Explanations

So, I started thinking. I throw around a lot of terms, like sats, de-sat, cpap, and never really explained any of it. Thought you might want to know a little about that. Plus, a few of you have "casually" mentioned that you don't know what I am talking about. So, I am going to do my best to try to explain things. I don't have a nursing degree, so bear with me. This might be a rather long post, so if you are just interested in knowing how he is doing today, I suggest scrolling to the end.

To start, when Nick was born, he was considered 28 weeks old by gestation (by date of conception). Upon assessment once he was out, they felt he was more like 26 weeks. This is common with most newborns. Some of it is based on the fact that there is no guarantee when I conceived, unless it was done by invitro. Also, his size, weight etc lent them more to think of him like a 26 week old preemie. That comes in to play when we are trying to figure out different milestones that he should be meeting while in the NICU.

Once Nick was here, there are a few health concerns that he could have. I am going to go over a few. Most of them, we will be looking for in the next few weeks.

Breathing: Most babies born at this stage have Respiratory Distress Syndrome. Their lungs are simply not mature enough to do the work that they need to do. Thus the ventilator and cpap. Both do relatively the same job, making sure he has the oxygen he needs. The ventilator provides more support than the cpap. However, the ventilator has it's own drawbacks. The longer he is on the vent, the more chance he will have chronic lung problems through his toddler years.

Apnea of Prematurity: When I say Nick has or hasn't had any spells/episodes or de-sats, this is what I am talking about. Basically, if Nick was still inutero, he would be all happy and content. No one would be messing with him, touching him, etc. He wouldn't have to worry about eating, breathing, going to the bathroom, all those things he is doing now. That is a lot for his little brain to have to worry about. Sometimes, his brain just has a hard time doing all these things at once, and something suffers. So, he kind of forgets to breathe. He is hooked up to machines that let the nurses know if that happens, and they can stimulate him to get him to breathe if he needs to. Right now, if he does that, he can usually bring himself out of it without any help. His oxygen level should be around 86-94%. Yours and mine is somewhere usually close to 100%, but if Nick actually gets too much oxygen from the machines, it can actually cause problems of it's own, so they like to keep him at about 86-94%. They can adjust the machine to deliver a percentage of oxygen as well. If his oxygen level is a little low, they can turn it up, or vise versa. A de-sat, or spell occurs when his oxygen level drops below 80. The apnea should continue to get better, and should be gone by the time he is about 36-38 weeks (by assessment).

Infection: Most preemies get some type of infection. Their immune systems are just to immature to fight off everything. We already experienced that with the staph infection. The nurses know what to look for in the case of infection. They do a cbc to look for indications of infection twice a week. If they notice something, they do a culture. If he has a bunch of de-sats in one day, they may do a cbc to look for infection as well. That is how they caught the staph so early.

NEC: This is Necrotizing enterocolitis. This is a disease that effects his intestines. You can't predict who will or won't get this. It generally starts two to three weeks after feedings start. He is past that point, but still at risk for this. They haven't had any trouble with him tolerating his feeds, and he continues to have bowl movements on his own, so hopefully we are in the clear for this, but there is still a risk. They treat this with some antibiotics, or in worse case scenario, surgery. Like I said, we look good on this front, but he is still at risk.

Retinopathy of prematurity: This is the development of abnormal blood vessels in the eye. It usually resolves itself without any vision problems. It may cause Nick to have to wear glasses. There is a risk of blindness, but it is a slight risk. An optometrist should come to look at him over the next few weeks to decide if he is at risk of developing this. He is at risk for this around 4-6 weeks.

Nick stays in an isolette everyday. He can't maintain his temperature well on his own, so the isolette delivers warm humidified air to make sure his body doesn't have to work to hard to keep him warm. The more work he doesn't have to do, the faster he can gain weight.

He still has his feeding tube. He has to be off the cpap for a while before he can try feeding on his own, from a bottle or the breast. He has to prove that he won't forget to breathe while he is eating.

Now for explanations of the things you see in the photos, attached to him. The cpap is the thing on his nose. It has tubes that are connected to it. There is one tube with humidified air, and one with just air. The tubes are somewhat cumbersome, so he wears a little hat to help keep the tubes situated and off his head. It also helps keep the cpap in place. He has two tubes in his mouth. One provides a constant feed for him. The other allows air to come out of his tummy. He can't really burp on his own. He sometimes wears a chin strap. It is the blue thing around the top of his head and around his chin. Nick likes to sleep with his mouth open. That lets too much of the air that is going in through his nose come out. So they have to keep the chin strap on to keep the air in his lungs.

So for now, the major issue is the de-sats. It is something he should grow out of. It seems like he is starting to. As of today, he still hasn't had any de-sats since the Jan. 1. That doesn't mean that he won't still have them. The next step will be to start weening him down off the bipap, and onto the cpap. (The difference in cpap and bipap: Bipap provides him with a little positive pressure to make sure his lungs are opening all the way when he takes breaths. Cpap doesn't do that, it just makes sure the oxygen is there) Basically, it is just getting him ready to do all this breathing stuff on his own. They will start to ween him down and see if he can handle it. Ultimately, the goal is for him to just be on room air.

To be able to go home Nick needs to between 4 and 5 pounds. Can gain and maintain between 15-30 grams a day. Able to maintain his own body temperature in an open bassinet. Doesn't have any apnea spells for 8-10 days. He also needs to be able to eat from the bottle or breast with no problem.

I think I have explained everything, but if I have forgotten something, I will try to explain better when I give you updates. Sorry for the extra long post, but there are a lot of things to explain.

Nick is doing well today. No de-sats. He continues to grow... 2 pounds 13 ounces. I can't believe he is almost 3 pounds. I can't believe that I think 3 pounds is this big number, but for him it is. So for tonight, all is well. I am still working on getting those photos, I promise. I will get some soon.