Week 35, Day 2

Yesterday was a banner day for Hannah. She got her first tub bath, and met her Grandma Minor at the same time. My mom and our friend Velma drove in from Shreveport to see Hannah, and we arranged their visit to coincide with "touch time" so they could see her while she was awake and alert, instead of wrapped up like a burrito. If you have high-speed internet, you can click here for another short video of Hannah looking around and sticking out her tongue.


Today, we went to Sandia and Sidney's wedding (two wonderful people I've had the pleasure to work with at TI for 7 and 10 years respectively), for feast and festivity that made our own wedding seem like a visit to the driver's license bureau. Carla got to see a lot of the TI crowd and do a lot of bragging about how well Hannah has been doing (OK, maybe I did a little of that, too). That probably seems weird to people that have just learned Hannah's in the hospital: "So, your newborn daughter is on oxygen and a feeding tube in the hospital, and you're happy about it?" Of course, it's all relative. Compared to where we were two months ago, we're walking on clouds today.

So it was even better when we stopped by to see Hannah after the wedding and found that she gained another ounce since yesterday and is now at 4 pounds 2 ounces. She was sound asleep, busy growing so she can come home sometime this winter.

Week 35, Day 1, Third Time's the Charm

Hannah is off the CPAP and back on nasal cannula today, after several blood gas tests indicated she was ready again. Hopefully, she'll be able to stay on it this time, until she can ditch the oxygen completely. Her O2 requirements this time are around 30%, which is much better than the 55% she was needing the last time she was on the cannula, so that's a good sign.

The timing of this change is good, because my mom is coming in this weekend to meet Hannah for the first time, and she'll be able to see most of her face.

Hannah had an Exorcist-style power poop yesterday during a diaper change, which apparently got all over everything and everybody nearby. This was one day after Carla had commented that she had never seen a particularly voluminous movement like the nurses kept telling us about. Perhaps Hannah overheard that exchange.

Week 34, Day 6

Just a quick update in case any of you are getting antsy . . .

Hannah is doing great, but she had to switch back to CPAP (continuous positive airway pressure) yesterday after her CO2 levels started to rise. This probably just means that she was having to work a little too hard to breathe with just the cannula. The first time she went on the cannula, she stayed on for 1.5 days; the last time was 5 days. Chances are that after a few more days of "rest" on the CPAP, which gives constant pressurized flow to keep the air sacs in the lungs open, she'll be able to switch back to the cannula until she doesn't need it either. Her CO2 levels dropped down to normal a few hours after going back on CPAP.

No bradycardia spells lately, and she's hovering around 3 pounds 14 ounces.

Week 34, Day 4

Sorry for the lack of an update yesterday. We got home pretty late after a 9pm-to-midnight kangaroo session. Hannah is doing great in all respects: gaining weight, becoming less dependent on the oxygen cannula, and starting to behave much like any other baby. She cried when she had go back to her crib today after kangaroo time. No bradycardia spells today so far, and just one yesterday.

Carla's parents are in town today, so Hannah had several visitors. Click here to see a short video of Hannah looking around as she's being put back to bed. The lump in Hannah's wrist below is caused by the tape holding in an IV tube, which is hidden behind her arm. The lump in my throat was from watching these two beautiful girls sleeping so peacefully, after all they've been through.

Week 34, Day 2

We had a good day with Hannah. At one point, Carla got the giggles about something (don't ask) while holding Hannah, and we were in the curiously new situation of worrying whether we were going to wake up Hannah if we couldn't stop laughing. Hannah didn't seem to mind, but I mention it because it seemed to be a turning point; while we have had pleasant hours in the NICU, it is the first time Carla has been relaxed enough to laugh out loud. We had just had a very optimistic talk with the doctor, Hannah was sleeping peacefully, and we're starting to see the light at the end of the tunnel.

Hannah's handling the nasal cannula and her feeds quite well, and might even graduate to bottle feeding next week. She's at 3 lbs 12 oz, still going in the right direction weight-wise. She had another slight bradycardia spell this morning, but everyone assures us that these are quite normal and it would be more surprising if she didn't have a few.

