Watch out for eye boogies

Josh had a much better night last night than he did the day before.  He only had a few desaturations and A's and B's after they bumped his oxygen back up to 50 ccs per minute.  This morning Josh's oxygen saturations were good at 100%, so the nurse was able to wean him down to 25cc of oxygen and he seems to be tolerating this well.  He only had one episode of apnea during the day today, so we are encouraged by this.

Mom and Dad came in to the NICU 2 today to see that Josh was resting very comfortably.  In fact, he looked so peaceful we delayed holding him for more than an hour because we didn't want to disturb him.  The nurse told us that Josh has started having some yellow discharge coming out of his left eye, and part of his eye is inflamed.  So they sent the discharge off to be cultured to see what type of organism is causing the infection.  When an adult gets an eye infection, it will generally stay there, especially if it is treated.  With a preemie, their immune system is not fully developed, and so a simple eye infection can spread throughout their body through their blood and become something much worse.  The doctors ordered blood cultures to be drawn for Josh, and they have started him on antibiotic eye drops.  Once his cultures come back, they will know if he needs more or different antibiotics.

Josh is continuing to get bigger, and chunkier.  He gained 40 grams overnight, and now weighs in at a hefty 1630 grams or 3 pounds 9 ounces!  We can't wait until he gets big enough to hold his own body weight.  Once that happens, he will be moved out of his heated isolette into an open "basinette" type container.  He will then be able to start wearing clothing, we are looking forward to that day.

Both Mommy and Daddy got a chance to share some time with Josh, with him all bundled up.  He did pretty well being out of his isolette.  He did have some desaturations, but the nurse thought they were related to reflux and Josh did much better when he was held with his head angled up.  Both Mom and Dad enjoyed getting to spend some time interacting with Josh and of course giving him some kisses.  Josh continues to be very stretchy and continues to reposition himself frequently.   He also makes the cutest facial expressions, which we enjoy watching, especially while he sleeps.

Prayer Request:

• Josh would do well with his oxygen at 25 cc and would not have many episodes of apnea and bradycardia
• Josh's eye infection would heal up quickly and would not spread to his blood stream
• Josh would continue to gain weight and become stronger everyday so that he gets closer to going home
• Josh would develop his suck, swallow, breath reflex soon so that he can begin taking his feedings orally
• Josh's reflux would decrease so that he is not having pain or desaturations because of it

Praises:

• Josh is up to 3lbs 9oz!!
• Josh continues to grow stronger and is moving around well on his own
• Mom and Dad got to hold Josh today and spend some time bounding with our little guy
• Josh's eye infection was found quickly and hopefully did not spread

 (Look at those chunky cheeks!)

 

 (Josh enjoying a little nap - doesn't he look so peaceful)

 

 (Josh sleeping in Mommy's arms)

 

 (Isn't he just the cutest baby ever?)

  

 

(Josh and Daddy having a very in depth conversation about his breathing)

The roller coaster ride continues

Josh had an up and down day today.  He gained 20 grams overnight to 1590 grams, or 3 pounds 8 ounces!  He had a good night, with very few desaturations or A's and B's.  In the morning, the doctors decided to try to wean him completely off of his oxygen (he has been getting 50 ccs per minute of oxygen).  Well, Josh did not like this at all, with his oxygen saturation going down immediately, and not coming up very well.  They then decided to bump up his oxygen to 25 ccs per minute, and he seemed to be doing better.

The doctors said that they want to challenge Josh, and babies being on oxygen is one of the biggest things that keep them in the hospital.  The good thing about all of this is that when they first put Josh on the pedi-flow nasal cannula a few days ago, he could not handle being on 25 ccs per minute, which is why they put him on 50 ccs per minute.  It looks like he might be strong enough now to be able to handle 25 ccs per minute.  They will try to ween him down again in a few days.

The doctors also told us that they have pretty much decided that most of his apnea and bradicardia is from acid reflux, which they are finding out is a dominant genetic trait.  Mommy's Mother had it, Mommy has it, and it looks like Josh may have it too.  The good thing is that now that it has been diagnosed, Josh may be able to be given something for it when he gets a bit bigger, and will probably go home with reflux medication.

Josh did well with his breathing for most of the afternoon, but in late afternoon he started having more episodes of desaturation, with accompanying bradies.  He did this for about 20 to 30 minutes, before going back to good breathing.  We aren't really sure what the reason is for this, and hope and pray that Josh gets stronger so that he does this much less often (if at all).

