XP: Pffffffth! (raspberry) *Adalyn 2/27*

Breathing

So, apparently there are different kinds of CPAP machines, although they use the same mask.  Adalyn has been on a type of CPAP machine called BiPAP--a biphasic CPAP.  It allows them to give her more control over the pressures when she breathes in and when she breathes out (biphasic) instead of just giving the 1 continuous pressure that a CPAP does.  It can also be set with a low rate of breaths to help her "remember" to breathe, which has been set at 5.  Compared to CPAP, it could be considered higher breathing support.  Well, when we went in this morning, she was put on the regular CPAP machine! Her blood gases have been doing very well, so her MD felt that she could step-down to the regular CPAP! Her oxygen requirements have ranged from the mid-20s to the high 30s, and she usually needs more oxygen during her Hands On times.  Once you leave her alone, she settles down and they wean her oxygen back down.  She gets particularly annoyed when we do her Hands On time at 8am--guess she is like her mom and NOT a morning person.

Feeding and Weight
She is still on 19.5ml of breastmilk, and they are adding the fortifier to give it a few more calories, and she has been tolerating those very well. She went down a little on her weight to 940g (2 pounds 1 ounce) from 950g, but again, that is to be expected since she now has to do all the breathing.  The more she sleeps, the more growth hormone is released, and the quicker she will gain weight.  Also, we're now able to do Kangaroo time (I'll talk about that in a moment), and that has been shown to also help with weight gain. 

Kangaroo Care
What we can now start doing, since she is not on the ventilator, is pretty stable, and weighs over 2 pounds, is something called Kangaroo care.  It gets its name since kangaroos have their babies, in essence, prematurely, and finish out their development in the marsupial sac.  Basically, it involves skin-to-skin contact of baby and mother for a period of time.  It was developed by a couple of neonatologists in Bogota, Columbia in the late 1970s because incubators were scarce in their unit and they had mothers have their babies on them, skin-to-skin, 24 hours a day, to help regulate their body temperatures.  They found that babies who did this gained weight faster, stabilized their oxygenation better, had less infections, and overall had shorter hospital stays.  It has become a standard practice in many NICUs in the US, and the neonatologists at Adalyn's hospital are big supporters of it once baby can tolerate it. 

Yesterday we did a little trial to see how Adalyn would do outside of the incubator being held by me for a short period of time.  I sat in the rocking chair, she was wrapped like a burrito loosely, and I just held her for about 20-25 minutes.  She did great and oxygenated high!

As I sat yesterday holding her for a few minutes, she opened her eyes a few times, but mostly slept.  She is so tiny! She's like a burrito from Chipotle or a sub from Subway.  It was amazing to feel her breaths.  My arm kind of fell asleep, even though it was on a pillow, but I was able to fix it without disturbing her. 

So, today, I'm going in about 1 hour before her Hands On and we're going to do my very first skin-to-skin Kangaroo Care!  They will check her temperature at 30 minutes, and if it is fine, then she'll get to stay on me for 1 hour.  The bigger she gets, the more "sessions" we'll get to do.  Right now, it will be restricted to 1 time for 1 hour per day. 

Miscellaneous
They no longer have to weigh her diapers or check her blood sugars! Less heel pricks makes Adalyn a happy girl! My dad disagrees with me in what she sounds like when she cries--he thinks it is more like a newborn puppy than a kitten.   The nurse did say that she is hoarse because she had been intubated, so her cry will definitely get louder. 

She gets pretty mad when she has a dirty diaper or when she isn't fed on time--definitely a diva! She also prefers to lay her head a certain way, and last night she was trying to lift her head up to change it! The nurse said that if she didn't have the CPAP mask, she might have been able to do it! She LOVES laying on her belly (as do almost all preemies) and it is safe for her to do this now because she is on monitors.  She'll have to learn to live with sleeping on her back when she gets home, but by then she will be big enough to be properly swaddled.  She is a big fan of having boundaries, so being swaddled will definitely help her.

On my way home yesterday from the hospital after I held her, the realization hit that sooner, rather than later, she will be home!  I mean, she could be home in as little as 6 weeks, but probably closer to 10.  Regardless, we have still so much left to do! Her room is not even really started! At least we do have the crib and dresser bought, and I think that I'll start putting that together (with DH doing the grunt work of moving the pieces) when DH is off from work.  I'm not going to worry too much about decorations or wall hangings yet--just get the basic stuff done.  In between all the pumping, visiting the NICU, and DH working, I think that it will take us a few weeks to get the basics put together.  I would rather get that done sooner rather than later!

Let's hope that she keeps on this positive path today and gains some weight! I can't wait to go see her in a few hours for my very first official Kangaroo Care! Here's a pic of her blowing a raspberry!