A slow weekend

Since today is a weekend day (Saturday), not much is expected to change.  The weekend staff just continue doing what was done during the week.  Josh continues to breastfeed 7 times a day, and is doing pretty well.  His weight increased last night to 2,100 grams (4 pounds 10 ounces).  He still is having the occasional desaturation and brayicardia associated with his feeding, and we found out that they are starting to count them, since he can't have any bradicardia for a week before being discharged.  So we are praying that this will go away soon so that he can be discharged as soon as possible.

Josh slept most of the day, and his parents used the day to rest (Mommy) and catch on a bit on some house projects that have fallen to the side since Josh was born (Daddy).  The one new thing is that Mommy has been trying to use a SNS (supplemental nursing system) to try to give Josh a bit more milk during his feedings, since he is still not able to eat enough milk from breastfeeding alone to continue to gain weight.  The results today were not good, as Josh got too much milk, choked and sputtered some, and then promptly desaturated and had bradicardia.  Mommy will try again when the lactation consultant comes by again.  Josh is however coming more demanding when it is time to eat.  If he is not feed in a timely manner he begins to fuss just a little.  He calms down quite quickly when it is explained to him that dinner is on its way.

Prayer Request:

• Josh grow stronger and feed better so that he can get enough nutrition through breastfeeding alone
• Josh continue to breathe well, and that his reflux not cause any desats or bradys
• Josh continue to hold his temperature well so that he can stay in his open crib
• Josh stay healthy, and not get any infections or get sick while in the NICU
• Mommy and Daddy stay patient and not get frustrated with trying to get Josh ready to come home

Praises:

• Josh is up to 4 pounds 10 ounces!
• Josh has done really well in his open crib
• Mommy continues to be provided with comfortable room to use at the hospital, which provides a convenient place to rest while still staying close to Josh

(Josh sleeping this morning with the blanket that his Grammie gave him)

(Such a cute sleeper!)

(An energetic Josh getting changed)

(Josh in his new clean outfit)

(Josh back to sleep in the afternoon - this time with the blanket that Aunt Lindsay gave him)

The baby with the healthy brain

Josh had a pretty good night, although he had several desaturations related to feedings.  Josh has had only one episode of desaturation today during his nap and he was able to recover on his own.  Josh is now breastfeeding 7 times a day for a average of 15 minutes a feeding.  Mom and Dad are very proud of our little man.  He is weight is up 75 grams (although they used a different scale so it might be off some, we will have a better idea of weight gain with tonight's weight) and is now 4lbs 9oz!  Josh continues to get a half a feeding via his feeding tube after nursing.  If he continues to gain weight then they might consider changing it to half a feeding every other nursing.  Mom did attempt to use a supplemental nursing system today with some success.  Josh was able to take half of his bolus feeding during his normal nursing time.  Josh was not a huge fan of the system, but we will keep working with him since it is a reasonable way for him to go home if he isn't able to take a full feeding.

Josh had his MRI of his head this morning.  This is something that is done routinely for preemies after 6 weeks of life and before discharge.  It is done to make sure that he did not have any issues related to hemorrhage from when he as born.  Results just came in - his MRI is normal, showing a premature brain, which is appropriate because he is premature!!!  No signs of bleeding or any other abnormalities!!!!  This is one huge milestone for us to overcome.

Josh continues to do well in his open crib.  He has been able to hold his temperature well despite the sometimes chilly conditions in the NICU.  He was also tagged last night with a baby anti-theft device called a huggs tag.  He will wear his little anklet until he is officially discharged and comes home with us.  Mom and Dad are a little disappointed that they can no longer sneak off with Josh in the middle of the night.

Josh is doing a good job of balancing sleep with some awake times during the day.  He seems to have these times in the morning and in the afternoon/evening close to when Dad arrives from work.  Mom and Dad enjoy interacting with him during these times.  Josh is also becoming quite the snuggler.  He enjoys sitting upright with his head on your shoulder, especially after eating.  He snuggles his little head down in the croock of your neck and gives little contented sighs. 