UPDATE:  We just spoke to Josh's night nurse who said that she had increased his oxygen back to 50cc and he was doing much better.  He had not had a desaturation since she came on at 7pm.  Even though they had to go back up on his oxygen, we hope it means he will have a better night.

Prayer Requests:

• Josh handle his oxygen flow of 25 ccs per minute well, and that he can be weened off of that soon
• Josh continue to breath well, and not have any A's and B's, or decreased oxygen sats
• Josh not get sick or develop an infection while in the NICU
• Josh continue to gain weight consistently and be able to hold his body temperature so that he can come out of the isolette
• Mom's milk supply increase to match Josh's current and future needs

Praises:

• Josh is down to 25 ccs per minute of oxygen... only one step below completely breathing on his own!
• Josh is up to 3 pounds 8 ounces!
• Josh continues to do well on his feedings

 (Josh enjoying a good nap when Mom and Dad arrived today - look at that double chin)

 

 (Having my oxygen saturations go up and down so much is tiring)

 

 (Josh taking a peep at Mommy, Daddy and Grammie)

 

 (Sweet little guy taking another nap when we left - he puts himself in the funniest positions)

I spy with my little eye

Josh started his second day at the NICU 2 well.  He gained 10 grams, and is now at a total of 1570 grams (still 3 pounds 7 ounces).  Josh has been tolerating his continuous feeds of 10 ml per hour pretty well.  He did spit up some food today, but his A's and B's have been decreasing some.  He had a relatively quiet day today, and was asleep for most of the day.

One big thing that hapenned today was that Josh had his first eye exam.  One danger that preemies face is that there is a delicate balancing act concerning the amount of oxygen that they get.  The most important thing when they are first born is that they have to be able to breath and get oxygen in their blood.  Because a preemie's lungs are underdeveloped, they usually require higher than room air (21%) oxygen just to be able to breath.  However, their eyes are also underdeveloped, and high levels of oxygen can lead to retinopathy of prematurity, where the oxygen actually damages their eyes.  So their blood oxygen levels are monitored closely, and the goal is to give just enough oxygen to keep their blood oxygen at an acceptable level, but not too much that it damages their eyes. 

A level of oxygen that is considered to be "high" for a preemie is anything over about 50%.  Fortunately, Josh's lungs were developed enough when he was born to where he rarely required a high level of oxygen.  When the doctors performed the eye exam, they grade on a 3 level scale.  It measures the amount of blood vessels in the eye, with 3 being blood vessels supporting the entire eye, and 1 being a low level.  Josh graded out to a 2, which is appropriate for his age and level of prematurity.  They will continue give him eye exams every 2 weeks, and we hope that as he grows, his score will increase to a 3 by the time he is discharged.  If not, then Josh will continue to have regular eye exams once he is discharged.

Josh continues to have good breastfeeding and bonding time with mommy.  Josh seemed to have more episodes of desaturation and apnea/bradicardia during kangaroo time than he normally has, which give mommy and daddy some cause for concern.  Josh may have just been having a bad day or sleeping very soundly, but he did not seem to be his usual active, stretchy self today.  We pray that he gets good rest tonight so that he can be back to himself tomorrow, and that he is not getting sick.

Prayer requests:

• Josh get good rest tonight so that he can have some good awake periods with mommy and daddy
• Josh be protected from any infections, and that he not get sick
• Josh continue to have less A's and B's or desaturations, and that they go away soon
• Josh continue to gain weight consistently and regularly
• Mom's milk supply increase to meet Josh's current and future demands
• Josh continue to grow stronger to be able to exclusively breastfeed

Praise:

• Josh's eye exam went well and there are no signs of retinopathy of prematurity
• Josh is up to 1570 grams, 3lbs 7oz
• Mom and Dad have the freedom to hold Josh more often now that he is in the NICU 2
• Josh continues to do well with breastfeeding attempts

 (Josh trying to get some peace and quiet as he sleeps)

 

 (Somehow Josh is comfortable in this position)

 

 (Mommy just told Josh that is is Kangaroo care time!)

