THE BIG MOVE-PART 2

It was a very quiet day in the NICU today. Ava is the ideal (and boring) patient to take care of because she is breathing in room air, on full feedings, and just kind of hanging out. She weighs about 4.5 lbs (a little under). I am not giving exact numbers today because the scales in the NICU are different than the scales in Special Care, therefore her numbers are a little inconsistent. But, a 4.5 pounder, I'll take it! We waited most of the day for the doctor to round, as they always round on the sickest babies first. She came at around 3:30pm and wasn't concerned about her belly at all. She said that some kids just have big bellies. She'll grow out of it. I requested to go back to Special Care as soon as we found out results from the test that I was almost sure would be negative. And, the results are NEGATIVE! Phew! I left the hospital a few minutes after the doctor rounded this afternoon and she called me by the time I got home. We didn't know if the results were going to come back today or Monday. I am so glad we didn't have to wait all weekend! So, things are good. We are headed back to Special Care tonight! Busy couple days!!! It should be smooth sailing from here on out-we hope!!!

THE BIG MOVE

I think Ava gained 15 grams since yesterday but to be honest, I have no idea. Unlike me to not know the details, huh? I always call around 3am to get her stats and last night was no different. But, today, there was a lot going on and I just can't remember that 3am detail. An x-ray was done this morning to take a look at Ava's tummy again. Still no change, even with the new formula. What we noticed (and by "we" I mean the docs) is that she is full of air in her bowel right above the rectum. Basically, she needs to fart (A LOT) but for some reason can't seem to get it out. So, they had a surgeon come take a look at her this morning and a rectal biopsy was highly recommended. What they are looking for is nerve endings in the rectum which is what helps pass stool and air. Some kids don't have the nerve endings and therefore things back up like a bunch of train cars until too much builds up and pushes it out. It is called Hirschsprung's disease. When they did the barium enema yesterday, everything looked fine from that stand point. But, sometimes it doesn't pick up Hirschsprung's if it is very low in the rectum. It is a pretty simple fix if she does have that, although it is a surgery...but, one day at a time. Anyway, in order to do the biopsy, the surgeon wanted her back at Children's in the NICU. So, at 2pm today we took the long walk back through the tunnel and were admitted to Children's. They didn't give her her 2pm feeding because of the procedure and started an IV right away in case that was necessary. The doctor rounded (a new doc) and said that the surgeons would arrive at some point this afternoon for the procedure. I REALLY like this doctor, by the way. The surgeon came to her room at about 3:30 for the procedure and was done in about 10 minutes. They needed to take two small pieces of tissue from her bowel to do the biopsy. The part that they were taking the biopsy from has no sensory nerves so that would not hurt her but just messing around down there is probably uncomfortable. So, she was given a little morphine to help with any discomfort. She did great and we should know the results tomorrow, we hope. At the latest, Saturday. She was able to eat again at her 5pm cares and we switched her back to breast milk because that was clearly not the issue. She was rather sleepy after all this craziness and morphine so she is just resting. I guess we will just see what tomorrow brings! But, don't worry, she is just fine!

100% NORMAL

Wow, I am tired! I got to the hospital this morning at 8:30am to make sure I got there in time for the transport over to Children's. Ava had just finished her 8am feeding (she bottled it on her own) and did great. She lost a little weight last night, less than an ounce. She is trending upwards but some days there isn't any weight gain. We headed over to the Children's Radiology department for Ava's barium enema around 9:10 and got back about an hour later. She is great. It's a pretty easy and quick procedure. I waited at the hospital for the results from the Radiologist and also wanted to talk to her doctor when she rounded as well. The results came back from Children's and everything looks 100% normal with her lower GI track. There was some talk about looking at the upper but the Radiologist said that things look so normal in the lower he would not recommend looking at the upper, not necessary. The doctor rounded this afternoon and still wants to try to figure out why her tummy is larger than normal. To start, we are going to try her on a formula called EleCare. Currently, she is getting breast milk. Sometimes if mom has dairy in her diet, that can cause trouble for baby. Highly unlikely, but it's the most benign test and a start. There are a couple other tests to try but we are starting there. Anyway, nothing to worry about and she is doing great. Also on her orders for the day, bottling 1-3 times per day (instead of only once), and weining her from her isollette. Instead of putting her in a crib right away, we changed her isollette to a warmer. Basically, she is still in the isollette but the top is off. You can turn the warmer on if she needs it but hopefully we can keep her bundled and warm without it. All steps in the right direction!

