville students (Play-Doh monster by Dad).

Toy photography taken by Dad, with assistance from Ottoville students (Lincoln Logs Cabin by Dad).

Toy photography taken by Dad, with assistance from Ottoville students (Crayola Crayons).

Refurbished rocking horse by Grandpa Long.

Fun hanging light that was assembled together with several small pieces of plastic.

Closet for Archer's goodies. Dresser refurbished by Dad.

One Less Tube

Archer had another great day by weaning off oxygen flow and having good feedings. His liter flow was reduced from 0.2 lpm to 0.125 lpm, or 1/5 to 1/8. He is close to the lowest possible flow setting of 1/16. Some babies have a rough time without this small whiff of oxygen, even though it is extremely close to breathing room air. Archer may have a chance to try breathing room air without any assistance before he comes home.
Archer's feeding tube was taken out because he has not required any feeding through his tube in almost 24 hours. He has been taking full bottles. His tube will be placed back in if he doesn't finish two bottles in a row.

Off the Wall

Archer made a jump and got rid of the Vapotherm equipment that supplied his oxygen. He is now taking oxygen "off the wall" from a valve and oxygenation system. He went from taking 24% on 1.0 liters per minute flow to 100% on 0.2 liters per minute flow. The oxygen supplied must be maxed at 100%, though the amount going through is very minimal. He will most likely require a small amount of oxygen when he is home, and it's something he will hopefully outgrow within a few months time or less. This setup that is "off the wall" is very similar to what he will have at home, so it makes for a smooth transition.
Archer's feeding sessions are improving by the day. He is up to taking six full bottles or more (out of eight) within 30 minute time periods. The hospital issued nipple is working great. Archer still tends to fuss during feedings because of gas or sleepiness, but Mom and Dad are trying to help him work through it. He is taking gas drops every four hours and he loves the taste of them.
Archer has officially made it to 6 pounds! He received a new Kate's Kart book: 1 Fish 2 Fish Red Fish Blue Fish.

Back on Track

Archer started out the day by taking a bath in a plastic tub for the first time. The nurses believe that a tub is usually more calming than wiping him down with cloths. Archer seemed to enjoy this new experience.
Archer's oxygen level made it back down to 25% since yesterday's procedure. He also took four full bottles, in four feedings, in a row! He then began to act tired for his next couple of feedings. His endurance seems to be improving when it comes to taking a bottle. Mom experimented with a hospital bottle nipple that seems to have a better flow of which Archer can take a bottle quicker without choking. A surgical nurse checked his hernia again and the consensus is to wait until Archer is about 55 weeks to have surgery, unless there is a medical concern beforehand.

Spirit

Archer prepared for his laser eye procedures today by missing feedings, receiving an IV line in his arm, and taking some eye drops. He still seemed pretty tired from yesterday's swallow study and eye doctor visit. He did take in all of a couple of feedings, but mostly drank just half of his other feedings since yesterday morning. Mom and Dad cuddled with him and gave him a good luck kiss when he was settled into the room across the hall, readied with the medical equipment and medical team. They waited in the family lounge for just over an hour until they were notified that the procedure was over and they could come back to the NICU.
The ophthalmologist said Archer did great throughout the entire procedure. He was content with sucking on drops of sugar water and didn't fuss very much. Archer only required a small bump in oxygen, from 24% to 28%. After the procedure was done he said that he opened his eyes and looked very content. He said he is a very spirited baby. Most babies would close their eyes and make a fuss when the procedure was completed. Archer's eyes were just slightly swollen. He does not require any temporary eye patches. The ophthalmologist was very optimistic that he caught the abnormal vessels very early and redirected them to grow normally. The results will begin to be noticed in a few weeks. If the procedure didn't fully work then Archer may have to have more procedures. He will have weekly checkups and will be taking drops for the next five days. Archer's IV line was taken out and is back to his normal feeding schedule.

Good News, Bad News

Good News: Archer began the day with a swallow study to see if he had milk going into his lungs during feedings. Archer took 30 ml of a bottle mixed with barium. The barium was detected by an x-ray video that was zoomed in on his head and neck. The milk could be seen going into the correct pipe without any flaws! G-tubes and G-buttons are hopefully now out of the picture. Archer just needs more time to build up his endurance during feedings. When he is taking 100% of his feeds by bottle, and is having little to zero bradys, he should be on his way home, unless other factors appear. His minimum feeding requirement was raised from 54 ml to 57 ml.
Bad News: The eye doctor felt a need to come in early and check on Archer's ROP status again. The checkup showed that both eyes had worsened and are in stage 3 ROP. Archer will undergo dual laser eye surgery tomorrow afternoon. The doctor feels that he is catching the abnormal vessel growth early. He said the success rate of the surgery is 80 to 90 percent of having semi-normal vision in at least one eye.  It will take 2 to 4 weeks to find out how successful it was. Archer will not be transferred. He will be the first preemie to have the surgery at Dupont Hospital, though the doctor has years of experience, just in other hospitals. Each eye will take about 45 minutes to complete. Archer will be sedated and will be able to take oxygen from the Vapotherm and cannula. The entire NICU will be closed to all visitors and parents during this time, even Mom and Dad.
Other News: Archer received his third and final vaccine, Pneumococcal. He received a Kate's Kart book: Chicka Chicka ABC.