XP: Latest Dish on Adalyn! Update 3/13

DrRx · March 2012

Hi everyone!! Things have been going well, so let's get started!

Breathing
At 4pm they transitioned Adalyn over to the Hi-Flo nasal cannulas from the CPAP. They've tried this before and she has miserably failed it. However, as of 5:30pm (last time I called to check), she is holding strong and doing good on them. Now, it is still early, and she very well may go back on the CPAP, but this is the longest that she's ever been on the cannulas, so I'll take what I can get! Let's hope that she keeps it up and is able to stay on them until she makes the final step and doesn't need anything!

Feeding and Weight
She now tips the scale at 2 pounds 15 ounces (1.33 kg)!! Yay! She is almost at 3 pounds! She is that much closer to wearing clothes at 3 pounds 5 ounces (1.5 kg) and living in an open incubator at 3 pounds 12 ounces (1.7kg)! Her head circumference is 10.4 inches (26.5cm), which is an increase from her birth head circumference of 9 inches (23 cm).

She was getting 27 ml of breastmilk every 3 hours, but today we tried something different. For the last few days, usually somewhat after she eats, she has been having a brady (decrease in heartrate) and a decrease in her oxygen saturation and either I or the nurse has heard her cough.

This could be that she is experiencing reflux, which is extremely common in preemies since their esophageal sphincter isn't mature enough to prevent the stomach contents from coming back up. It is also common for the children to have the bradys and decrease in O2 (oxygen) saturation when they have reflux. So, today the doctor is having her get her food fed to her slowly over a 3 hour period, with a 1 hour rest in between, all day long. They call it a cycle feed. They usually only do it when babies are unable to digest all their food, but since she has been having those episodes, her MD decided to give it a whirl and see if it helps, especially since he switched her to the Hi-Flo. We don't want her to fail the Hi-Flo only because she is having the reflux, you know? He will switch her back to regular feeds in the next few days depending on how she does.

Vision
So, more than 80% of preemies who weigh less than 1kg at birth and were born before 30 weeks will develop Retinopathy of Prematurity, ROP. Of those who get ROP, 91% have it resolve on its own. However, it is a very serious condition if it is not treated early enough, and is a potentially blinding disease. Stevie Wonder is a famous person who is blind because of ROP (well, according to Wikipedia, which is where I think the nurse who told me got it from).

A normal full-term infant has a nearly fully formed retina. Blood vessels grow from the back of the eye to the front, with this process completed just after birth. When a baby is born prematurely, the retina is only partially formed. The blood vessels have started to grow, but have not into the whole retina. The greater the prematurity, the greater the amount of undeveloped retina. If it is not treated, partial or complete retinal detachment occurs, which is what leads to permanent vision loss.

ROP is classified into different zones denoting how much the vessels have grown, zone 1 being the shortest and zone 3 being fully grown. Then, the disease is classified into stages, 1,2, 3, 4, and 5. Stages 1 and 2 do not lead to blindness at all, 3 is borderline, 4 means partial detachment, and 5 means complete retinal detachment. So, the best would be Zone 3 and Stage 1 and the worst would be Zone 1 and Stage 5.

Yesterday the nurse for the pediatric opthamologist who specializes in ROP came in and took pics of her eyes and today he examined her as well as looked at the pictures.

He diagnosed her with ROP, Zone 2 and Stage 1. He said that where the blood vessels stop at Zone 2 is closer to Zone 3 than to Zone 1, so it is pretty far out (which is good). He said that her case is very mild and what he would expect for a 27 weeker. I told him that she was actually a 26 weeker, and he said then that she is actually doing better than what he would expect for a 26 weeker!

He said that this is a good report, and that it could be a lot worse. They will continue to monitor her and will re-examine her in 2 weeks. His prognosis is that there is a good chance that the ROP will resolve on its own and that she won't require the injections in the eye or the laser surgery. However, she is at increased risk for lazy eye or the need for glasses at a young age. Therefore, she will need to be closely followed by an opthamologist for quite some time, but that if things are caught early, generally the prognosis is positive.

Kangaroo Time
It is still going really well. She has been tolerating being on momma for 2 to 3 hours at a time twice a day! Today, however, since she had her eye exam and was poked and prodded, we only did it for an hour. She wanted to be left alone and did a lot better on her oxygen saturation when we put her back in her incubator. As much as I wanted to hold her, I knew that she would do better without all the stimulation and I really wanted her to have the best shot at the nasal cannulas. DH is going to do Kangaroo time tomorrow in the morning since I have a phone conference for my part-time job. I wonder how she will feel about his chest hair??

Sorry it's been a few days, but time has literally been flying! Losing that hour this weekend didn't help things either! The pic is of her last night, with her eyes open wide and waving hello for the camera!

Thank you for all your thoughts and support! For those keeping track, today is Day 39 in the NICU. Hopefully we're at least halfway through by now! Smile