THEY ALL DO IT DIFFERENTLY

Let's start with the easy and fun stuff for today. Ava gained an ounce since yesterday and is up to 4 lbs 3.2 ounces. A whole pound from when she was born!! They have turned her isollette down to 30.0 which is where it needs to be to wein her. In the next couple days, I am guessing they will just put her in the crib style beds. It is nice for the nurses to have her in the isollette because they can turn the temp up if they need to. But, she is at the weight she needs to be to get out of there! The other great news of the day is that she drank a WHOLE bottle today. Debbie, her primary nurse, tried at her 8am cares this morning and she did so well! Debbie says she is "amazing"! We think so too ;-)

As I mentioned yesterday, we have a new doctor this week. She seems to be concerned with the size of Ava's tummy. It's sort of big, but has always been that way. No one has mentioned anything until she did yesterday which is interesting to me. I don't understand why four doctors that have rounded on her in the past couple weeks wouldn't be worried about something but this one is. I guess they all do things a little differently. Better to be cautious and find nothing than to not be and find something!! Ava had a tummy x-ray a couple weeks ago when she was in the NICU to make sure everything looked good (because she was slow to get started with feedings). It all looked fine then. So, the doc looked over that x-ray again yesterday and ordered another one to be done today. They did that this morning and everything looked fine, she just has some air in there. They also took away the fortifier that they put in her milk (to increase calories), because it is a cow's milk biproduct and they want to make sure she isn't having a negative reaction to the cow's milk. So, since they didn't find anything on the x-ray, they want to do a barium enema tomorrow to do some further testing. The doc listed off a million reasons that this could be happening (I wish she wouldn't have) and we are just doing the testing to rule things out. Like I said, it could be as simple as an issue with the fortifier. I am really not worried about it but we'll see what they come up with. The procedure will be done tomorrow morning at Children's at 9:30am. I am going to be down there for the morning to go with her to Children's and be with her before and after the procedure. I guess it is a pretty simple one and shouldn't take too long. I will hopefully be able to blog tomorrow mid-day with an update.

NEW DOC

Today was sort of a busy day. We got a new doctor that has never rounded on Ava, so that is always a little different getting used to. You get comfortable with one doctor for the week and then they change. We do see some of the same doctors more than once, so that is nice. I always try to touch base with all of them, just to make sure we are all on the same page. Ava lost 11 grams from yesterday but they weighed her right after two big poops, so a weight decrease will happen in that case. The NP talked about possibly switching Ava from aminophylline to caffeine if she is still needing it by the end of the week. Some babies need to go home with it, and caffeine is what they would use. It is the same stuff, caffeine just lasts longer so we would only need to give her one dose per day instead of a few. We'll see what happens. She took 15 mls from a bottle today!!! That is almost half a feeding for her. A full feeding is up to 35 mls. We will try again tomorrow. She should improve every day. We also did a bath today and I did the whole thing by myself. It gets easier every time. Overall, a good day in Special Care. And, a big HAPPY BIRTHDAY TO JUSTIN!!!

4 CC's

Today, Jason and I got to spend a lot of the afternoon down at the hospital together. We rarely get to visit together because one of us is usually home with Justin. We were celebrating his 2nd birthday today (one day early) so my parents had him over nap time. Ava gained 15 grams so she is 4 lbs 2.5 ounces. They started turning down her isollette temperature today to wein her out of it. Once the temp gets low enough, they will move her to a crib. Actually, the cribs look like a tupperware container without the top. Whatever works, I guess. It will be fun to have her out more though. It is easier to get her in and out to hold when she isn't in the isollette. Also, the big news for the day...she took 4 cc's out of her bottle tonight!!! She has a LONG ways to go but we took a step in the right direction today!

FOUR

We have a 4 pounder today!!! Ava gained 90 grams since yesterday and she is now 4 lbs 2 ounces! She seems to have little weight gains and then a big one after a couple days. Whatever works! She had a great day today. They checked her billirubin levels and some other blood work and everything looks good. They did start her on some iron supplements today. All babies become anemic after they are born but since they do blood draws on preemies, they like to give them a little boost of iron. Justin actually needed a transfusion when he was in the NICU but Ava won't. We tried bottling for the first time this evening. She didn't really like it, which is what I expected. She has only had little tiny tastes of milk in her mouth before and the bottle is a big change, something she has never had to do before. So, it will probably take all week of trying just to get her used to it...then we will start giving her more throughout the day. I am guessing it will be another 2-3 weeks before she is totally capable of all her bottling and ready to go home. That's fine, no reason to rush her...although we are really ready to have her home!