 

 (Mommy and Josh sharing a tender moment)

   

(A very happy mommy kangarooing with Josh)

The big move

Mom and Dad got up at 1am to pump and made their nightly call to see how Josh was doing.  When the clerk at the NICU 3 desk answered the phone, we were told that Josh had been transferred to NICU 2!  We were quite surprised to hear this as no one had mentioned that we were so close to this happening (although we knew were were close).  NICU 2 is a different world and will take some getting used to.  Dad went by on his way into work to scope things out.  The beds are much closer together, with only about 3-4 feet of personal space between them.  The parents are more hands on and the nurses take care of 4 patients each.  When Mom arrived, the nurse told Mom that she could take Josh out of the isolette by herself and hold him if she was comfortable.  Needless to say Mom was very surprised by this since we have not been able to do this in the NICU 3.  With a little instruction, Mom was able to pick up Josh (and all his wires and tubes) and hold him... then Mom and Dad were able to do it by themselves this afternoon.  Josh enjoyed sleeping in his parents arms as much as they enjoyed having him there!

Josh had a good day today.  He had 6 episodes of apnea last night, so they increased his caffeine dose today (which had not been adjusted for his weight increase in a while).  They are hopefully that this will decrease is apnea episodes.  Josh continues to do well with his pedi-flow nasal cannula at 50 ccs. 

Josh is still receiving his continuous feedings.  The rate was increased to 10ml per hour to keep pace with his weight gain.  Josh gained 30 grams last night is now 3lbs 7oz.  Josh continues to do a good. Josh is doing better at holding his own body temperature, needing the help of the isolette less.  The doctors also removed the tube being used to vent his tummy since he is not on the high flow nasal cannula anymore. Josh and Mom got to spend some time this morning and again this afternoon working on breastfeeding.  Josh continues to do a good job.  After talking to the doctors during rounds today, it was decided that if Josh has a good weekend then early next week Mom and Josh will be able to try breastfeeding without pumping first.  Mom and Dad are very excited to see how Josh does with this new activity!

Josh continues to be very active and seems to be adjusting to the NICU 2 well.  He did have a pretty long awake period this morning, which might have been related to increased noise levels in the NICU 2.  Mom and Dad are hoping that Josh will be able to get the rest he needs and that the noise level isn't always that loud. 

Prayer Request:

• Josh would have fewer or no episodes of apnea and that his brain would continue to mature so he would not need the caffeine any more.
• Josh would continue to tolerate his feedings and continue to gain weight steadily
• Josh would continue to do well with his breastfeeding and continue to grow and mature in this area
• Josh, Mom and Dad would quickly adjust to the NICU 2 and the new routines
• Josh not get sick or get any infections while in the NICU 2

Praises:

• Josh was transferred to the NICU 2 were he will spend time feeding and growing
• Josh is up to 3lbs, 7oz and doing well with his breastfeeding attempts
• Josh is continuing to do well with his pedi-flow nasal cannula
• Mom and Dad are able to pick Josh up from his isolette and hold him more often now

(Josh resting comfortably this morning when mommy arrived)

 

 (Josh and mommy enjoying some time together)

 

 (Isn't that a happy looking mommy?)

 

 (Josh... the jello baby version... after some good cuddling from both mommy and daddy)

A breath of fresh O2... a new pedi-flow nasal canula adventure

So Josh had a better night last night. He still had some episodes of apnea/desaturations, but fewer than the night before. Josh seems to be tolerating his 24 hour feeding a bit better than before. His belly is actually a little smaller and he seems to be refluxing in his venting tube a little less. The doctors seem to feel that it is making enough of an improvement that they did not make any changes to his current feeding plan today. Josh gained 20 grams is now up to 3lbs 6oz.


They did however decide to change his nasal cannula around a bit. instead of getting the high flow nasal cannula (where is pushes in air at a high rate with a little bit of oxygen) he is now on a pedi-flow nasal cannula (where he is just getting a small amount of oxygen without the high flow rate). Although the cannula looks the same, the flow coming out of it is different. Josh started the morning out on 100cc of nasal cannula and they were able to wean him down to 50cc, which is a very little bit of oxygen. The nurse tried him on 25cc but Josh started to have decreases in his blood oxygen, so she went back up. He seems to be tolerating this well and seems to like it better than the high flow nasal cannula. Josh has had a few episodes of apnea today, but it is hard to tell if they are related to his feedings or related to the change in his nasal cannula.