Mom continues to room in and is very thankful to be able to stay at the hospital another night.  Dad enjoyed a slightly interrupted night's sleep with Mom last night at the hospital.  We are thankful that Dad is able to stay with Mom from time to time as they miss each other when apart.  Hopefully we will only continue this set up for a few more weeks and then Josh will be home with us.

Prayer Request;

• Josh would not have any apnea now that his caffeine has been stopped
• Josh would outgrow his desaturations and bradycardias so that we can being the count down to discharge (he can't have any desaturations, bradycardias or apnea for one week prior to going home)
• Josh would continue to do well with his feedings, taking more milk each time he eats so that he is able to take a full feeding each time he nurses
• Mom and Dad would be able to get some extra rest this weekend and Mom would be able to continue to find places to room in

Praises:

• Josh's MRI was normal for a premature baby!!
• Josh's weight is now 4lbs 9oz!!
• Josh is doing well in his open air crib
• Josh is settling into a good schedule of eating, sleeping and awake times that will be compatible with going home
• Mom is able to room in at the hospital for another night.

(Josh resting comfortably in his open crib)

(Josh in his cute penguin outfit his Aunt Anita and Uncle Nick gave him - it's Mommy's favorite!)

(Josh's huggs tag on his left leg... his antitheft device)

(Josh nice and bundled up wearing the hat Mimi gave him)

(Josh and Daddy having a great time after a burping attempt)

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.

(Josh's new bed... no more isolette!!!)

(Josh sleeping in his new open bed)

(A cute little relaxed Josh snuggling on Daddy's shoulder)

(Josh in his cute "Daddy and me" dinosaur outfit)

A very tiring night and day

Mommy and Daddy had their second straight night of rooming in, and it has been very tiring for Mommy.  Josh is feeding every three hours, which means that after Mommy has breastfed Josh and them pumped, she is only getting sleep in an hour and a half to two hour increments.  The doctors suggested that Mommy skip one feeding time a night (not breastfeed or pump), and so she is going to try that tonight to see if a shot of about 5 hours straight of sleep will help, because otherwise she will not be able to keep this up for very long.  The nurse practitioner also increased his breastfeeding attempts to every 3 hours as tolerated.  So far Josh seems to be doing well with eating every 3 hours - Mommy will still skip one feeding tonight in an attempt to get some rest.

Josh seems to be breastfeeding well, but when the nurses weigh him before and after his breastfeeding session, he isn't gaining very much weight, which is suppose to be an indicator of how much he has eaten.  They say that since he is so small, he may not be sucking very strongly, or very much, but so far we have not had a single feeding where he gained more than 10 grams (roughly equivalent to 10 ml of breast milk).  So this has been frustrating for Mommy, because Josh seems to be eating well, and he needs to be taking all his nutrition orally in order to go home.  Josh also lost 5 grams yesterday, and so is now 1,880 grams (still 4 pounds 5 ounces).  The doctors are pushing bottle feeding when he is not being breastfed, but we have heard so many stories of babies that are given the bottle who stop breastfeeding because the bottle is just so much easier (requires less work to get milk).  Also pumping is not a good way to keep up Mommy's milk supply indefinitely, and so once bottle feeding starts, the vast majority of the time so does formula feeding, and breast milk is just so much better for Josh than any kind of formula.

In other news, Josh's doctors are talking about taking him out of his isolette in the next few days.  This of course will make it much easier to pick up and hold Josh whenever Mommy and Daddy would like to.  We choose to delay this transition for a few more days because of the extra calories required for Josh to keep himself warm.  Josh has an MRI of his head scheduled for Friday, which is just a standard test that they run on preemies before discharge to make sure there isn't, or hasn't been any bleeding in the brain.  Josh finished his course of tylenol today, and was a much happier baby than yesterday (when he got 5 shots of immunizations).

Prayer Requests:

• Josh gain weight consistently, and not lose any weight
• Josh develop a stronger suck so that he can get more food at each feeding
• Josh do well holding his temperature so that he can be moved to an open bed
• Josh not get sick or develop any new infections while in the NICU
• Mommy's milk supply increase to meet Josh's demand as he grows
• Mommy be able to get supernatural rest when she is able to sleep

Praises:

• Josh is close to moving out of his isolette
• There are open rooms for Mommy to room in at the hospital so that she can try to feed Josh as often as possible (Daddy is going home for a night of rest, chores and cat petting)
• Josh tolerated his first round of immunizations very well

(Josh in hospital loaner clothing after he pooped his previous outfit)

(A proud Daddy spending some time with Josh after work)

(A very content Josh after feeding)

Josh is a growing boy!