IT'S BOTTLE TIME

Today is a great day for Ava! She hasn't had any spells since yesterday and rarely de-sats. I am so glad the meds are working for her. She obviously still needed them. It's always trial and error with preemies because they all need things at different times. She gained 20 grams and is almost 3 lbs 15 ounces. I am sure by her next weight check she will be. They always check her weight at 2am so we never know until the morning. Also, the NP put in orders to try one bottle per day. She said she went to do her daily rounds on Ava and she was wide awake and looked like she was ready to eat! I am heading down for her 5pm feeding and if she is awake and ready, we will try a bottle. In my experience (with Justin) this will be a slow process getting started...and, it might not even work yet. She might not be ready. I would guess that if she can do it, she will get down some of the milk, and then we will have to put the rest in her feeding tube. It's a lot of work to eat for the first time!

We are expecting that Ava will come home in the next two to three weeks. We don't have a for sure discharge date yet. That will come much closer to when she actually goes home. There is no weight limit for going home. All she has to do is learn how to eat ALL of her feedings on her own and have the stamina to do it. Also, she will need to be able to maintain her temperature outside the isollette. We can't wait to get her home though!!! She'll be 34 weeks tomorrow!!!

EASIER DAY

Phew! Today is much calmer in Special Care! Yesterday, there was so much going on when I was there. Ava was getting all of her procedures taken care of and getting back on her meds. And, there were a set of twins that were admitted that were both getting sterile procedures done. There were docs, NPs, and nurses EVERYWHERE! Today, things were quiet! Ava has been getting her aminophylline doses and is doing SO much better. She clearly needed the medication! The NP talked to me about it this morning. Typically, they increase the dose as babies get bigger. Starting next week, we will probably try to stop increasing the dose as she gains weight and gradually she will just grow out of it. Hopefully by then she will be ready for it. She gained 25 grams from yesterday and is only 5 grams shy of 3 lbs 14 ounces. Her weight gain is right on track and we are so close to 4 lbs!! We had another spa day today as well. I did most of her bath by myself with a little assistance from the nurse. She was awake the whole time and enjoyed every minute of it!

UPS AND DOWNS

No matter how healthy a little preemie is, I learned with Justin that there will always be good days in the hospital and some not so good. I would call today an "ok" day. A few days ago, the docs discontinued her aminphylline which is the drug that helps with breathing and spells. It basically relaxes and opens air passages making it easier to breathe. The drug takes about 3-4 days to wear off and it has been pretty noticeable for Ava. She is clearly not ready to be off the meds. Each day since they discontinued the meds, she has had more de-sats and spells. So, today we decided to put her back on the aminophylline. We will try again to discontinue the meds when she is a little bigger and older. It's a good thing we didn't take her off her O2 monitor! I also talked to the NP this morning about doing some blood cultures in order to make sure she wasn't getting an infection. I think I am a little sensitive to that because of Justin's infection when he was in the NICU. So, she ordered blood and urine cultures just to make sure. I really wasn't worried about an infection because she was still acting normally and has been very alert. The tests came back this afternoon totally fine. We will not get her urine culture back until tomorrow. She got her first "loading dose" of aminophylline at 2pm (orally, through her feeding tube) and will get a constant dose every 8 hours going forward. Again, hopefully she will start growing out of these spells and de-sats soon, they normally do between 34 and 36 weeks. So, not a great day but could be much worse. And, I am so relieved it is nothing more than just needing the meds. Oh, and she gained half a pound. 3 lbs 13 ounces.

PIGGY

Today, Ava had a nice big weight gain!! She is up to 3 lbs 12.5 ounces! The NP stopped by when I was at the hospital this morning to chat. She increased her feedings to 32 mls based on her weight and she is tolerating those just fine. She does have occasional de-sats when she has a full tummy but that is normal. We talked about starting to wein her off of her isolette and into a crib. That will take a couple days and we will probably start tomorrow or the next day if she continues to gain weight. Other than that, nothing else new in Special Care. Hopefully I will have lots to report as we start feedings and getting her into a crib.