Josh has been very active today. He is constantly moving and stretching when he awake or semi awake. He especially likes to reposition himself once the nurse or Mom has him all settled in. It is funny to watch him get into what look like the most uncomforable positions. He feels the need to be independant when it comes to positioning and we are happy to let him as long as it doesn't effect his breathing. Josh also managed to pull out his venting tube this morning and was unhappy when it had to be reinserted. One day he will learn that when you pull it out it gets put back in.

Mom decided to give Josh a day to get used to his new oxygen rate on his nasal cannula before trying him again with breastfeeding. We didn't want to have too many changes to in one day. Mom continues to enjoy being able to use the netbook and skype to keep our families updated on Josh's progress and provide some live views of our little guy. Mom and Dad also enjoy being able to chat with each other during the day and share some of Josh's awake time too. Modern technology at its finest!!

We are also happy to report that Uncle Steve drove down today from Jacksonville to donate blood for Josh. Thank you Uncle Steve!!!

Prayer Request:

• Josh would continue to do well with his pedi-flow nasal cannula and would be able to be weaned off of the oxygen
• Josh would have less episodes of apnea/desaturations
• Josh would have less reflux with his 24 hour feedings
• Josh's brain would continue to develop steadily so that he is ready to start actual feedings in the next week or two

Praise:

• Josh is up to 3lbs 6oz!
• Josh is doing well with his new nasal cannula
• Josh is becoming increasingly active and is moving around more
• Uncle Steve was able to come down and donate blood for Josh
• Dad, Mom and Josh are thankful for our family and friends who are so supportive as we continue on this adventure together.  We couldn't make it without you!

 (I sense a familiar presence... who could it be?)

 

 (Oh, it's my mommy!)

 

 (Um... I really enjoyed our kangaroo time yesterday.  Can we do it again?)

 

 (Pretty please?  Who can resist this face?)

 

 (Ah man... mommy has the sniffles... I guess I will go back to sleep.)

 

 (Mmm... napping is fun.  Wait... is that a camera?  Make sure to get my good side!)

The return of Kangaroo time!!!

Josh had a rough night, having many episodes of desaturation (decrease oxygen in the blood) and apnea last night. This resulted in the nurses suctioning his nose many times during the night.  The suctioning causes his little nose to bleed (and hurt we assume).  It also doesn't look very good because his little nose has dried blood on it. All of this makes for a "bad" looking baby, even though he is doing ok.  To hopefully decrease his apnea/desaturations and nose suctioning, they have changed Josh to continuous gastric feedings.  So he gets 9ml of breast milk every hour in his tummy.  This is supposed to decrease the volume in his tummy and hopefully prevent his reflux.  They also added a second tummy tube (oral gastric tube) that is vented all the time to provide Josh with a way to burp and reflux if he needs to.  So far, he has only had one episode of desaturation/apnea since they made this change this morning.  Mom and Dad are hopeful these changes will decrease Josh's reflux, apnea/desaturations and pain.

In other news, Josh is doing well with his feeding (except for the reflux).  He gained 40 grams last night and now weighs 3lbs 5oz!!!  He is also 15.5 inches long now.  He is getting to be quite the big boy!!!  Josh continues to be able to hold his body temperature needing less support from his isolette.  He should need the isolette less and less with the more weight he gains.

Mom and Josh got to attempt breastfeeding again today.  Josh did very well, latching on and sucking a little bit.  Mom was very pleased with his efforts and feels he is making good progress for such a little guy.  Afterwards, Mom and Josh got to have some extended kangaroo time.  Then when Dad arrived, Mom and Dad traded off and Dad got some kangaroo time too!!  Josh was out of his isolette for about 3 hours, which is his longest time so far and he did very well.  He was able to maintain his body temperature the whole time, which is quite a feat, especially on one of the coldest days of the year.

Josh continues his quest to help his recovery any way he can.  Sometimes that means he "helps" remove his tubes.  Sometimes that means he tries to scootch out the isolette doors.  Today Josh was doing lots of stretching and mobility training.  At one point it looked like he was trying to swim out of his snuggli.  Josh continues to reposition himself after the nurses have gotten him all snug in his bed.  We aren't sure if he does it to be more comfortable or just because he can.