Josh had an excellent night last night, with no desaturations or bradycardias.  Mom and Dad would know first hand because they roomed in last night!  The NICU has two rooms that they allow parents to stay in when they are available and we were able to stay last night.  The main room they use has a standard twin bed, a pull out bed, a full bathroom, and a tv.  Mom and Dad decided to stay the night to see how Josh did with breastfeeding every 6 hours.  The trial went well and Josh did a great job of breastfeeding every 6 hours all night long and sleeping in between feedings.  Mom and Dad wish they could say that they did a well with their sleeping as Josh did.

Because Josh did so well with his feedings through the night, Mom has decided to room-in everynight possible between now and when Josh is discharged.  This will help us to reach our goal of having Josh 100% breastfed and it will speed up the discharge proccess if we can prove that Josh can still gain weight while nursing.  Although we all agree that this is the best thing for Josh, Mom and Dad are sad that they will be seperated occasionally for the next several weeks.  Dad can stay with Mom from time to time, but to enusure that Dad gets enough rest to be able to go to work, Dad will also sleep some nights at home.  Hospitals are very noisy places at night.  Mom is hoping not to go crazy after being at the hospital 24 hours a day.

Josh is doing well with his breastfeeding attempts and was awake enough today to do two feedings in a row this morning.  He continues to tolerate his feedings through his tube as well, which are being given over an hour.  Josh gained 85grams overnight and now weighs 4lbs 5oz.  He also had a growth spurt since last week and is now 17.25 inches long!  Mom and Dad are very proud of their little man!

Since Josh is over 8 weeks old and quickly approaching 2 months old per calander days, he received his first round of vaccinations today.  The nurse said he tolerated them well, with only a slight squeak with each shot,  he recieved a total of 5 shots.  Josh will get doses of tylenol every 6 hours for the next 24 hours to help with pain and possible side effects from his shots.

Josh continues to do well on room air and has not needed to go back on his oxygen.  He does have occassional desaturations, but they are all associated with reflux related to feedings.  The plan right now is to work on getting Josh to take full feedings by mouth so that his feeding tube can be removed.  Once the feeding tube is out, the erythromycin will be stopped.  This will allow the doctors to see how his reflux is and decide if he will need to go home on medications for reflux.  Most preemies outgrow their reflux a few months after birth, so any medciations won't last very long.  They are also allowing Josh to outgrow his caffeine dose and will stop it once it is low enough.  This will enable them to see if he has any residual apnea once he is no longer recieving caffine.

Josh is definitely making progress towards discharge.  Mom and Dad are very excited at the prospect of being able to take little Josh home soon.  We are looking forward to having our little guy home with us sometime in the next 3-4 weeks.   Many people have asked us about helping out both now and when Josh comes home.  Although we are not quite sure of what our needs willl be yet, we will definitely keep you updated via the blog of any possible needs we have.  Our church has offered to host a baby shower for Josh on February 6, so if you are interested in learning more, please contact us.

Prayer Request:

• Josh would continue to do well with his breathing and not need to go back on the oxygen
• Josh would continue to do well with his breastfeeding and be able to eat on a 3 hour schedule and take in enough milk to continue to gain weight well
• Josh would do well with his vaccinations and not feel bad over the next few days
• Josh would not get an infection or suffer any set backs as we are working towards discharge
• Mom woud do ok with rooming in and not become too stir crazy at the hospital and that there will be a room available every night for her to stay 
• Mom and Dad would deal well with the seperation and the new/different responsibilities they will undertake

Praise:

• Josh is tolerating brestfeeding every 6 hours and sometimes more frequently
• Josh remains off of oxygen!
• Josh gained 85 grams and now weighs 4lbs 5oz
• Josh is making good progress and there is an end in sight!!
• Mom and Dad were able to room in last night and Mom will be able to continue to be at the hospital to meet Josh's needs.

