A time to eat, a time to reflux

Josh had several episodes of reflux accompanied by bradycaridas last night.  One of his episodes of reflux was so forceful he had projectile emesis - which was quite impressive.  Josh was not interested in nursing at midnight, so he received a total of 3 bottles of fortified breast milk last night.  After some experimenting we have found a bottle nipple that he likes and is able to eat from without causing him to "drown".   Josh lost 3 grams last night and his weight remains at 4lbs 12oz.  Needless to say Mommy and Daddy are a little frustrated that Josh can't seem to gain weight.

Josh continued to have more reflux today accompanied with bradycardia.  He had one episode so bad he refluxed milk out of his nose after a feeding.  After talking to the medical team for a while this morning, we have decided to make quite a few changes to his medications and routines.  They have stopped the zantac and instead are giving him prilosec, which is once a day (instead of 3 times a day) and tastes somewhat better.  They have stopped his erythromycin because they think it is contributing to the sudden increase in reflux (it can cause thickening of the stomach lining).  Instead he is now going to get reglan 4 times a day.  The plan is to watch Josh for a few days on these medications to see if they improve his symptoms of reflux (there is no way to cure reflux, only treat symptoms). 

In addition to the medication changes, there were also changes to his feedings in the hope that he will gain some weight.  Now after each time he nurses he will be offered a bottle of Similac Special Care formula and he can drink what he wants of it.  Then he will receive 2-3 bottles of fortified breast milk at night time.  The goal is for him to be able to get breast milk at each feeding without wasting milk if he does not want to eat after nursing (milk can only be heated up and used once).  If Josh continues to not gain weight then they will increase his formula and breast milk to be 27 calories per ounce.  Mommy and Daddy are hopeful that Josh will do well with this regimen and be able to start gaining weight.  We are also hoping that he will be interested in and continue to nurse well despite the supplementation.

Josh continues to do well socially.  He is thought to be quite the cute baby by all of his nurses and his parents would have to agree.  He does have quite an opinion about having to take so many medicines  - it can be rather uncomfortable to be too close to him when this happens.  He is starting to have better head control and can hold his head up for short periods of time when he is being held.  He is also starting to put things in his mouth (like his hand and his IV), which is a sign that he is progressing well developmentally.  He has actually already met all of his developmental milestones for a one month old baby (he is considered to be negative one month old developmentally).  Mommy and Daddy are very proud of our little guy!!

Prayer Request;

• Josh would do well with his new eating regimen and have some good steady weight gain
• Josh's reflux would improve with the new medication changes and his stomach lining would heal up from the erythromycin
• Josh would have little to no bradycardia or desaturations (which result from is reflux) so that he will have meet this discharge criteria
• Josh would not get any more infections while in the NICU and his bone marrow would catch up with his growth quickly so his immune system would work well
• Mommy would be able to keep up her milk supply and not become frustrated when Josh won't nurse.

Praise:

• Josh is doing well with his developmental milestones!
• Josh is holding his body temperature well
• Daddy is feeling better and hopes that after another day or two of herbs and vitamins that he will be cold symptom free

(Josh is having a good time lately taking his hat off and doing different things with it)

(Sweet boy waiting to have his diaper changed before his feeding)

(Big boy sucking on his fingers)

(Yeah!!  It's time to eat!!)