Prayer Request:

• Josh's new method of feeding and venting would prevent him from having any apnea or desaturations
• Josh would continue to steadily gain weight and grow big and strong.
• Josh would not develop any infections while in the NICU or get sick
  
• Josh would continue to do well with his attempts at breastfeeding and develop his suck, swallow, breath reflex soon so he can begin real feedings soon

Praises:

• Josh is up to 3lbs 5oz!
• Josh continues to be very active and helpful to the nurses
• Mom and Dad both got some good kangaroo time with Josh today
• Josh did well with his second attempt at breastfeeding today

 (Josh basking in the sun this morning)

 

 (Josh being a big boy with his pacey - gotta build those sucking muscles)

 

 (Josh growing very sleepy)

 

 (Drunk on breast milk and pacey time)

 

 (Mommy and Josh enjoying a moment together - he makes a large lump now when you hold him)

 

 (Daddy and Josh enjoying their own little moment)

Somebody pass the tums

Josh again had several episodes of bradycardia which sometimes include apnea.  He required stimulation for a majority of these episodes.  The good news is they seem to come in clusters around the end of feedings.  It appears that right at the end of his feedings he is having some severe reflux that causes him to either breath shallowly or hold his breath (apnea) because of the pain.  Although Mom and Dad are not thrilled that Josh is having pain that is so severe, there are some good things.  First, the reflux doesn't seem to be occurring with every feeding, it seems to be in about half of his feedings.  Secondly, Josh will eventually out grow his reflux.  We are thankful that his bradycardia/apnea can be explained and it isn't something more serious and that he doesn't need to go back on CPAP.   It is possible that his feeding times could be given over more time or even given continuously.  In fact, Josh had some significant times of desaturation with his 5pm feeding so they changed his feeding time to a hour and half and he seems to be doing much better.

Josh continues to tolerate the volume of fortified feedings that were increased yesterday.  He is now at full feeding and his feeds won't be increased again until he has some more weight gain.  Speaking of which, Josh gained 40 grams last night so new now weights 3lbs 3oz!!  Mom thought he was looking positively chunky with his little double chin, then he stretched out to his full length and you can see that all his chunkiness is in the middle of his body (face, chest, tummy).  He needs some fat rolls in his arms and legs!  The doctor who took care of him his first two weeks stopped by today and thought he looked amazing!!  We would have to agree!

Since Mom is feeling better, she took the opportunity to have some kangaroo time with Josh.  Both Josh and Mommy enjoyed their time together.  Josh also got to have his first attempt at breastfeeding.  Although he is a little young for this to be his primary form of feeding, it is good practice for both Josh and Mom.  Josh did a good job on his first try!  He showed some big boy traits such as rooting, opening his mouth, opening his eyes, and attempting to do some sucking.  Mom and Dad are very proud of his effort and hope to continue to work on breastfeeding as much as possible.

Josh continues to amaze us with his abilities.  Last evening his managed to do a two handed pull on his feeding tube and pull it out.  Today he has been very fond of turning his own head.  He is getting quite strong and is able to pick his head up for short periods of time as well.  Today when Mom was kangarooing he picked his head up several times to readjust himself.  We are very proud of his little guy and how strong he is becoming.

Prayer Request:

• Josh would have a decrease in his reflux with the longer feeding times and that would prevent his bradycardia and apea
• Josh would continue to put on weight steadily and grow big and strong
• Josh would do well with attempts at breastfeeding and he would develop good reflexes (rooting and suck, swallow, breath)
• Josh would not develop any infections while he is in the NICU

Praises;

• Josh is up to 3lbs, 3oz!!  And has had 3 days of steady weight gain
• Josh is getting bigger and stronger and is able to move himself around more
• Josh did a good job at breastfeeding today
• Mom is feeling much better and Dad is fully recovered from his illness

 (Josh (aka peepers) peeking at Mommy when she arrived today)

 

 (A content Josh with his pacey and his hand on his tube during a feeding)

 

 (Look at that baby...who could sleep like that?)

 

 (Jello baby after some good kangaroo time with Mommy)

 

 (Uh?  what?)

 

 (Josh being a good boy and waiting for Daddy to come - Daddy told him to be awake)

(Big Boy Josh turning his head all by himself to find a different view)

WEEEEEE the return of the roller coaster

Josh had a rougher than usual night last night, with multiple episodes of apnea/bradicardia or desaturations.  He recovered from many of these on his own, which is good.  The episodes also seems to be clustered together and are usually related to his feedings.  The nurse practitioner said that Josh is still having a tolerable level of episodes, and that they will continue to watch him, but that if the number increases then he might have to go back on CPAP.  She also said that it is possible most of these episodes are related to reflux and if the primary team feels that is the case, then there are some alternatives we can try.