(Josh sleeping this morning after a good feed)

(A very proud Mimi seeing Josh in person for the first time)

(A tuckered out Josh after a some good feeding time in the afternoon)

A day of big firsts!

Josh had a great night last night.  He has now been mroe than 36 hours without any desaturations. Everyone is quite impressed with our little guy.  Since he is doing so well on the erythromycin, they have decided to continue it indefinitely.  The doctors decided to try to give Josh's tube feedings over 30 minutes (from 1 hour 30 minutes), but this was a bit too big of a change, so they changed it to 1 hour in the evening.  He tolerates this fairly well with only a few episodes of bradycardia, which resolve quickly on their own.  The episodes are definitely related to his reflux - you can see him rapidly trying to swallow when they occur.  Josh gained 5 grams overnight so his weight is now 4lbs 2oz.

Josh also spent a majority of the night with his oxygen on the bridge of his nose instead of in it (he kept removing it). So this morning the nurse practitioner wrote to turn off his nasal cannual.  This is the first time since Josh was born that he has not had some sort of respiratory support!!  Josh has done very well on room air with his oxygen saturations ranging 88-96%, mostly at 96%, even during breastfeeding.  Josh has had a few episodes of desaturation today, all associated with reflux - probably related to his feedings being given over a shorter period of time.   Mom and Dad are very proud of our litte guy and are hoping we are done with oxygen therapy forever!

On Friday Mom and Dad had started dressing Josh in clothes and when they arrived on Sunday Josh was again naked.  We think he was undressed to do his weight Saturday night and was not redressed.  Some of the nurses do not like to dress a baby while in the isolette.  When our regular nurse practioner arrived this morning, she wanted to know why he wasn't dressed.  I told her of our experience over the weekend and she was not pleased.  So Josh now has an order that says he is to be dressed while in his isolette.  In addition to getting to dress him again, our nurse today said that Josh is not needing the support of his isolette as much.  So she changed the settings so it keeps a steady temperature in the air and then it can be adjusted down to compensate for Josh's body temperature.  So his isolette is set to 28 degrees and his body temperature has been staying at or above 36.5.

Josh had a rough start to the day with breastfeeding.  At his 9am feeding he was very awake and alert, latched well, but wouldn't eat.  He did this for about 30 minutes but never actually ate anything.  This was very frustrating for Mom, espeically because she feels this is the result of getting out of our routine this weekend.  Our wonderful lacation consultant had already arranged to come by for his 3pm feeding, so Mom was very excited to get some help from her.  After a few adjustments, Josh had one of his best feedings so far and ate for about 12 minutes.  Mom and Josh were both very pleased with this!!  So hopefully we are back on our way to having a good routine and good feedings.

Prayer Request:

• Josh would be able to stay on room air and not need any more oxygen
• Josh would be able to tolerate his feedings at the faster rate and his reflux would not become worse
• Josh would have turned a corner with breastfeeding and be able to slowly increase the duration and frequency of feedings
• Josh would be able to hold his body temperature well after the changes to his isolette temperature controls were made
• Josh would begin to gain weight steadily again

Praise:

• Josh is now back to 4lbs 2oz!
• Josh is on room air and currently not needing any oxygen!
• Josh is wearing cloths and looks super cute in them!
• Josh and Mom have a wonderfully helpful lactation consultant

(Cute Josher in his car outfit - the bandaid is from a morning lab draw)

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

(Little Josh napping after being fed)

(Mommy and Josh enjoying a nice bonding moment)

(Doesn't he look amaing without that nasal canula?  Just one tube left!)

(Daddy and Josh in a serios discussion about how to get some sleep around here)

Slow, steady Sunday

Nothing particularly exciting happened today.  Josh maintained his string of good days.  He did not have a single episode of desaturation last night, or throughout the day.  Josh even gained 15 grams last night, and is up to 1,880 grams (4 pounds 1.7 ounces).

Josh was too tired to nurse in the morning, as he was again had his hands on with almost an hour and a half before his feeding time, and was back completely asleep when Mommy and Daddy arrived in the morning.  When the nurse practitioner and doctor rounded, we asked about our frustrations with Josh getting worn out prior to his scheduled feeding, and the doctor said that it was not unreasonable to ask that he not be messed with except right before his feedings.  So hopefully Josh will go back to the good feeding that he was having earlier this week.