Week 34, Day 1, Bradycardia

Carla had a good session with Hannah today, but just after Hannah was put back in her bed, she had a "brady" episode. Not the kind with horrible 70s clothing and astroturf lawns, but the type that happens when a baby forgets to breathe (apnea) long enough to cause the heart rate to drop (bradycardia). It's very common in preemies, and is one of the reasons Hannah is hooked up to monitors that start to squawk if her blood oxygen or heart rate drop too low. In this case, the nurses hurried over and gave Hannah some extra oxygen, and she snapped right back to normal and was breathing fine when Carla left.

It scared Carla to tears, of course. Reading up on it afterward, the only thing particularly surprising was that she hasn't had a brady episode before today. 80% of babies born before 30 weeks gestation (Hannah was 24.5) have apnea and bradycardia, and it almost always goes away on its own. There's a slight chance that it is a sign of a more serious problem like NEC or reflux, but most likely it will be a non-issue by the time Hannah is full-term (in about a month).

Here's a picture I took last night when I visited. The camera settings were messed up at the time, so it's sorta dark and grainy. But a good view of her perfect little face nonetheless. The clear tube is the nasal cannula, and the tube in her mouth is the feeding tube.

Week 33, Day 7, Take Two

We're back on the nasal cannula! The blood gas tests looked good enough to let Hannah try the "big girl" oxygen again today, so she's back to the nasal cannula. We'll cross our fingers and hope she's seen the last of the bulkier CPAP masks.

In other news . . . she's up to 3 pounds 10 ounces today. The growth chart below (click the image to enlarge) shows her progress since birth. Note how the first artificial weight gain around 7/29 began right after she started a course of antibiotics (it was mostly fluid build-up) and she resumed her weight gain just after the PDA surgery (which improved blood flow and lung function) and the end of the light treatment for jaundice. Also, note the dip in her weight gain around 9/8, when she switched to CPAP and had to start breathing by herself. And lastly, note how I have made you tilt your head to one side like a confused puppy. Hah!

Week 33, Day 5, Second Eye Test OK

Hannah's second eye test today turned up nothing alarming. The development of her retinas is about where it should be for a preemie her age.

Since today is a slow news day, I thought I'd give you a rundown of what Hannah's daily schedule is like. She sleeps most of the day, of course, but her day is punctuated by "touch times" every three hours, when she gets a diaper change, manual temperature check (there's a temperature probe on her at all times, the manual check is just a backup), and anything else that needs to be done while she's awake and unswaddled. She also gets fed at each touch time, which for the moment means that the machine driving the feeding tube gets refilled with milk. She's now getting 3o ccs (about 1 ounce) of milk at each touch time, over the course of an hour. Eventually, they'll shorten that to 30 minutes, which is about how long a feeding session would naturally be. To be able to hold Hannah, we have to be there at touch time, since they don't want to disturb Hannah any more than necessary when she's this small. After touch time, she's wrapped back up and goes back to sleep. Usually, Carla goes in for the 3pm touch time, changes Hannah's diaper, then holds her until the next touch time and diaper change at 6pm. Then we go in around 10pm together to visit. Obviously, touch times are the best times to see and interact with Hannah, while she's awake and not wrapped up like a larvae.

As Hannah gets older and bigger, the rules will relax and she will "graduate" to an open crib in a less restrictive area of the NICU, where she lives more or less like a regular baby, just with lots of nurses nearby. That's our next big milestone after getting back off the CPAP, but it will be a few weeks.

Week 33, Day 5, Rewind

Well, that was fun while it lasted. About an hour into Carla's kangaroo session with Hannah today, the doctor decided that Hannah needed to go back to the CPAP mask. Apparently, the latest blood tests showed that she was still having to work a little too hard with just the cannula. So, she's back to the mask for a few more days, after which they'll try the cannula again. She's also back on an IV for some antibiotics. She developed what looks like a zit on one ear, probably from all the headgear she's been wearing, but they want to knock it out before it turns into anything more serious.