STATUS QUO

Absolutely nothing new today. Ava gained 10 grams but is still at 3 lbs 9 ounces. Hopefully she starts gaining a little faster in the coming days so we can get her out of the isolette and into a crib. She has to be around the 4 lb mark for that. If they take her out too soon, she will burn too many calories trying to keep warm. The doctor that delivered her rounded today, she is very happy with her progress! Ava is really starting to show signs of being ready to eat on her own. She is waking at most of her feedings and is very active! All good signs.

MORE OF THE SAME

Today, we didn't really change much. I think my posts will be like this pretty much all week until little Ava starts eating on her own. The NP did discontinue her pulse-ox but I asked to keep it on a few extra days. It makes me nervous to not know her numbers. Since she is still having small de-sats every once in a while, I would just rather wait a couple days to see how she does without the caffeine meds. I am sure she will do just fine, and I remember going through the same thing with Justin. You get used to looking at the numbers on the screen and at some point you have to learn to look at the baby (for color changes, etc.) in order to tell if they are breathing ok. Again, just wanted to give her a couple extra days...more for me than anything ;-) She gained 35 grams and is up to 3 lbs 9 ounces. This week we will see how she does with feedings, probably towards the end of the week (closer to her 34 week gestation). Other than that, smooth sailing in Special Care!

SPA DAY

Today was Spa Day in Special Care, for Ava at least. She got another bath today and got all cleaned up! She gained 1 ounce since yesterday so is back up around 3 lbs 8 ounces. Because of her weight gain, they have increased her full feedings to 30 mls (a whole ounce!). She seems to be tolerating those just fine. The NP also discontinued her amenophlin (sp?) today which is what they mentioned doing a couple days ago. I guess it takes a few days to get out of their system so we won't really know anything until mid-week. We'll just see how she does! If I remember correctly from when Justin was in the hospital, she needs to be off the caffeine for 2 weeks prior to discharge in order to not need a monitor at home. And, babies usually grow out of de-sats and spells around 34 weeks. Only one week away from that!! Oh, and happy 2 weeks to my baby girl!

NOTHING NEW TODAY

Today, we don't have anything new to report. Ava lost 1.5 ounces but that was to be expected. She went off her IV fats and lipids before she was up to full feedings yesterday so we expected a small drop. Not a big deal at all. She is up to 28 mls today which is a full feeding for her. I would imagine she will gain weight today. Tomorrow, we will increase her fortifier to 24 calories. Other than that, she is doing exactly what she needs to do. Eat, sleep, and grow!

Happy Friday. 2 weeks old tomorrow!!

FORTIFIER

3 lbs 8 ounces today!! She just keeps growing and growing! She is up to 23 mls every three hours on her feedings and since she is growing so much, her full feeding amount has also gone up. Now, we are going up to 28 mls. They have also added fortifier to her milk. An ounce of breast milk has 20 calories so they like to give these little peanuts a calorie boost. We will fortify her milk to 22 calories per ounce today and see how she does. Eventually, she will get 24 calorie fortified milk. She has been having a few heart rate/oxygen dips but it is not something to worry about at all. She seems to have high O2 saturations at all times until her belly is really full. Right at the end of a full feeding, her levels drop a bit. Her lungs don't have as much capacity when her belly is so full so that is expected. Over the next couple weeks, she will grow out of that...it just comes with prematurity. The NP mentioned today that based on her gestation, she is eligible to have one eye exam by the pediatric opthomologist. Justin had eye exams every two weeks because he was on oxygen for a while. Babies that are on oxygen sometimes can have trouble with their retinas detaching due to prematurity. It is called ROP (Retinopathy of Prematurity). Ava was never on much oxygen, at the most half a day. They worry about the babies that are on high levels of oxygen for an extended period of time (weeks and weeks). But, since they are willing to give her an exam, why not! They will do that on October 6th. That's all for today!

