The adventures of Joshua Alexander Cobb: Baby steps towards discharge

Josh had a great night. He has been doing every 3 hour feedings for the last 24 hours, expect for one time at night. He misses that feeding to give Mom a chance to get more sleep at night. Josh gained 38 grams last night and is now 4lbs 6.5oz!  He is doing well with his feeding averaging 15-20 minutes a feeding. He seems to be getting good milk even though it is hard to quantify exactly how much he is getting.   Josh does seem to have most of his desaturations and bradycardia associated with breastfeeding - this is most likely either related to reflux or a lack of coordination with his suck, swallow, breathe reflex. Josh continues to recieve half a feeding through his feeding tube after each time he breastfeeds.  Mom spent a good bit of time talking to the attending physician today, trying to feel out what comes next for Josh and what milestones we need to reach.

Tomorrow Mom and Josh will try breastfeeding using a supplimental nursing system. The system is designed to increase the volume that baby takes in while not increasing the work required to eat.  The doctors are hoping that this will eliminate the need for Josh to be bolused with half a feeding through his feeding tube after breastfeeding. They are also hoping that it will decrease the effort required to obtain a full feeding which might decrease his bradycardias and desaturations while eating. Josh can go home on this system and it will only be used while he grows more and is able to eat better and grow stronger. Mom and Dad are hopefull this will help Josh with his feedings and be another step towards discharge.

Josh will also continue to his erythromycin for at least 2 weeks after he is discharged from the hospital. The attending feels that it works really well for Josh and that it is the best drug choice because it effects the whole GI tract to increase motility. The drug does have a slight increased risk for thickening of the mucosal lining with prolonged use, but this risk is very small. The attending also feels that Mom and Dad will be able to monitor Josh for signs of this at home and take him to his pediatrician immediately if needed. We are glad Josh will continue on this medication because it has had a huge impact on his desaturations.

Josh also had his caffiene discontinued today. He has been on this since he was born. It is used in preemies to stimulate his brain while the brain is still developing. The main objective is to help Josh's brain to remember to breathe so that he doesn't have any apnea. Josh has been slowly "outgrowing" his dose and today they stopped it completely. It takes about a week for his body to completely be rid of the caffiene, so he will be monitored closely over the next week for episodes of apnea. Mom and Dad are hopeful that Josh will do well and not have any episodes from now on.

Josh graduated from his isolette to an open crib today! We are very proud of our little guy. He has shown over the last few days that he is able to hold his body temperature well in the isolette, so they are giving him a try at being out. So far he has been able to hold his body temperature well for the last 8 hours - despite the fact that the NICU has been very cold today. We are hopefull he will be able to continue to do well in the open crib. Now that he is in one, the nurse try to treat him as if he were home. That means no more tummy sleeping and no more proping him up to help with his reflux. This is another exciting step towards discharge.

Mom continues to room in and has been very thankful for her accomodations. She is staying in a rather large hospital room, which is big enough for two beds with room left over. Mom definitely feels better today after getting to sleep for about four and half hours of uninterrupted sleep. Dad too is feeling better after getting to spend the night at home sleeping in his own bed.   We are very thankful that Mom has been able to secure the room for another night and feel that being at the hospital as much as possible will help Josh come home sooner and ease his transition home.

Prayer Request:

Josh continue to do well with his breastfeeding and that tomorrows trial with the supplimental nursing systme goes well
Josh would grow and mature quickly over the next few weeks so that he does not have any desaturations or bradycardias, espeically while feeding
Josh would do well with having his caffine stopped today and would not have any apnea as it slowly leaves his system
Josh would continue to do well outside of his isolette and not have any problems with keeping his body temperature up and gain weight even though he is using extra calories
Mom and Dad would continue to adjust to their temporary roles and seperation

Praises:

Josh is now 4lbs 6.5oz!
Josh was taken off of his caffine today
Josh is out of his isolette and doing well
Josh is making good step towards going home
Mom and Dad both got some good sleep last night - they are storing it up for when Josh comes home.