The doctors are going to run some more labs tomorrow to check to make sure that Josh does not have an infection, which may be the cause of the increases episodes.  The nurse practitioner does not think that Josh has an infection, because he was just recently on a round of antibiotics, is very active, has good color and he is not showing other signs of infection (weakness, poor skin color, etc).   So the labs are precautionary, which we don't mind doing if it helps them to make good decisions on Josh's care.

Josh is tolerating his feedings like a big boy, with very low to no residuals.  They have increased his fortifier to give him more calories per feeding and help him gain weight steadier.  His weight is up 10 grams today to 1430, which is still 3lbs 2oz.  Because Josh is dong so well, they removed his PICC line today!

One good bit of news that we got was that the nurse practitioner said that she did not think that there was any reason why not to try starting Josh on breastfeeding.  Since he is off of the CPAP, he could at least try to start.  The worst thing that could happen would be that he might choke and sputter a bit on a mouthful of breastmilk, since he may not have the coordination of sucking, swallowing, and breathing yet.  If this were to happen, he would just wait a bit longer before trying again. To give him a better chance, Mom will start with trying to "feed" him after she has pumped so he isn't overwhelmed with milk in the beginning. Josh has shown that he has a decently stong suck reflex, and so we may try this soon, once Mom is sure she isn't infectious. 

Mom continues to recover from her cold and is feeling better today.  Both Mom and Dad are tired today, probably because of some late night football on Friday (Go Gators!)  We are hoping to catch up on our sleep some time in 2030.  We are both looking forward to being able to touch and hold Josh again very soon (we have to feel comfortable doing so after being sick), we miss our little guy.

Prayer Request:

• Josh would have a decrease in the number of desaturations and apnea and would not have to go back on CPAP
• Josh would not have an infection (or get one) and that his labs tomorrow would look good
• Josh would continue to tolerate his feedings with fortifier and gain weight steadily
• Josh's reflux would decrease and he would out grow it quickly
• Mom would be able to begin working with Josh on breastfeeding soon and that it would go well
• Mom and Dad would both get to rest and Mom would continue to feel better

Praises:

• Josh is tolerating his feeding with fortifier
• Josh is steadily gaining weight everyday
• Josh is very active and had some good awake time today
• Josh and Mom will get to begin the adventure of breastfeeding soon

 

 (Josh resting comfortably when Mom and Dad got there)

 

 (Look at those chubby cheeks developing!)

 

(Josh and his full head of hair)

 

 (Josh got into this awkward looking pose by turning his head all by himself - even though we wanted to move him, he seemed comfortable)

 

 (Oh my!  Why was I flipped over?  I was having so much fun scooting around!)

 

 (Hey, that's Mommy and Daddy!  Where did my hat go?)

 

 (I am getting sleepy now)

 (Josh sporting his new feeding tube that goes down his nose... this will make breast feeding easier!)

Its the amazing growing baby!

Josh had a good night last night, with only a few desaturations.  Josh's nurse gave Mom and Dad a bit of a scare by saying that his belly was bigger, and she was going to have to talk to the nurse practitioner about it, and then said that it probably was nothing.  Way to make a set of new parents feel great at 1:00AM!?!?  When we called again at 5:00AM, she said that Josh had a very big poop and his belly was back down to normal size.  Mom and Dad were very relieved and thankful for that.

Even after his big poop, Josh still managed to gain 20 grams.  This puts our little man at 1420 grams, or 3 pounds 2 ounces!  He has officially gained one pound from his birth weight, and 1 pound 3 ounces from the lowest weight he was measured at!  Josh's feeds have been increased to 27 ml per 3 hours, which are full feeds for Josh.  Because Josh is back up to full feeds, they started putting the fortifier back into the breast milk in order to add a few extra calories and help Josh gain weight more consistently.

Josh's air coming through his high flow nasal canula (HFNC) has been fiddled with a bit.  His oxygen was reduced to 21-percent (room air), but the flow rate was increased.  This seems to have helped out, and he is keeping his oxygen saturation up much better and having less bradicardias.  Josh continues his quest to remove his nasal cannula but with a twist.  He has taken to putting it back in himself!