NO MORE IV

Ava is doing great today! She has gained another ounce, 3 lbs 6 ounces!! We changed plans a little bit from yesterday. Since she still had her IV in, I wasn't able to give her a bath, but the nurse did. I will get to next time. She was so nice and clean yesterday when I went to visit. The NP said that they will probably take her IV out tonight when it expires, sometime between 4 and 6pm. Unless it goes bad before then. It will be nice to finally get all her arms in her clothes. She didn't discontinue her pulse ox today, but will do that tomorrow. No reason for that, just didn't write the order. She also talked about discontinuing another medicine that she is on this weekend. When babies are premature, they typically need a drug called amenophlin (sp?) or something similar to caffeine. Justin was on caffeine for a long time! This is to help prevent them from having "spells". A spell is when their heart rate and O2 levels drop and sometimes they need a little stimulation to get going again. Basically, they forget to breathe. Justin had spells all the time so we got used to them with him. Ava has never had a spell before. She has dropped her heart rate a couple times but always brings it right back up on her own. Very normal and something they expect. Anyway, the NP talked about discontinuing her amenophlin this weekend because she will be at an age where she really won't need it anymore. Yesterday I noticed a note on Ava's white board that said "DC-10/8". I didn't know what it meant but guessed and was right. Her discharge date is going to be right around Oct. 8th if she can get everything figured out by then. Of course, that is just a goal to shoot for. If she is not ready, they will not send her home. But, the nurse said if we don't have a goal, we have nothing to shoot for. All good news today. I am taking it easy this afternoon and heading down tonight!

BATH TIME!

Big day today!! I talked to the Nurse Practitioner this morning, they round on the babies in the morning and the Neonatologist rounds in the afternoon. A little different than in the NICU. Ava is doing great. She gained quite a bit of weight today! She is up to 3 lbs 5 ounces!!!! There is a little discrepancy between the scales in the NICU versus Special Care so that could be some of the weight gain right there. Either way, we'll take it! Her face has filled out quite a bit and she isn't looking as skinny...to me at least. She got a new IV last night in her other hand. They usually only last a day or two because their veins are so little and fragile. This will be her LAST IV!!!!! She will be up to her full feedings soon and won't need the fats and lipids through the IV anymore. The NP thought we would have the IV out tomorrow. She has also done so well with her oxygen saturations that they are going to take her off that monitor tomorrow as well. The NP didn't want to make any changes today since she is new to the unit and wanted to have her for a day before making any changes. Makes sense to me! But, tomorrow, we will move forward. She will take a bilirubin test tomorrow to make sure her levels aren't too high, it probably went up since she is no longer on lights but they think she is big enough where she won't need lights anymore. So, slowly but surely we will be taking off different monitors and leads and she can be free of all the stuff!

She hasn't had a full bath yet, just the hair wash that Christy and I did the other day. So, today, we are going to give her a bath!!! Yay! I am sure she will love it. She liked getting her hair washed! We have to be careful with the IV but we can wash the rest of her! I know I haven't posted any new pics lately. I will do that tonight.

THE BIG MOVE

Today was a big day for Ava! She got to move over to the Special Care Nursery at Abbott this morning. The doctor rounded early today because of the move. She didn't gain any weight from yesterday. So, still 3 lbs 1 ounce. Her bilirubin levels are down to the normal range again so she went off phototherapy. I think she will be done now, especially now that feedings are going so well. She is up to 12 mls with her feedings so we are half way to a full feeding. By the end of the week she should be there and then we will finally be able to take out her IV! I took down a few outfits today so she could finally wear clothes. She isn't able to wear anything when she is under the lights so this will be fun. Her smallest outfit is for a preemie size 4-6 lbs but I put it on her anyway. She needs a little pink ;-)

That's all for today. Just working on eating and growing!!

3 POUNDS TODAY

We made it back over the 3 lb mark today! She gained 50 grams and is up to 3 lbs 1 ounce! Yay! I remember when 3 lbs was such a huge deal for us with Justin but it took him a lot longer to get there. Her feedings are going perfectly. They are still increasing 1 ml every two feedings and as of this morning we were up to 7 mls. By tonight, we will be up to 9 mls! The doctor said in the next couple days we will start fortifying the milk as well, just for a little calorie boost. I forgot to mention yesterday that she was back on phototherapy for two days because her bilirubin levels were a little high. She should be done with that after today. Our final piece of BIG news today is that Ava is graduating to the Special Care Nursery tomorrow already!!! The NICU is jam-packed with a ton of sick and little babies and since Ava is doing so well, she is moving on up to the next level. I have mixed emotions about the move. Ultimately, I am thrilled because it means she is healthy and moving quickly to come home! But, we just LOVE the docs and nurses in the NICU so it will be hard to leave. Not to mention, we have our own room in the NICU. We will go to a 4 baby room in Special Care. That is what we were used to with Justin so it won't be so bad. The nice thing about Special Care is that the same doctors round there as the NICU. We won't have the two docs we know best, Dr. Hustead and Dr. Hoekstra, but the same group. They are all great. Lots of good news today!!!