Two steps forward, one step back is the mantra in the NICU, but overall Hannah's still doing great. She's up to 3 pounds 5 ounces at the last weigh-in.

Week 33, Day 4, Off the Vent!

Another milestone . . . this morning Hannah's doctors decided to see how she would do with a nasal cannula (nose tube) instead of the CPAP (pressurized mask). They tried a couple times a few days ago and Hannah just wasn't ready for it. Well, she's been on a nasal cannula since 9am this morning and is doing just fine.


I know this can sound trivial to those not familiar with the NICU, but it really is a big step toward independence for Hannah, and we're nearly giddy with optimism. There are still a lot of hurdles left for Hannah and potential setbacks, but this is the lowest level of breathing support that a preemie can need, and a nasal cannula is one of those things that can come home with her if necessary. She'll also be more free to move around, look around, and nurse.


We went to the NICU at 3pm today to stay with Hannah, but another preemie nearby was undergoing surgery so we didn't get to go in. We waited a few hours and decided to go eat and then try again at 9pm (the NICU is closed for shift change from 6pm to 8pm, and 6am to 8am, presumably to let the nurses pass the baton and write up reports; but I suspect it is also to force obsessed parents to go eat at least twice a day).

Anyway, since Hannah is doing so well today, if you could aim some of those positive thoughts and prayers at the baby that needed surgery this afternoon, and his parents, and all the other parents and babies that we share the NICU with, I'm sure it would be appreciated. We've been there and our hearts ache to know the stress and worry they're going through.

Week 33, Day 2

Hannah's doing great today, and is up to 3 pounds 4 ounces. Here's a picture of her looking around at us while we're getting her ready for nap time with Mommy. The tape under her nose is to keep the oxygen mask from irritating her skin, and to form a better seal. The tape under her chin is to keep the feeding tube in.



And here's a picture with Mommy to lend some scale.


And this one I included just so you can see the pooh on her diaper. And in case you hadn't noticed already, you can click on any of these pictures to see them full-size.


Gonna brave the masses at Ikea tonight to see what they have in the line of cribs.

Week 33, Day 1

If Hannah had been born today, she would have been only six weeks premature. Her official due date was November 1st, although they were planning to deliver mid-October just because it can be risky to let twins grow to term. Preemies are usually in the hospital until around their original due date, so Hannah might be home before Thanksgiving.

She graduated to a lower level of CPAP air pressure today, one more step toward breathing without assistance. If she can tolerate the new setting (so far, she's handling it well) for several days, she might be able to get rid of the oxygen mask and use a nasal cannula.

Week 32, Day 7

Not much new going on, but Hannah's doing fine and getting stronger every day. She grabbed the thermometer right out of my hand yesterday while I was trying to take her armpit temperature, as if she knew exactly what I was doing and didn't like it one bit.

Week 32, Day 6, Evening

Here's a picture of Carla reading to Hannah tonight. Can't see much of Hannah with the CPAP cap and face mask on, but she's breathing well and slept through most of the holding session.

Week 32, Day 6

I just noticed I forgot to post an update yesterday. Probably because everything is cruising along as expected, and nothing new happened yesterday. Hannah is still breathing and eating well, just not gaining weight as fast as we'd like. That could be because she's burning a lot more calories working her lungs, where the ventilator was doing much of that for her before. In any case, the doctors are not at all concerned and say this is a pretty normal rate of weight gain for a preemie with her history.

Week 32, Day 4

Hannah's been a troublemaker tonight, pulling out her feeding tube, spitting up all over herself right after her bath, and pooping on her freshly changed bedding. Or maybe the nurse was just telling me that to prepare me for parenthood, since she relayed all this as if these were good things. In any case, Hannah's doing fine and sleeping soundly now. All her stats and settings are where they should be.

