NICU

the premature birth their blood pressure can get quite high and also lead to hemorrhaging. The bleeding is known as Intraventicular Hemmorhage (IVH). Lydia had two ultrasounds done. The first just three days after she was born showed no signs of hemorrhaging and the second done a month after she was born also showed no signs of hemorrhaging. We were so relieved as the bleeding if severe can cause brain damage in the developing brain.

Once Lydia fully recovered from the surgery she really started to put on weight quickly. She was on nutritional IV supplements initially and then gradually introduced to breastmilk which I had been pumping since the day she was born. She tolerated the feeds well via a feeding tube and she was on continuous feeds and then weaned to feedings once an hour and eventually to once every three hours. She was then introduced to nippling on a bottle. She did excellent with that, and was marginal at the breast itself. It seemed when she was at the breast, she found much more interesting things going on around the room. I didn't let that ruin my day, I was just so happy she was eating well. During her weight gain, she was gaining anywhere from 20 - 50 grams a day. That is a little under an ounce to almost two ounces. It was so encouraging to get the daily weight reports.

Premature babies often have problems with what are called apnea and bradycardia spells (A & B spells), also known as Apnea of Prematurity. The apnea is a cessation in the breathing for a period of 15 to 20 seconds. During this time the blood oxygen saturation plummets and the baby generally will begin to get pale and change colors depending how long the episode lasts. Along with the apnea the heart rate usually slows down which is called Bradycardia. If the baby has one of these episodes the alarms on the machine will sound and the nurse will stimulate the baby to breathe again. Many times the baby will self resolve and the alarm will stop before the nurse gets to the baby. We were extrememely fortunate in that Lydia had minimal A & B spells. During her entire 82 day stay in the NICU she never did even fill one side of her episode page. I noticed there were some babies that were filling a side a day. I was so relieved. She never did require the common medications of aminophylline or caffeine. The nurses were quite stunned as they said, "we have never heard of a 24 weeker not needing these medications". I was present for Lydia's biggest apnea spell ever she was off the ventilator and on nasal canula at the time. It was so scary. She stopped breathing and her oxygen saturation fell below 40% and her heart rate was in the low 60's. She turned purplish-gray and was completely unresponsive. The nurse finally got her to come around with very vigorous stimulation and masking with 100% oxygen. The episode seemed like it lasted for hours but it lasted about a minute to a minute and half. I have never been so scared in my life. She came out of it nicely and never had another episode like that. She generally self resolved out of any episode she was having.

Lydia also had her bouts of Hyperbilirubinemia (high bilirubin in the blood) and she did spend a few days under the photo therapy lamps. She looked so cute with her little stylin' sun shades on to protect her eyes. She would be laying there with just her tiny diaper on and the sun shades on basking in the radiant glow of the phototherapy lamps. Looked like she was tanning in the Carribean.

After 6 weeks, Lydia began getting weekly eye exams checking for Retinopathy of Prematurity. This is a common problem wtih premature babies and the smaller they are, the more likely they are to have some problems with it. The retina in the baby is still developing at birth and for reasons unknown for sure (though suspected high oxygen levels with the respirtory support) the retina may actually start growing extra blood vessels and form a ridge at the edge of the growth. This often times self resolves, but it also may not and the if it progresses badly enough it can cause the retina to detatch and cause total blindness in that eye. The babies are watched closely for any signs of the disease. The exam requires the eyes to be examined and the doctor looks with a bright light and checks the status of the retina and how much it has grown and how it is developing. There are several stages of retinopathy with stage I being the least and stage IV being the worst. stage I and and stage II generall resolve and the retina continues normal growth. Stage III is getting pretty serious and usually requires the intervention of surgery. The eye is lasered at the periphery of the developing retina to stop the over growth of blood vessels. This surgery does stop the retina from grown but it preserves sight in the part of the retina already developed. If untreated it could lead to total blindness. Lydia fortunately had only stage I retinopathy. She was reported as having it twice in her left eye, but upon the following weeks exam, it had disappeared and normal retina was seen. She did not like the exam as it requires the eye to be held open with a "rake" like instrument that pried the eye open so the doctor could look. The eye exams are very stressful on these tiny babies and they often have more apnea after and exam and don't eat too well afterwards. I was there for all of Lydia's eye exams and would hold her and comfort her afterwards. Many parents did not watch the eye exams because it was difficult to watch, but I am nosey and wanted to be there. It wasn't so bad really.