We are heading down to visit this evening. Something that we haven't done with Ava yet is Kangaroo Care. This is when you hold the baby skin-to-skin. Studies have proven how good this is for babies...and moms and dads too! We "kangarooed" a lot with Justin and will enjoy it tonight with Ava! Pictures to come later.

ONE WEEK OLD

Wow! I cannot believe my little girl has been here for a week already! She is doing great today. Not a lot new. Breathing is still normal and on her own. It's crazy to hold such a little peanut that is just breathing on her own. Makes me want to bring her home! She is finally starting to put on some weight now that she is eating more. She gained 3 ounces from yesterday and is 2 lbs 15 ounces. Almost back up in the 3's! They have increased her feedings today and she is tolerating them very well! They increase the cc every 6 hours/2 feedings. So, she was at 3 mls as of this morning and will be up to 5 mls by tonight! Jason took the phone call from the doc today so I don't have any more details than that. He is not used to taking the phone calls and didn't ask any questions. Typical guy ;-)

FUN AFTERNOON

I will usually only post once per day, but today was so much fun in the NICU, I had to write about it! I went during Justin's nap so had lots of time to spend there. Right when I got to the hospital, it was time for "cares". That is when the nurse comes in and does the diaper change, vitals, feedings, etc. Usually, they let the parents help with all of that. We do diaper changes, take temperatures, the easy stuff. She is tolerating her feedings really well so she got her feeding while I was there. Then I got to hold her for over an hour. She slept the whole time. I was hoping that sometime soon we would be able to give her a bath or wash her hair because it was getting a little gross after being almost a week old and not having a bath yet. We can't fully submerge her because she still has IVs but a sponge bath works! So, my friend, and our favorite nurse Christy, stopped in to say hi. She was Justin's primary NICU nurse when he was born and we have stayed in touch and become friends since then. She is not allowed to take care of Ava since we are friends but it is nice that she can stop in and help out from time to time. So, today, she got off work a few minutes early and asked if I wanted to wash Ava's hair!! OF COURSE!!! She and I were the first ones to give Justin a sponge bath and now Ava. How cool! Anyway, it was so much fun to have her there and so nice to get Ava cleaned up. Christy is always very attention to detail with these babies and that is very much appreciated! Fun day! Oh, and Ava has her umbilical IV out and a new IV in her foot. I guess she did just fine. They give babies "sweeties" (sucrose on a pacifier) which works as a pain block, somehow! Wish it worked on adults! Hopefully she can be done with IVs soon...as long as her feedings keep going well!

Tomorrow my post might be a little later in the day. I am having my first baby shower! I was admitted to the hospital 4 days before my shower when I was pregnant with Justin so I missed that one! And, almost missed this one too! Yikes!

MORE FEEDINGS

Things are good at the hospital today! Ava tolerated all of her nightly feedings! Her weight is up 10 grams. She had a head scan this morning, something that is pretty routine for all preemies. They typically do them when they are about a week old. They worry about brain bleeds with babies that are really really early (23-26 weeks gestation) but they check them all just to be safe. Justin had the same tests. The radiologist had not read the results when I talked to Ava's nurse this morning but she said "unofficially" everything looks great!! We are increasing feedings today since she tolerated them last night. She got 1 ml at her 11am feeding this morning. She will get 2 mls at the next two feedings (2pm and 5pm) and then 3 mls for the rest of them until tomorrow. The ultimate goal for her current weight is 24 mls every three hours. Seems like a lot! And, that number will increase as her weight increases. We also need to take her umbilical IV out today. They don't want to keep those in too long for risk of infection. They will put in a peripheral IV (a normal IV that we are all used too) until she is up to full feedings just to administer the rest of her nutrients. Her bilirubin levels have increased a bit today but we are not putting her back on phototherapy just yet. We will see how the next couple days go.

Dr. Mrozek has been on all week (she was the Dr. in the delivery room) but today is her last day. Next we will have Dr. Hustead who we just love. She took care of Justin when he was in the NICU. The following week, we will have Dr. Hoekstra, our favorite!!! He was in Justin's delivery and we are so excited to have him take care of Ava too!

That's all for today. Heading to the hospital for the afternoon. Happy Friday!

