NICU

 

Next Week

Chloe's First Week Outside the Womb

 


(Day 1)

  
  Chloe has made a remarkable journey coming into our world.  Remember, she was in a water based environment, where she weight 2/3 less then when she was born. Her skin was water soluble, not like our skin which is water repellant. She had no use for lungs, stomach and a few other things.
 

Now she comes into our environment, with barely developed lungs (Cheryl only received one of the two Steroid injections [the injections tell the baby to start developing the lungs] only 5 hours before surgery -- I doubt that it had any measurable effect). The air, although easier to run in than water, it is not as soothing as liquid -- besides Chloe has absolutely no clue about running.

 

  
 


(Second Day)

  
  On the first day (September 16, 2001) Chloe was born she weighed 1 lbs and 11.4 oz. and 13.5" long with her head being only 9 inces in circumference.  She had an Apgcar score was 8 for the first minute and a 9 after five minutes which for a preemie is far greater than one could ever hope for (most preemies are less than 7 on the Apgar score).  

Chloe was irritable. She was trying to figure out what happen. She stayed many hours just lying down and moving her fingers. Occasionally she would try and fight the lung machine for a few breaths and then tire out. Her mouth was always open and there was no noticeable saliva. This was the scariest part for me, because I did not know if she would fight or not. Being thrown put into the world of preemie parenthood, I had no clue what was the norm.

Chloe was given a single dose of Surfactant (generic name -- Survanta is the brand name) to help develop her lungs, this was given to keep her lungs stay open and breath better.

Chloe was also hooked up with a Umbilical Arterial Catheter (UAC) which is placed in a belly button artery. It is used to check blood pressure, draw blood samples and give fluids. 

Chloe has a Umbilical Venous Catheter (UVC) in the belly button and is used is used to give the infant fluids and medications.

An Endotracheal tube is placed down her throat and it uses a  High Frequency Ventilator to help her breath to work the lungs.  The High Frequency Ventilator is a new machine that has revolutionized Neonatology by putting 420 small puffs of air into the lungs which allows Oxygen and Carbon Dioxide. 

To best understand the importance of this machine is to understand what they had in the past.  The old machines, worked on the basis as treating the lungs as a balloon forcing air in and drawing air out.  This is great if lungs are like a balloon, but they are not.  Forcing air into the lungs causes damage to the lung sacks and sucking all of the air out of the lungs forces the sacs to collapse which causes very little reserve air in the lungs.  So preemies with this machine will have lung problems later on in life.

What the High Frequency Ventilator does is simply give the baby 420 micro puffs that are barely noticeable to the preemie thereby keeping the lung sacs open and forcing CO2 out.  The bad side is that it is noisy and huge (see the black machinery in the below photos).

On the second day picture she has you will see a wrap placed around her right foot.  This is actually a Transcutaneous Oxygen Monitor which measures Chloe's Oxygen level.  This monitor will be placed in a different spot each day because it will burn a small portion of the skin (yes it will heal -- providing it is not in the same place for the duration of her stay).

Chloe was given a few X-rays, whcih I was asked if I wanted to see them and I told them no, because I wanted to spend time with Chloe. Besides the doctor told me that all was well and healthy X-rays are very boring.

 
 
Day two (September 17, 2001) she was kicking and moving all around. Now I know that she was difficult for mom. She loves to stretch out her right leg over and over again. She also has dirty diapers, which demonstrated her plumbing is working. Her Oxygen assisted intake is 40% (ours is 23%), but she was still fighting the lung machine (Go Chloe!).

Chloe was given 3 doses of Surfactant (generic name -- Survanta is the brand name) to aid her lungs. They also started her on Aminophylline which is used o treat her Respiratory Distress Syndrome by stimulating her heart and lungs.

They are using one of the service tubes in the Endotraheal tube to drain fluid out of her lungs.  The time I saw the nurse do this, there was not much fluid in the lung to drain.
 

  
  Day three (September 18, 2001), you thought day two was active, wow she is really active. Her lungs are breathing in the double digits and then she tires out for about 10 to 15 seconds and then starts up. Her oxygen assisted levels have been decreasing to ca. 26% / 28% which is fantastic. Those little lungs will be working on their own sometime soon. Her skin tone is getting better. She has developed swallowing skills and is sucking on her mouth piece (while trying to pull it out -- what a rebel). She is now slobbering on her hands and she hates dirty diapers.

Chloe, had her first blood transfusion.  A blood transfusion is done, because the hospitals loves to take blood and preemies have no way of replacing the blood.  The average preemie cannot loose more than a teaspoon of blood before it affects them. As a result of drawing the blood for testing and Chloe having no way to produce blood cells, she has been diagnosed with Anemia. It is kind of a NICU testing thing.