Week 32, Day 3, Bear Watching

We were hesitant to leave Hannah to drive three hours away for Carla's sister's wedding. We knew Hannah was in the safest and most nurturing environment available, with a platoon of good people that care for her as if she were their own. But we had always been able to tell ourselves "We're only 15 minutes away." Upping that to 200 minutes was a small leap of faith.

Of course, we needn't have worried. Hannah did very well while we were gone and is requiring less and less support from the ventilator. And, when we walked into the NICU at 11:30 last night, we found this little guy watching over Hannah, burp cloths and extra blanket at the ready. He was apparently brought in over the weekend by one of the nurses that watched over Carla during some of the roughest days of our hospital stay. Thank you, Sandra. I wish you could have seen Carla's eyes when she read the card.


Hannah's oxygen requirements and blood tests are good enough today that they are dropping her PEEP (airflow pressure) from 7 to 6 to see how she handles it. Over the course of a couple weeks, if she can get down to 3, she may be ready for a nasal cannula, which is the least intrusive form of breathing aid.

Week 32, Day 3

Just a quick update to let you know Hannah's exceeding our expectations today. Her oxygen supplement has been down in the 30s most of the day, and that's with her doing most of the work breathing. We just got back from Jon and Cat's wedding in Shreveport, and stopped at the hospital with Rena and Gabe to visit Hannah. I'll post some pictures and more details tomorrow. Gotta get some sleep now.

Week 32, Day 1

Hannah's doing great today. We took a few pictures with the new CPAP setup. We used to see her nose, but not her mouth; now we can see her mouth, but not her nose. But it's a pretty cute little mouth to go with the cute nose. :-) If she moves on from CPAP to nasal cannula in a couple weeks, maybe we can see both at the same time.

Week 31, Day 7, Evening

Still going strong tonight, breathing well and back to bolus feeds (a "meal" every three hours instead of a continuous trickle). Carla got to hold Hannah for a while this evening, and Hannah's oxygen saturation stayed pretty steady. These are all encouraging signs, so let's hope for some quiet days of sleep and growth ahead.

Week 31, Day 7

Hannah is handling the CPAP quite well this morning. She started out yesterday needing 100% oxygen after the tube came out, but is down to 58% this morning. Her blood gas tests were OK yesterday, but actually look good this morning. Those are all good signs that she is learning to breathe on her own, with a little air pressure and oxygen enrichment provided by the machine. Over time, they'll try to wean her off the pressure and enrichment until she's breathing room air. The enriched oxygen will be the last to go . . . she may need that for many more weeks, or longer.

Week 31, Day 6, Learning to Breathe

Look Ma! No Tubes!


Hannah had another busy day. She's been taken off the breathing tube and put on CPAP (continuous positive air pressure), which allows her to take all the breaths on her own, but maintains a constant airway pressure in her nostrils to make it easier for her to draw breath and keep her lungs from deflating too much. This is a potential step toward breathing without assistance, but if she appears to be working too hard at it after a day or so, they'll put her back on the breathing tube and try again later.

One downside of CPAP is that it isn't very attractive. The nasal prongs, tubes, and harness holding it all in place covers up the top half of her face, so we can't see her as well as before. She still has a feeding tube in her mouth, but it is small enough that she has a tiny pacifier as well. If all goes well, she might be able to graduate to a simple nasal cannula for oxygen after a few weeks. But that will require her to grow and expand her lungs.

Speaking of which, she gained another ounce today, so she's up to 3 lbs 1 oz. The nurse snapped a couple of photos after they removed the breathing tube and before they attached the CPAP rig (we weren't there when they did all this), so we'd have a record of what Hannah looks like without tubes and wires. Not a flattering picture, but we all have occasional bad hair days. Fortunately, we don't have hair all over our face, like poor little Hannah. The fine white hair, which tends to show up most with a flash, is lanugo, which usually disappears before or just after birth.

