Day 36: Bottle Feeding

Great day for the boys ( and me ☺️)

Peter gained 10 grams and weighs 4 lbs 3.4 oz

Maurice gained a little too and is 2 lbs 7.5 oz

Biggest change for the day is trialing Maurice on a little formula to help him gain weight. The calories are measured more accurately but there are always some risks. It’s harder to digest. Peter has done so well with it and I’m hopeful Maurice will have the same response.

Peter otherwise remains on a nasal cannula set at 1 liter and 21% ( 21% is the same oxygen as we breathe). It’s minimum respiratory support and the next step would be nothing at all. He’s not ready yet but getting closer everyday. He has some episodes of intermittent tachypnea ( sometimes breathing fast) so we know he still needs it. He continues to have a “soft murmur” on exam ( the nurse can hear the hole in his heart with the stethoscope ) but it is not loud and doesn’t seem to be causing problems so we are not too worried about it. His last blood test showed his wbc is 10 ( which means no infection) his hematocrit is 27 and retic count is 3.37. He is making new blood cells and his bone marrow is working but it still is not as good as it needs to be. He is a little anemic. The anemia is not causing any significant problems and we will continue to just watch and hope his numbers improve on their own without a blood transfusion. He is taking 40% of his bottle feedings ( all formula) which is pretty impressive for his first day. On rounds they even called him an “over achiever.” He continues on caffeine, iron and vitamin d supplementation. He had an eye exam which was appropriate for his age and is also being evaluated by PT/OT. He seems to be favoring his head to the right so we are working on moving it to the left so he doesn’t develop torticolis. The lump on the back of his head seems a little smaller and we are continuing to monitor it. His only issue for the day is some difficulty maintaining his body temperature. He is about 97 and needs to be 97.5 to stay in an open crib. It was very cold in the NICU this morning so I’m blaming it on environmental issues but if it does not go up soon he will have to go back into an isolette.

Maurice is on high flow 3 liters 21%. His next step would be a nasal cannula. He has intermittent tachypnea and we will not change yet because he has to use all his energy on growing. His White blood cell count is also 10 ( no infections ) and his hemoglobin 12.4 and hematocrit 34.8 with a retic of 2.37. His blood cells are higher than Peter because he had a blood transfusion of packed red blood cells. He is no longer anemic. His feeding was increased yesterday to 30 min and he is tolerating that well. The goal today is to introduce some formula ( 25% formula / 75% breast or donor milk) in hopes of better calorie control and getting him to grow a little more. We have to do with close observation and caution because formula is harder to break down and there has been a link to increased risk of NEC ( bowel infection). He is older and bigger now so the doctors feel the benefits outweigh the risks. I, of course, still cannot help but worry a little. He continues on caffeine, iron and vit d just like his brother. His eye exam was also normal for his age. He too has a murmur or hole in the heart but right now doesn’t now seem to be causing additional issues and we will continue to watch it.

Everyone always asks when do I think they will come home. Maurice still doesn’t weigh what Peter did at birth ( Peter was 1170 grams at birth and today Maurice is 1120 grams). The nurses said babies usually are at least 5 pounds when they go home. They have to be off all respiratory support ( although in rare cases babies are sent home with some). For Peter he is just one step away but Maurice still has to come off high flow and then down to nasal cannula. They also have to be able to bottle feed and have the tiny feeding tube in their stomach taken out. Right now Peter is tolerating about 40% of his feeding. This is pretty good but we still have a long way to go. They also must come off caffeine. Caffeine is a stimulant which, like our morning coffee, helps get us through the day. For preemies it mainly helps them to remember to breathe. It’s safe to say they will be there for at least 3 more weeks and Maurice will likely need more time than Peter.

We have come so far! Today we made some wonderful progress .. bottle feeding for this little guy is a big deal! I’m very proud of my boys and looking forward to having them home soon!

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