Are we there yet...?

Well it has been quite an eventful week-little Bean is getting to be a big girl! Not only has she doubled her weight (4 lbs 4 oz!), but she has finally graduated to a big girl bed (open air bassinet)! Don’t even think that that is all our little ‘overachiever’ has been up to as last night she officially lost her feeding tube! So the countdown to homecoming has officially begun!

As I had mentioned in my last blog there are four criteria Brenna must meet before she is allowed to come home:

1. She must breathe on her own/no A’s & B’s (apnea bradicardia-or forgets to breathe)

2. She must maintain her own temperature

3. She must take all her feeds by breast or bottle (no gavage feeds/tube feeds) &

4. She must consistently gain weight (on a 22 cal or lower feed).

First all the good news, & don’t worry it is a much longer list than the not so good news list which I will get to later.

1. Brenna has been sans snorkel gear (CPAP) & had her caffeine stopped last week (preemies are given caffeine to help remind them to breathe) so she is/& has been breathing on her own for over a week(ish). However, before she can go home she will have had to go at least 7 days without any episodes of A’s & B’s (not breathing.) Brenna had a few episodes initially, but luckily each of these were ones that she self recovered which means that she began breathing again on her own or she began breathing with some stimulation on her back (think baby back rub). The good news is that she has been episode free since the 17^th, 3 days down, 4 more to go! Now, this sounds a lot scarier than it is (not breathing?!) , as these events last no longer than 20 seconds & (as far as I know) do nothing more than cause a brief heart rate drop. The main cause of this is that she is premature: her brain/nervous system has not fully developed but will correct itself in time (this is not an issue in term babies unless there is something wrong with them-abnormal). When she is done cooking (so to speak, hey I am a chef) she will no longer ‘forget’ to breathe.

2. Brenna has been in an open-air crib for almost a week now & has had no problems maintaining her own temperature. The best part about this (besides the fact that she is one-step closer to coming home) is that she can wear clothes & that we can pick her up & hold her anytime we want to! Which reminds me, I still owe y’all a picture of her in her ducky outfit…..On second thought, look up cute in the Dictionary & if there isn’t a picture under the definition of cute, well then you probably need to buy a newer edition….J

3. As of last night, Brenna finally lost her feeding tube, which means that she has taken all her feeds by bottle for over 24 hours (she eats every 3 hours). Again, this is something that comes with maturity, somewhere between 34 & 36 weeks (Brenna was 35 weeks yesterday) babies begin to acquire the ability to suck, swallow & breathe. She must be able to take her entire feed within 30 minutes by bottle or breast. This is a lot easier said than done, I did not know that (in preemies anyway) this is a learned behavior. What I also did not know is that, apparently, a parent being able to teach this skill (for me anyway, did I miss the class on this?!) is one learned through much trail & even more error. I figure that between my bath time exfoliating blunder & my many initial failed attempts at feeding her (think baby milk bath-or baby milk facial) Brenna will have some of the smoothest & softest skin around……On a personal note, I finally understand why people would cry, cry a lot & then cry some more (with very good reason), over spilled milk….

4. Lastly, & I know what your thinking: ‘with all this good news why isn’t she home?’ So here comes the not quite so good news-Brenna’s weight gain. I know, trust me I know, it seems like Brenna has been gaining weight like a Sumo wrestler preparing for a fight, so what could be the problem?! Initially she was on a 28 cal feed (I think it is calories per mL/cc, but don’t quote me because I am probably wrong -there is a big number 28 on the bottle), but over the past week she has been gradually reduced on the amount of calories & gradually increased on the volume per feed. However, as they make these changes, it is not a zero sum game; there is a reduction in calories as the calories (per something) go down & the volume goes up. Currently we are on a 22 cal feed, & yes as you probably correctly remembered this is the amount she will be Ok to go home on (rarely they will send preemies home on 24 cal), but she is not gaining weight consistently. In the past three days she has been up 9 grams (15 to 30 is average/optimal), up 14 grams & then last night down 4 grams. Not all hope is lost however, instead of bumping her up on a higher calorie feed (read: delaying homecoming), the Dr. instead has ordered that Brenna ‘eat until she can ‘eat no more.’ Let her eat as much as she can (but no less than 45 cc’s) & see if her weight gain begins to stabilize to a consistent amount. What this means (to me anyway) is that the Dr. is still thinking about Brenna going home in the not too distant future, as that is the ONLY reason she hasn’t just been bumped up to a higher calorie feed (ok, this is what the nurse said too).

Well, that is where we are, we should “start thinking about going home”, are “one to three weeks away” & “definitely under a month” to homecoming depending on which Dr I corner & force some sort of vague answer from. All I know is that it is getting close to feeding time & that the next four to seven days are critical. I don’t want Brenna home until she’s ready, but let me tell you Mom & Dad are ready (to be done with the NICU at least). Some of the Moms I know who have already gone home all tell me it ‘sneaks up on you’... this is only true in as much as a watched pot finally boiling sneaks up on you (I guess if you have a ill-timed blink…). All I can ask is Are we there yet…?! How about now...?!