Week 31, Day 5, Evening

Hannah weighs three pounds tonight! That's double her birth weight. And, we went for almost an entire kangaroo session with fairly stable blood oxygen saturation. Normally, it dips low occasionally and sets off alarms, sometimes requiring the nurse to adjust the oxygen levels. Tonight, Hannah and Carla dozed on and off for about two hours with only one de-saturation toward the end of the session.

Week 31, Day 5, No ROP So Far

Hannah passed her first ROP test today, showing that her retinas are developing normally so far. This doesn't rule out the possibility of it cropping up later, but they'll re-test every two weeks so they can jump in and correct it with laser surgery if needed. Amazing that they can test and repair such tiny little eyes. My thanks to all the poor lab rats that made these technologies possible, may they rest in peace.

The ROP test involved propping her eyes open and looking inside with a scope, and that's a lot of excitement for a 6-week-old. So we'll postpone kangaroo time until this evening today, to give Hannah some time to rest and recover from the ordeal.

Week 31, Day 4

Hannah had a good day today. The new vent settings and transfusion last night seem to have done the trick and her CO2 levels are looking better. She and Carla got to kangaroo for a couple hours, after which Hannah went back in her isolette and started looking around at us as if to say "hey . . . why'd we stop? That was working OK for me . . ."

She only gained 10 grams tonight, so after converting and rounding, she's still 2 lbs 14 oz. Maybe we'll hit the big 3-0 tomorrow. Her scalp IV left a bit of a welt on her forehead (it will go away), so she looked a bit like a Klingon tonight. Fortunately, Carla didn't seem to notice.

Since it might not be obvious to those of you who have lives outside of cyberspace, I'd thought I'd point out that any highlighted words in my posts, when clicked, will take you to some explanatory page or picture. I try to do that at least when throwing around medical jargon.

Week 31, Day 3, Really Late

Well, Hannah is up to 2 lbs 14 oz tonight, so she's definitely growing. The doctors are concerned that her oxygen requirements have increased today and her CO2 levels were high, so they've adjusted the ventilator settings and scheduled another transfusion to top off her red blood cells again. They take a lot of little blood samples every day, and she's still too young to regenerate her own red blood cells at a fast enough rate to replace the ones she loses. And those red blood cells are what carry the oxygen around, so if they are low, it could be affecting the oxygen requirements.

Hannah had a few visitors tonight: her Aunt Rena (my sister) and Uncle Gabe, and Aunt Rosemary (aka CeCe the Clown). Even half asleep and without much to say, Hannah doesn't seem to have a problem making friends and convincing everyone that she's the most beautiful baby in the world. :-)

Gabe flew in for Jon and Cat's wedding next weekend, and Rena and Rosemary drove over from Bossier to pick him up. We watched Dad's Slideshow (35MB), then had to crash, because they all have to get back on the road at 8am. Speaking of which . . . I've uploaded some pictures from Dad's funeral. If you were there and took some pictures, I'd very much appreciate it if you could email them to me. Thanks!

Week 31, Day 2

I usually only see Hannah's face, since Carla goes in for "touch time" while I'm at work, and by the time I visit in the evening, she's swaddled up like a grub in the isolette. Preemies like to be wrapped up with limbs confined, since that's closer to what they'd be experiencing in the womb. Anyway, that means that weekends are when I get to see her during touch time, when her limbs are out and flailing about. We arm-wrestle a bit (so far I'm letting her win) and generally stare at each other for lack of conversational topics of common interest.

So, the upshot is that I haven't seem her arms and legs since last weekend, and I was struck today by how much they've plumped up in a week, particularly considering that she was off her feeds for a couple days while the air bubble worked its way through.

Here's a quick video of Hannah just after we woke her up. That's not her you hear crying on the video . . . that was another baby nearby. Hannah won't make any real noise until the ventilator tube comes out, although occasionally we hear a squeak or two. Note also the scalp IV back on her head, which she'll need for nutrition until she gets ramped back up on her feeds. The "E.T." light on her foot is the pulse oximeter, which shines a light through her skin and detects the oxygen level of the blood by how red it is.