A stable weekend

Jac looking very peacful. When I come in most days I find him in a position very similar to this!

We have all had a very busy weekend. The Chiu's have been in town and we had a nice time visiting with them. This meant less time spent with Jac but as always he was in the care of the doctors and nurses at DCH - although of course I wanted to be there.

Jac is now up to 3.0 ml/hour on his feeds - he has been moving up 0.5 ml/hour each day. He has also increased his weight - as of Saturday night he was 821 grams and his head was 25 cm (up from 23.5 cm) and his length has increased to 34 cm (up from 32.5 cm). He is growing! As imperceptible as it may be! I can see that he is starting to fill out - his cheeks and belly are a little plumper!

The doctors calculate how much nutrition Jac needs on an hourly basis as a function of milliliters per kilogram - which is a function of the number of calories in an ounce of breast milk. At his current weight full breast milk feedings is 5.0 ml / hour - and he is at 3.0 now - so we are getting there. Jac still has his PICC line in which is used to supply him the additional nutrition that he is not getting from breast milk yet. Once they get the breast milk amount up they will fortify the breast milk to add to its nutritional content and to add the additional electrolytes and vitamins that he needs. It will be an exciting day when he gets his PICC line out. He has not had use of his right hand for several weeks - and it will be very calming for him to be able to bring both of his hands to his face and more easily touch them together.

Jac's phosphorous level is still being monitored closely, His level has been stable for a week or so but they continue to monitor it closely. Phosphorous is used to to make ATP and is required for muscle functioning. His PICC line removal may be delayed if his phosphorous level starts to move back down as they reduce his TPN and the level of phosphorous in the TPN. The hope is that Jac's body is now maintaining the phosphorous level on its own.

Jac started on Sunday morning to have some reflux. This is like reflux in adults where some stomach acid comes back up into your esophagus. Not good. This is common in preterm infants - and especially so when they have an NG or OR tube as Jac does. The OG tube holds the sphincter at the top of his stomach open and allows acid from his stomach to come back up. We have tilted his bed (even more than it was before) to raise his head above his stomach.

Last night (Sunday night) I spent about 5 hours talking to Jac's nurse. She is specially trained in NIDCAP, which is a way of looking at preterm development through behavior. It is both fascinating and incredibly helpful. Preterm babies canot be treated as small full term babies. Many of their systems are not yet developed and this has to be respected in their care. We spent quite a bit of time doing Jac's cares - and it was really wonderful. We monitored his state and level of organization and did the things we needed to do at his pace. I truly appreciate all of the time she spent talking to me and explaining and also directly caring for Jac. NIDCAP based care is truly challenging as it forces you to empty yourself of whatever else is going on outside the isolette and get in there with Jac and work with him - and his cues - that tell you what he can handle and what he can't.