Lydia contiued to grow well and develop well in the NICU. It was so exciting to see her change daily and take on the more characterstic looks of a baby as she gained weight and fat. She begin to look like a little chipmunk with her chubby cheeks which dimple up when she smiles. All in all, she did excellent in the NICU and quickly became the little princess of the unit. She would often end up being the team leader's baby to watch because she was doing so well and that she didn't need high maintenance so the team leader could care for her and still get the team leader work done. It was very hard having a baby in the NICU and the changes it makes in your life, but we are so thankful to have her with us.

After delivery I was feeling good physically. The nurses were pretty surprised I was ready to be up and around, but I wasn't hurting at all. Mark and I were very anxious to see our little girl albeit very scared too. His sister Patty left after a while. I can't thank her enough for being there. She was such great support!

Two hours after they admitted Lydia they invited us down the hall to see her. We were terrified as to what this new chapter in our lives was bringing us. We learned the routine of scrubbing up and donning the gowns to protect the babies in the NICU. We walked tentively to the back room where the sickest babies were. There she was laying on the open bed warmer with more wires, IV tubing, and sensors than I cared to count. She was surrounded by various instruments like the oscillating ventilator, computer monitor showing an array of numbers and graphics depicting her heartrate, respirations, temperature, and blood pressure. I could hardly believe that basically they did their best to simulate a womb for her to grow and develop. They told us the next few days are critical and that she may actually have a honeymoon period for a week or so where she may be doing well but then after about a week things start to catch up to her. As we looked over her with awe we were amazed at how perfect she was. She had everything she was supposed to have, only in miniature. She had dark hair (quite a bit) and eye brows, ten toes, ten fingers complete with nails. Her eyes were closed and it was suspected they were still fused since she was so early in development. Her skin was very red and shiney. I cried when I saw her laying there working desperately to remain here with us. I spoke very quietly to her and told her I loved her. I kept it brief as I didn't want to over stimulate her. Her delicate nervous system wasn't ready to be bombarded by all the activity of the modern world yet. I said many prayers over her and invited the Lord and His angels to watch over her. She was so incredibley tiny. I felt guilty when I saw her because she was still supposed to be growing inside of me, but I had to let that feeling go as it was doing neither of us any good. I had to be there for her now not feeling sorry for myself.

Lydia started out on the open bed warmer where she lay under the radiant warmer with only a diaper on. She was diagnosed with respiratory distress syndrome from the beginning because she wasn't able to breathe on her own due to being so premature. Lydia was initially placed on a high frequency oscillating ventilator (HFOV). This is a special ventilator that is very gentle on the lungs as it delivers tiny puffs of oxygen in rapid succession. She did not require surfactant therapy to aid lung expansion. She was on breathing treatments of Furosemide, Dexamethasone, and Albuterol for 35 days. These seemed to help her immensely. She was also on some injectible medications, Dexamethasone and Ranitidine, to aid her breathing and lung development. On her second day of life Lydia was transitioned to the normal ventilator as she didn't require the HFOV any longer. They also kept her on antibiotics for a week just in case she was infected from the infection I had. She did not show any signs of being infected however.

Lydia did well for the first week of life. She had lost weight and dropped to 1 lb 5 oz but this was normal. Even though it was normal, it was still scary. After the first week the doctors discovered that Lydia had a Patent Ductus Arteriosus (PDA). This is duct that is open and connects the aorta to the pulmonary arteries and is present in all babies. In normal full-term infants the duct closes shortly after birth. However, in premature infants it often doesn't close due to the body not being mature enough to detect that it should close. This causes a problem when it remains open because it allows blood to bypass the lungs and thus not get proper oxygenation. This is fine in utero as the baby isn't breathing and doesn't need much blood in the lungs. This results in the body's cells not getting proper gaseous exchange at the cellular level and can cause poor growth and tiring easily. To try and get the PDA to close the doctors first tried a course of Indocin. Lydia was on this for several days, but it did not work to close the PDA. This drug generally works best when given within 24 hours after delivery. Lydia did not show signs of a PDA at that time and the drug is not routinely administered after a premature delivery because it does have potential risks as well. It was decided that Lydia needed to have the PDA surgically closed and she had the surgery done on March 9th, 2000. The surgery itself only took 20 minutes. Lydia and another baby who weighed the same but was born 5 days before Lydia, Jessica, had the PDA ligations the same day. Lydia tolerated the procedure well. It was a scary time for us considering this is an operation near the heart of a baby weighing less than two pounds. In retrospect, even though the surgery was scary it is one of the most curable problems a preemie can run into. Once the PDA is closed, there is generally no looking back. The nurses were so sweet, they put bows in both Lydia's and Jessicas hair after the surgeries. They were so sweet.