GOOD PROGRESS TODAY

Today has been a great day in the NICU! Ava has finally stopped losing weight and was up 10 grams. By the way, 30 grams equals one ounce. So, she is still 2 lbs, 12 ounces. She had two big poops throughout the night last night which is what we needed her to do. When any baby is born, their first few poops are a sticky tar-like substance called meconium. When you are not getting fed and your system isn't up and running yet, it is hard to get all of that out. Finally, she was able to get it all out last night!! So, we were able to start feedings again today. She will get 1 ml every three hours and we will see how she tolerates it. I am guessing she will have no problem now that things are moving. If things go well today, they will be able to increase her feedings pretty rapidly. We were also able to stop her phototherapy lights today as well. It is so nice to be able to see her little face without the sunglasses on. Now that her feedings are established, her bilirubin levels should steady and the lights won't be necessary. She might go on and off phototherapy over the next few days depending on her levels. We'll just have to see. The doctor did discuss the possibility of her needing a PICC line in the next few days also, depending on how quickly we start her feedings. A PICC line is just like an IV but can be left in for a longer period of time. This would be so she can still get the nutrients she needs in case she is not up to full feedings yet. She has been getting her nutrients through her umbilical IV but that will need to be taken out in the next couple days to avoid infection. We will just see what happens.

Please feel free to leave comments if you have questions. I am happy to answer them. Unfortunately, this all seems so normal and routine to us that I forget some of the basics. And, I forgot to mention this is my previous posts but Ava was 31 weeks when she was born.

AND HERE WE ARE TODAY

I am finally home from the hospital (as of yesterday) Wohoo!! Boy, is it ever nice to be home. It is going to be interesting trying to juggle a two year old at home, and trying to get to the hospital. A little different this time around.

I just talked to the doctor today. Everything is going great. Jason and I keep commenting about how boring the phone calls to the NICU are because there is never any news or updates. THIS IS A GOOD THING!!!!!!!!!!!! I will take boring ANY DAY! So, the report today is breathing is going great. Still on her own. We are still skipping feedings today. No need to rush. She did poop again over night so we will probably start feedings again tomorrow. The doc did order an x-ray of her tummy to make sure there wasn't something we are missing...and things look just fine. She lost a small amount of weight. Still 2lbs, 12 ounces. Things are good today. Jason and I are celebrating our 4 year anniversary today. We were originally planning on going out to dinner for the evening but I think tonight will consist of a quick dinner and night in the NICU. Fine with us!

WE HAVE A BABY!!!!

Normally, I will post all of Ava's updates daily. However, I will post a series of them today in order to get caught up. It's been a little busy over the weekend!

So, back to Saturday. We got to the hospital around 5am and contractions started to pick up. I hadn't had any before my water broke, but they started up on the way to the hospital. Ava had been in the breech position for the last couple weeks so we already knew we were likely to need a c-section. Once we got to the hospital, they set me up on monitors, confirmed she was still breech, and things moved quickly at that point.

One thing I forgot to mention in my last post. There is a steriod called beta methazone (sp?) that can be given to mom if it is likely that the baby will be born early. This is to help the lungs develop. You need two doses of the shot, 24 hours apart, and then an additional 24 hours for the second shot to metabolize. I got my first shot on Friday. So, didn't even have the first one in for 24 hours before she was born...bummer.

Back to Saturday...I went into the OR around 7:45, things moved very quickly, and Ava was born at 8:08am. Because of her positioning, the doc really had to work to get her out. Her head was way up by my ribs on my right side and feet down. Since it took her a few extra minutes to get her out and a lot of wrestling (not fun for me!), Ava was a little stunned when she came out. They handed her immediately to the NICU team that was waiting in the OR room next door. We didn't get to see her because they were in a hurry. At that point, the NICU team intibated her (put her on a ventilator) to help her breathe, put some IVs in her umbilical artery (belly button), and got her stabilized. She was doing great. Jason was able to go next door and take a picture of her so I could see her. Then, he headed over to Children's Hospital with the NICU team and Ava while I was sent to recovery. They needed me to be able to move my feet before they would wheel me over to see her.