Josh did feed better in the afternoon, as Mommy and Daddy were there to make sure that he was not messed with until immediately before his feeding time.  Josh has been a mischievous boy and has been pulling out his nasal cannula today.  The good thing is that not having it in his nose does not seem to bother him very much (he hasn't desaturated), but the doctor wanted to give him a few more days before writing an order to discontinue it.  They don't want to make too many changes at once and since we are asking him to work harder with his eating we will wait a few more days. This is a great improvement from the last time they tried to wean him down to room air.  When they did it about two weeks ago, he immediately started desaturating, and staying with blood oxygen levels in the 60-70% percent range (they want him higher than 85%).

Other than that, Josh is maintaining the status quo.  He slept for most of the afternoon, opening his eyes every once in a while to peep at his parents.  He is handling his feedings well, and they are going to stop the erythromycin tomorrow and see if he has outgrown his reflux issues.  If he starts having more desats after discontinuing the erythromycin, then they may put him back on that, or put him on a different reflux medication (like Zantac).

Prayer Requests:

• Josh get good rest so that he can be wide awake for his feeding attempts
• Josh do well in his feeding attempts and continue to gain weight
• Josh continue to breath well and have his nasal cannula removed soon
• Josh not get sick or develop any infections while in the NICU
• Mom's milk supply increase to meet Josh's demand

Praises:

• Josh is breathing very well!  No desats or bradys in over 24 hours!
• Mom and Dad got some good rest and feel a bit better
• Josh gained weight again and is up to 4 pounds 1.7 ounces
• Josh is doing well staying warm when wrapped up and out of his isolette

 

 (Josh snoozing when Mommy and Daddy arrived)

 

 (Josh makes sleeping into an art form - its a little hard to see but his nasal cannula it blowing more in his eye then his nose)

 

 (The light is blinding me!!)

 

 (Josh sacked out after eating his mid afternoon snack)

 

 (Mommy doing some reading while snuggling with Josh this afternoon)

A day of sleep and frustration

Josh had a good night last night, with very few desaturations. However, he lost 45 grams, and combined with the 15 grams he lost the day before means he lost 2oz over the last two days. So his weight is down to 4lbs 2oz. The nurses have told us this weight loss can occur because he is out of his box more and he has to burn extra calories to stay warm while breastfeeding. To help increase his weight, the nurse pracitioner has added an 18ml feeding after each breastfeeding attempt to make sure he is getting enough calories. Hopefully this will help to increase his weight.

Breastfeeding has been very frustrating today. When Mom and Dad arrived this morning the nurse us that Josh was ready to eat, that she had completed his hands on. When we looked at the flowsheet she had completed his hands on more than an hour before his feeding. So when Mom attempted to wake him up to feed him he was too deeply asleep to eat for more than 7 minutes. When we arrrived back for his 3pm feeding she again said his hands on was done, this time 30 minutes prior to his feeding time. When asked why she did it so early she said he was awake then. This time when he went to eat he was too sleepy to do more than latch on. This is very frustrating because he must be eating to go home and we desperately want to go home. Also, Mom frequently uses the diaper change/hands on time to help wake Josh up so he can eat.  Missing this opportunity to wake him up makes it very hard to get him to eat.

Breastfeeding issues aside, today was a good day of rest for Mom and Dad, but especially Mom. After Josh's 9am feeding we headed back home and back to bed. Taking the opportunity to get some extra sleep since Josh still isn't doing well with back to back feedings. Having Dad here on the weekends makes the feeding/pumping routine go faster, so it enables us both to be able to take some time to rest. The extra sleep did a world of good for both Mom and Dad. We don't often get a few minutes to catch on sleep, so we are very thankful for the extra time.

Josh had a very sleep-filled day overall today. He did have a brief awake period in the early afternoon, but was otherwise a very sound sleeper. He does like to peep at us while he is sleeping, almost like he is checking to see if we are still there.  Josh does this even when we are holding him - it is quite cute to see his little eye peep open, check things out, and then close again.  Mom and Dad are thankful they can be here so much so he has someone to look at when he peeps.

