Due Date

Saturday was Morgan's original due date and she must be ready to come home now. She decided to take two entire bottles today, the first in only five minutes and another this evening in a 15 minute span. The nurse who gave her the bottles today was the same nurse to give her most of a bottle more than a month ago. Either Morgan really likes her or she is just more stubborn than Morgan can be.

To show off even more, they have also weaned her oxygen flow down to just 1/8 of a liter. They tried her at a 1/4 liter starting at 3:00 in the afternoon. By 9:00 she was still doing so well they decided to wean her again. The nurse said if she continues to do well over the next day or two, they could take her off the nasal cannula completely and see how she handles it.

Morgan also had plenty of attention from her all of her Thanksgiving visitors.

Ouch

The good news it that Morgan's MRI came back normal. However, the results of Morgan's pH probe showed she had 44 episodes of reflux in 24 hours. Of those, 21% were high acidity. Ouch. The doctors and nurses think this is one of the reasons she has been so inconsistent with bottle feeding. They have decided to go up to two bottle feeds a day though, to see if she will improve. Now she will get one during the day from an occupational therapist and a second in the evening from either a nurse or one of us. She is also on two medicines to try and cut down on the reflux, one to make the food move faster through her stomach and the other to lower the acidity. However, Dr. Khan has told us that neither is usually as effective as they would like.

He also explained that if she doesn't start to show some improvement with the bottle over the next week, he would consider placing a gastronomy "button". It is basically the same tube she has now for feedings but, instead of running it down her esophagus and into her stomach, it is placed surgically through the skin on her belly. The logic behind this is that feeding would be the last obstacle keeping her at the hospital. Apparently the button it easier for parents to manage, so she could be sent home and we could continue working with her on bottle feeding but still have a way to give her full feedings when she won't take a whole bottle. If they do put in the g-button, they might also do another procedure at the same time that would cut down on her reflux.

So it seems like this is her last obstacle before coming home. We both would like it if she could avoid another surgery, but we are also very ready for her to come. The doctors have said that being at home is much better for her developmentally than being in the NICU, which is why they wouldn't want to wait for her to master bottle feeding if that is the only thing keeping her there. With everything she has been through it seems like this should be the easiest task but the staff says this can sometimes be the biggest hurdle. Either way, in the next week we should have much better idea of when she will be coming home.

Have a great Thanksgiving!

Six Pounds!

With Thanksgiving only a week away, things are getting much busier here and it seems an update is overdue. Only 10 days from what was her original due date, Morgan's is now just over 6 lbs. She is still doing fine on the nasal cannula but they haven't really been able to wean her down very much.

One of the reasons her oxygen requirements haven't improved is that she started retaining some fluid again. Because of this they decided to give her a dose a lasix last weekend and continue giving her a dose every other day to make sure she is getting the fluid off of her quickly enough. Her doctor and nurses think that reflux during her feeds might be at the root of the problem. It's possible that she is refluxing and then breathing in some of the milk which would irritate the lungs and lead to fluid buildup.

On Wednesday they put a pH probe into her esophagus for 24 hours to monitor what's going on during her feeds. We should know by the weekend if it is severe enough to require treatment, however, they've already started thickening her milk which seems to be helping. If the pH probe shows a need, they might also put her on some medicine for the reflux.

Morgan is also getting a visit from an occupational therapist once a day to work on bottle feeding again. The first couple of days she didn't take very much, but again they think reflux might be working against her. Thursday morning, with the thicker milk, she took her entire bottle in about 15 minutes which is great. If she does well again on Friday, they may go up to two bottle feeds a day.

Also on the schedule for this week is a brain MRI. The hospital does them for preemies at around 38 weeks gestation as a standard practice. We don't anticipate any problems showing up, but we'll pass on the results when we have them.

Here's looking at you!

Morgan's eyes are developing really well. She has no signs of "plus disease" which is when the blood vessels grow large, twisted, and inflamed. They are growing so well that she is now only getting bi-weekly checks instead of weekly. She is in the clear for any significant vision loss!

She is still struggling with taking a bottle. Her original due date was November 28th and the Dr discussed that when that date passes they would consider a G Button if she wasn't bottle feeding so she could still go home. The estimate on her chart for discharge is the second week of December so she has about a month to conquer bottle feeding before they put that button in. We know a lot can happen in those weeks. Her respiratory rate these past two days has been much better, around 40-70 which means she has a better shot at being physically able to take a bottle. A chest x-ray the other day showed that her right lung had little pockets that collapsed but no one seemed concerned. They kept her on her left side and yesterday her x-ray looked much better and her breathing rate improved also.

We were also told that she would go home on oxygen and a heart monitor. Her oxygen setting on the nasal cannula is at 2 liters and they usually wait to send babies home until they are at a half to one liter. Her lungs are buying her some time to figure out how to bottle feed.

Now that we are looking at roughly a month away, its hard to remember to take one day at a time!

Late Halloween

Morgan was on the CPAP when Halloween came around and since this is so large around her head, I didn't bother with her frog costume. Now that she is back on the cannula, I put it on her last night long enough to take some pictures. It didn't take long for her to be done with it.

They tried again bottle feeding her last night and she dropped her heart rate (Bradycardia) a few times so they quit for that go round. In addition, her respiratory rate needs to be under 65 breaths per minute for them to attempt the feed and she is anywhere from 40-110. She is still showing a few signs that she is not ready for the feedings but we know she will get there eventually.

3 Months, 5 Pounds and Nasal Cannula Part 2

Apparently it's a milestone week for little Morgan. First, she made it back to the nasal cannula on Thursday. She did really well on the CPAP but they decided to wean her slowly to be sure she would do well on the cannula...and so far she has. It's nice to see her face again and we are thrilled that she is moving forward.

Also, as of Thursday night, she was up to exactly five pounds. Shelly and I are both amazed at how much she has grown. Even though it has happened right in front of our eyes, it is hard to believe that she has more than tripled in size since she was born. In the past, five pounds was one of the major benchmarks for sending preemies home. However, since they are dealing with such early babies now, they focus more on their ability to regulate temperature and not have apnea episodes, in addition to feeding and gaining weight.

She is already holding her own temperature and rarely has apneas, so bottle feeding is the next step in the process. Since she is back on the cannula they will probably start working on bottle feeds again next week. The first time around she seemed to do well with a little patience. Anything other than waiting for her start on her own terms ended with her not take taking very much at all. In the meantime, they think she might be having some reflux during her feeds (another common preemie problem) because a couple of times she has spit-up a little and also tends to desat if her head isn't propped up while she feeds through her tube. They have already lengthened the amount of time that each of her feedings is given and may thicken her milk some to help her out even more.

She got another eye exam this week as well, and her ROP had not worsened. She is still classified as stage two so they'll continue to check her every week. Unless it progresses to stage three it shouldn't cause any significant vision problems. Considering her dad's eyesight, any need for glasses in the future will more than likely be genetic.

Since it depends on several factors, it is hard to say exactly when she'll come home. It seems early December is still a realistic estimate. We've heard different opinions from the doctors and nurses on whether she'll still need some oxygen support after she's released. Some say it's pretty likely, but others have said a lot of the babies there are off of it by the time they are released. Lung improvement is really just a time and growth issue, so if she still needs a little bit of oxygen support by the time she meets all of the other requirements it wouldn't keep her from being released. Regardless, we aren't too concerned considering what we've made it through already.

I'm thinking it must have been all of Morgan's special visitors last weekend that made for such a great week for her.