AVA ELIZABETH GEHRMAN
3 lbs, 3 ounces
15.75 inches long
11 inch head

DAY 1-NICU: Ava was doing great right away once they got her to the NICU. The ventilator is able to show how much a baby is breathing on their own versus needing the vent for support. She was breathing on her own with no oxygen almost right away. They did a chest x-ray to check maturity of her lungs and some other tests throughout the day. It was determined by Saturday evening that they could extabate (take the ventilator out) because she was not needing it. The shorter you need one, the better! She is getting antibiotics and also TPN (fats, lipids, nutrients) through her umbilical IV. By Saturday night, things were good. She was MILES ahead of her brother on his first day and we couldn't be happier. The part that is so weird about all of this is that is seems so normal to us. Everyone was commenting on how calm we were, but again, this is all we know...unfortunately.

Things we expect over the next few days based on what we already know:
-Ava's weight will drop (Typically up to 20% of birth weight)
-She is likely to need phototherapy lights
-They will try to establish feedings (through a feeding tube)
-She might need oxygen, might not
-Things are up and down in the NICU...some good days, some bad days...hopefully we stick to the good days ;-)

DAY 2-NICU (Sunday): Ava is still doing great. Over night, they put her on a high flow nasal cannula to help with her breathing. They can adjust her oxygen levels but she didn't require any. The flow in her nose is just to give her a little extra help breathing. Certainly don't want to tire her out after only one day!! She lost some weight and is down to 3 lbs. We are starting her on feedings today as well. She will get 1ml of breast milk through her feeding tube every four hours. Then, we will see how she tolerates it. She hasn't really pooped yet, which is a HUGE step for getting feedings established. It might not work the first time, we'll see. FYI, the reason she needs a feeding tube is because babies do not know how to do the "suck-swallow-breathe" thing until around 36 weeks. So, she's got some learning to do.

Justin got to see his sister today. He took one look at her and said "done". He was more interested in all the lights and sounds! Hilarious!

DAY3- NICU (Monday): Today, the doctor decided to take out one (she has two) of Ava's umbilical IVs. She is not requiring both. When things like that are not neccesary, they try to get them out as soon as possible to avoid infection. She is also not needing any flow any more so they got rid of the nasal cannula and she is breathing all on her own! Doing great!! She lost some more weight today, down to 2 lbs, 12 ounces. That is the weight that Justin was born at. Weird. Her bilirubin (jaundice) levels are a little high so she will go under phototherapy lights today. Also, since she hasn't really started pooping yet, her feedings aren't going the best. We have stopped them completely to give her tummy some time to get going and will try again soon.

DAY 4-NICU (Tuesday): Really nothing new today. She did lose a little weight but is still 2 lbs 12 ounces. They measure in grams (she lost 10 grams) because of how small these little ones are. We have been able to hold her a couple times. When they are this little and fragile you really don't want to take them out of the isolette too many times. Plus, she is under phototherapy lights which is where she needs to be. Still no feedings today. However, they have ordered suppositories (sups) every 12 hours to get her pooping. Once she is pooping, feedings will go better, and which means her jaunidice levels will improve and then we can get rid of the lights. The sups are working. Huge poop today! Way to go!

HERE WE GO AGAIN

BACKGROUND INFO:

Well, I didn't think we would ever need another blog again. But, this is the best way I can get information out to people on a daily basis. I thought I would start with a little background information about everything and then start updating.

Many of you know that we had Justin at 28 weeks. When we got pregnant with Ava, it was our number one goal to prolong this pregnancy as much as possible. We developed a game plan with the doctors to make sure that happened. I received progesterone shots (once per week, starting at 16 weeks) to help minimize contractions, and had an ultrasound and fetal fibronectin (to tell whether it was likely I would go into labor in the next two weeks) once every two weeks. Things were going great! Contractions were under control, ultrasounds looked good, fetal fibronectins-negative. Last Thursday, I went for my normal two week visit with the doc. We did the normal testing. We also noticed my blood pressure was slightly elevated. 140/100. They worry about preeclampsia (high blood pressure during pregnancy) which can be harmful to both mom and baby. The plan last Thursday was to do some more testing on me and to come back Friday morning. I went back to the doctor's office Friday morning, my blood pressure was a little higher than Thursday, so they sent to be monitored in the hospital for the day. They told me that my fetal fibronectin was positive this week-yikes! I was sent home on bedrest with a plan to have ultrasounds once per week (to monitor baby's growth) and two additional appts. to check my blood pressure every week. That was the plan :-) We went to bed Friday night and I woke up around 2am to watch TV because I couldn't sleep...not uncommon. I got up at 4am to go to the bathroom and my water broke. Totally unrelated to the blood pressure issue that was creeping up, apparently I was just done being pregnant. So, we called the doctor and headed to the hospital.