Josh had a decent feeding at 6pm, which Mom and Dad were thankful for.  We realize that today has been stressful and frustrating, but that Josh is doing very well for a baby born 14 weeks premature.  We have been extremely blessed, both in Josh's health, and by the love and support of friends and family.  We are just getting to the point when we want so badly for Josh to come home, after 8 weeks in the hospital, that it is sometimes hard to just wait for him to grow big enough to come home.

Prayer Request:

• Josh would start gaining weight again so he can build us a fat supply and be able to hold his body temperature easier
• Josh would be able to wake up enough to breastfeed effectively and that he would build up the stamina needed to take all off his feedings orally
• Josh would not get another infection while in the NICU
• The nursing staff would work with Mom and Josh so that breastfeeding times would be more producitve and less frustrating 

Praises:

• Josh is doing well with his gastric feedins and having very few desaturations
• Josh has not had apnea in several days
• Josh gets cuter everyday and his personality is more apparent everyday
• Mom and Dad got some good extra rest today

 (Our precious little Josh)

 

 (Josh sleeping after his midafternoon hands-on and feeding attempt)

 

 (Mommy and Josh sharing some cuddle time after his feeding)

Look who is wearing some clothes!

Josh continued to have a good day today.  He lost 15 grams overnight, but we attribute that more to the fact that his isolette was changed, and so it has a different scale, than to an actual loss in weight.  We will see tonight how is weight has gone since last night.

Mommy and Daddy arrived at the hospital this morning together to see Josh squirming around.  Since Daddy had been out of town on business the last three days, he decided to work from the hospital in order to be able to spend more time with Josh.

Josh was squirming around because the eye doctors had come in earlier and dilated his eyes, which upset him.  The eye doctors then came around during his normal feeding time to check his eyes, and so his breastfeeding was postponed to the next available time.  The eye exam went fantastically however.  The doctors said that his eyes looked perfect for his age.  They are still immature, but have increased on the grading scale from a 2 from last exam to a 2-3 this time (on a 3 point scale).  The doctors said that they did not see anything to be concerned of at this time.  They will come back in two weeks to repeat the exam.

Since Josh was too tired from his exam to eat, Mommy decided to dress him for the first time ever!  She put this cute orange onesie on, that had a shark on it.  Well, Josh promptly pooped himself and the onesie about an hour later.  It was cute while it lasted!

Josh's first feeding of the day, which came around noon went really well.  It was his longest feeding so far - 25 minutes!  He is really getting to be a big boy.  Mommy and Daddy went to lunch afterward, and came back to find a crying baby boy who wanted to be held.  So Daddy pulled him out of his isolette and this immediately calmed him down. Josh spent a large portion of the afternoon outside of his isolette, all bundled up and happy.  He was too sleepy for his midafternoon feeding, but was wide awake for his evening feeding.  The nurses have him on a eating regimen where if he breastfeeds, then they will not feed him by his feeding tube, so that he will be awake and hungry the next time it is time to be fed.

Prayer Requests:

• Josh continue to do well with his breastfeeding, and that he develop the stamina to do it longer and more frequently
• Josh continue to gain weight steadily - he is 4 pounds 4 ounces - so that he can come out of the isolette
• Josh continue to breathe well and not have any desaturations or bradys
• Mom and Dad get the rest that they desperately need

Praises:

• Josh is a big boy, wearing big boy clothes and is double his birth weight
• Josh's eye exam went great!
• Josh's personality is developing and likes to spend time with his parents
• Dad made it home safely from his business trip

 (Josh in his first outfit ever)

 

 (Isn't he a cute little gator?)

 

 (Josh's socks are just a tad too big)

 (A happy Josh after politely requesting to be removed from his isolette - by screaming his lungs out)

 (Jello Baby on his tummy after a good lunch feeding)

 

 (Josh in his second outfit ever - the first mysteriously got pooped)

 

 (What a gorgeous head of blond hair!)

Double the pleasure, double the fun... double the baby's birth weight!