Overall, Josh is doing very well.  So well in fact, that it is almost impossible not to think about the criteria that he would have to meet in order to be discharged.  The progression of his care is that he must first be transferred to the NICU 2, which is the step down unit from the NICU 3, where he is.  In order for him to move down to the NICU 2, he needs to meet the following:

1. Be off of the ventilator or CPAP
2. Be off of any IV fluids or IV nutrition

Josh is very close to being ready to go to the NICU 2.  Once he makes it down to the NICU 2, the milestones that he needs to reach to be discharged are the following:

1. Must not have any apnea or bradicardia for 1 week
2. Must be able to maintain his own body temperature (usually starts at over 1,800 grams [4 pounds])
3. Must be off of oxygen
4. Must be taking his feeds completely orally (not by feeding tube)
5. Must be gaining weight consistently

So these two lists are things that everyone can be praying for as the day comes closer for him to be transferred to NICU 2 and then to be discharged.

Prayer Requests:

• Josh continue to tolerate his feeds well, and that he not have any reflux (which causes him pain and he stops breathing)
• Josh continue to gain weight
• Josh have constant, high oxygen saturations so that he can stay on low oxygen levels
• Josh not get sick or develop any infections
• Josh's suck, swallow, breath reflex would develop quickly so that he will be ready to start breastfeeding in the next few weeks.
• Mom continue to get better and that Dad not get sick again
• Mom's milk supply increase to meet Josh's needs
  

Praise:

• Josh is up to 3 pounds 2 ounces!
• Josh is back up to full feeds with a fortifier!
• Josh is doing well overall and making progress toward going home
• Josh is starting to need less help from the isolette to maintain his body temperature

(Josh resting like a little angel this morning)

(Hey there Daddy!  Where's Mommy?)

 

(Look at that beautiful blond hair!)

 

 (Are you still taking pictures of me Daddy?  I'm trying to sleep!)

It's a New Years baby!

As Dad is fond of random trivia, a random fact for today (courtesy of Dad's older sister's stay in South Korea) is that if Josh were to give his age in "Korean age" then he would be 2 years old today.  That is because a person is 1 year old in the year you are born, and each subsequent year you go up by one, no matter when that year you were born.  So Josh was 1 year old when he was born in 2009, and then became 2 years old in 2010.

Josh had a better night last night than the night before.  When Dad came in to the hospital (Mom unfortunately cannot spend a lot of time with Josh because she is sick), Josh was sleeping comfortably.  He had a few episodes of A's and B's, but it was most likely because he was on his tummy, and for some reason he is not liking that right now.  He likes his sides a lot though and he has not had any episodes at all while on his side.

Josh is getting to be a big boy!  We have crossed the 3 pound barrier!  After losing 20 grams yesterday, he is up 80 grams today to 1400 grams (3 pounds 1 ounce)!  Josh is also up to 25 ml feeds every 3 hours!  That is pretty close to full feeds, and 3 ml more than last time.

Dad had some fun with Josh today.  He got to change his diaper, take his temperature, and do his chest PT.  Josh definitely does not like the chest pt.  It is basically taking something that vibrates like a cell phone, and rubbing it all over his chest, sides, and back (everywhere his lungs are).  Mom got to spend some time with JKosh and Dad via skype today.  Mom and Josh enjoyed hearing Dad read some nursery rhythms. Mom also got to see Josh briefly later in the day.

Other than that, Josh had a really good day today.  He continues to put on weight, and have good breathing, and has not gotten sick or developed any infections.

Prayer Requests:

• Josh continue to breath well with few to no episodes of A's and B's
• Josh continue to gain weight and handles his feeds well
• Josh not get sick or develop any infections
• Mom get well quickly while on her antibiotics

Praise:

• Josh is over 3 pounds!
• Dad is feeling great... should be able to come off the mask at the NICU soon
• Josh is up to 25 ml feedings

 (Josh sleeping in is most comfortable position... leg and arm sticking out... when Dad got there this morning)

 

 (Good morning daddy!)

 

 (Josh says hello to mommy through the webcam)

 

 (Josh snug as a bug in a rug after his hands-on)

 

 (Doesn't that look like a happy baby?)