Chloe had another X-ray and everything looked good to the doctors. Chloe's ribs are where they should be and looked fine.

Now they are putting food in her stomach. It seems that the stomach at this age has absolutely no clue of its purpose. They (the smart people) have found that if you put a little nutrients in the stomach then the stomach will catch a clue.
 

Jaundice has set in and it is being treated by this bright spotlight on her.  They have her eyes covered to protect them from the spotlight. The technical term for this is Hyperbilirubineamia which means that there is a high level of the compound bilirubin which can cause brain damage. Thus the reason to expidite the elimination of Jaundice.

Chloe has also been diagnosed with Patent Ductus Arteriosus which are big words with a lot of meaning behind them. Basically when a baby develops in the womb, there is no need for the lungs so the baby has what best can be described as a By-pass blood vessel to skip the lungs. In premies (and in some industrial stregnth babies) the blood vessel is not closed. Chloe needs to close the by-pass. This is a very mild case that was more of a watch than a worry.

One of the Neonatologist spent about an hour with Cheryl and I. He went over a tremendous amount of material relating to the NICU/Premie world. I am sure that we forgot about a lot, but we also retained a lot and this would be helpful for the days to come.

 

 
 


(Third Day)
(Third Day)

  
  Day four (September 19, 2001), brought Cheryl and I to tears.  Chloe was breathing on her own.  She did have a CPAP supplying her with 38% Oxygen.  This single action took her off the biggest and noisiest Gizmo they had (see the black box with red readouts) . 

They also put a tube down here throat to and extending to her stomach.  This is when she will start the feeding process.  She, like her mother is biting down on the tube and not cooperating with the nurses (Go Chloe!).

Chloe still has Jaundice but that is being treated and is greatly reduced from yesterday.

What a difference three days make.  Wow.

 

  
 

Day five (September 20, 2001), Chloe is still on the CPAP, but they have removed all of the High Frequency Ventilator equipment from her crib side.  The significance of the NICU staff removing a piece of equipment is huge, because it means that they feel very confidence that Chloe will not go back to it.

A funny thing happened to Chloe when I was there at the NICU.  Chloe did not like the CPAP in her nose, so she pulled it out of her nose and put it in her mouth (Go Chloe!  -- That's our daughter).

The Jaundice has been eliminated and Chloe's eye wear (basically taped up material over her eyes) has been removed.  Now Chloe's father can take great pictures of her and not compete against the spotlight.

Chloe, also started digesting food in her stomach -- not much, but a tremendous accomplishment for a little girl and a stomach that is just now figuring out what to do.

Chloe, decided to go on a diet program, she is holding her weight at 1 lb 7 ounces.  The weight loss is nothing to be concerned with, it is just excess water that all babies get rid of.  Now she is putting on real weight.

 
 

Day six (September 21, 2001), Chloe still weighs 1 lb 7 oz, but she is now digesting food in her stomach.  In fact they have increased the food by 50% and gave her full strength food.  None of that diluted diet food stuff for her.  Unfortunately, her increase in food was from 2 cc to 3 cc of the food, but from a father's perspective I have to do the percent thing because it makes her sound better.  Keep in mind that this is real progress.

Her oxygen assist is now down to 24%, which is very good.  When put into the perspective that a normal person's oxygen intake is 21%, she is doing very good for someone only six days old and 13 weeks early.

 

  
 







(Chloe with her pet beanie baby -- day 6)
 

  
 

Day seven (September 22, 2001), Chloe has now survived the first week outside of the womb.  She is doing exceptionally well considering that she was delivered at 27 weeks.  The next big thing everyone is worried about is her gut functions.  Her ability to digest food and her ability to dispose of the waist product using the digestive track.

Chloe on Thursday (day four) had an Ultrasound in her cranium to check for blood clots and leaks.  The test came back, and she has a normal brain.  This was a worry in the Lewis household, because it is not a rare event.

Chloe has gained some weight (1/2 ounce), so that is making her parents very happy.  Hopefully she will catch up quickly to her birth weight.

 

  
 
 		  
 

Proud Parents

  
 


 

  
 

Weekly Rap Up

What can I say, except that this is truly a week that God has blessed us. 

These are that I have as the husband/father person:

    Cheryl is alive - she was hours away from death.
    Chloe is alive - see above
    Chloe's adjustment and health has been extraordinary
    Nothing like being surrounded by people you care about and who care about God in a situation like this

All the things that we were worried about did not come to pass.  God truly watches over us and Chloe.