Josh had  great night last night.  He had not desaturations and no apnea.  When Mom called to check on him last night the night nurse told us that he had bee an angel.  He got a nice bath and a new bed last night as well.  Josh has only had 2 episodes of desaturation today, both of which were associated with feedings.  He also spit up a little bit, but that is just part of being a baby - it is only worth mentioning because it is a first.  (And no, we are sure these things won't be as interesting the 700th time) :-) 

Josh did well with his continuous gastric feedings yesterday.  So today his feeding were changed to be given as boluses every 3 hours and the feeding runs over 2 hours.  Since Josh is doing so well with breastfeeding, he is no longer receiving a tube feeding after breastfeeding.  So Josh ate 2 feedings himself and did not need to be tube fed twice today.  He ate well for both feedings going for 12 minutes and 17 minutes.  Josh did seem to do better at his second feeding when he had some time to become hungry between feedings.  We are hoping that he is taking in enough at each feeding that he continues to gain weight.  Speaking of weight, Josh gained 60 grams over night and is now 4lbs 4 oz (1925 grams) - he has officially doubled his birth weight!!!!!  We are very proud of our big guy and how well he is doing with gaining weight. 

The nurse practitioner said we were getting to the point where we would need to decide if Josh would receive bottle feedings while in the NICU.  Mom and Dad have discussed this issues and decided that they do not want Josh to receive any bottle feedings.  This is because there is a strong possibility that once Josh learned to drink from a bottle he would grow to prefer it because in some ways it is an easier way to feed.  Josh does such a good job breastfeeding that we don't want to disrupt his progress.  So Mom will be at the hospital as much as possible, even staying the night when there is a room available so that she can provide milk for Josh.  Then prior to discharge Mom and Dad will "room-in" the NICU for 2 nights to show that they are able to care for Josh prior to discharge and so Mom can breastfeed him 24 hours a day.  Josh will have to eat well and gain weight those two days in order to go home.  Feel free to begin praying for this already.  We are a few weeks away from this final milestone, but it doesn't hurt to start praying now.

Josh continues to be an active boy.  The nurse changed out his feeding tube today to give him a small tube, which should decrease reflux caused by the tube.  While she was working to get the tape off of his face, Josh grabbed the tube an pulled it right out.  He is a very helpful boy.  Josh also enjoys stretching and moving around while he is sleeping.  Today he kept raising his little butt in the air while sleeping on his tummy.  It looked like it would be a good exercise for his abdominal muscles.  He is also very talented at getting all wrapped up in his wires while swaddled to eat.  It takes Mom and Dad several minutes to untangle him afterward.

Later in the evening, some wonderful friends (Dawn Long, Carrie Roberts, and Priscilla Brown) came over to our home to help finish decorating Josh's bedroom.

Prayer Request:

• Josh would do well with his new feeding schedule and would feed better when he breastfeeds because of the time between feedings and that he would get enough when he breastfeeds to keep gaining weight.
• Josh would continue to develop stamina and strength so he can tolerate more times breastfeeding
• Josh would not develop any more infections while in the hospital or any other complications
• Josh's reflux would continue to improve with his medicine and he would eventually outgrow it
• Josh would be able to be 100% breastfed baby when he is discharged from the NICU

Praises:

• Josh has doubled his birth weight and is now 4lbs 4oz!!!
• Josh is doing very well with his breastfeeding
  
• Josh is having fewer desaturations and has had no apnea for 3 days!!
• Josh continues to be very active and is growing stronger everyday
• Dad is back home and both Mom and Josh are happy to see him

 (Josh sleeping cutely when mommy got there... is he trying to suck his thumb?)

 

 (Isn't that just the most amazing boy in the whole wide world?)

 

 (A very awake Josh having some pacey time)

 

 (Josh is getting to be a big boy and can hold his pacey in all by himself - most of the time)

 

 (Josh passed out after some pacey time)

 

 (Josh very comfortable after a nice meal and cuddle with mommy)

 

 (Dawn putting together the memory board for Josh's room)

 

 (Priscilla putting decorations on mirror frames for Josh's room)

 

 (Daddy hanging up picture frames in Josh's room)

 

 (Carrie putting up Josh's wall decal -- It says "Every good and perfect gift comes from above")