Thirty Weeks

The boys are 30 weeks gestational age today. Even for preemies, gestational age is important because certain systems and abilities (for instance, swallowing) develop on somewhat the same schedule as they do in the womb. That's part of the reason why the rough estimate for when preemies can come home is on their due date (which for our boys is August 11). Of course, depending on how they're doing, it may be a bit earlier or a bit later than that -- and not necessarily the same time for both babies.

The basic things that the boys have to be able to do are 1) to regulate their body temperature, 2) keep up their breathing and heart rate, and 3) eat on their own. (And of course, get bigger!) Some of the milestones along way involve moving to different types of cribs -- the next step up is an isolette, a more enclosed type of crib that is still temperature-controlled, and then after that they go to an open crib (and might even be able to be reunited and share the same crib at that point!) These steps also involve reducing the number of tubes and wires they have attached to them, which will make it easier to hold them.

I'm still just taking things one day at a time, but it's nice that the nurses are starting to talk about the progressions and next steps. We're looking forward to the babies' continued growth and improvement, but trying not to get too impatient (especially given the constant reminders that progress isn't always linear; it's not uncommon to have setbacks).

The morning update is that the little guys are doing well; today it was James rather than Matt who gained weight! (We're realizing that there does seem to be a margin of error in these weight totals, though! I'm not sure I really believe that James gained 60 grams in a day.)

Take Two

They gave Matthew another try on the nasal cannula, and this time, he did great! (As opposed to last time, which one of the nurses described as "he failed spectacularly.") The plan is to have him on it for three hours a day for now, with the rest of the time on his CPAP. He was fine for that amount of time, just having one apnea episode at the end. Then Mike held him this afternoon for about an hour and a half with the cannula on, and he was also fine (just one little apnea episode in the middle). As you can see from the picture, the cannula is a lot easier to deal with than the CPAP -- much smaller tubes!

To our surprise, they also gave James a try on the cannula, but (not surprisingly) he wasn't ready for it yet. He's doing pretty well on the CPAP, but he still has occasional times where his heart rate goes low (bradycardia) and he needs a bit of extra oxygen. They've actually changed James to an older type of CPAP that has a mask that goes over his nose. The bubble CPAP (the newer one) has prongs that go in the baby's nose, and they were starting to cause damage to James's nose. (Poor James -- one more challenge the little guy didn't need!) The mask version seems a lot more comfortable for him. And it was easier to hold him with it, too, because it's less likely to slip out of place.

Matthew continues to gain weight. His feedings are up to 16 milliliters at a time, and they're continuing to increase them. And he's gotten the meconium out of his system -- he had his first yellow-colored baby poop today. (Woo-hoo! And also, gross!)

Matthew's hematocrit levels are a little low; this is basically anemia, which is common in preemies. He doesn't seem bothered by it, but they may give him a blood transfusion to get his levels up if they drop lower.

James actually lost a few grams yesterday, so they're changing his IV fluid mix to give him more calories. (Too bad he can't just have some extra dessert!) He got upgraded to preemie size diapers today, but not because of his size -- but because he was peeing through the smaller ones!

Mike is now calling James "elephant boy" due to his new "trunk". That's not a very nice daddy!

More Videos

Both boys are doing OK. They continue to gain some weight and they haven't developed any new life-threatening or scary conditions.

While Matthew had his CPAP (air mask) off for a few minutes this afternoon we shot a short little video. He had spent the last 90 minutes or so sleeping on daddy's tummy so he was in a good mood (if I do say so myself). Matt's nose is somewhat deformed by the prongs in his air mask -- hopefully the pig-snouted shape will disappear before he comes home!

Yesterday (May 31) we took a short video of James. Unfortunately he was wearing his CPAP breathing hose.

P.S. The boys say Happy Birthday to their Grandpa Green!

Equal Opportunity

It seems like we've been posting more pictures of Matthew recently, so in fairness, here's one of sweet baby James. (He's got a bit of dry skin here, but they're not allowed to have lotion until they're bigger!)

Fat and Sassy

Baby Mattie got a promotion today -- he's now wearing preemie size diapers! (I don't know what they call the size below preemie, which is what they've been wearing -- pre-preemie? sub-preemie? fetal?) James has also been gaining weight, but he hasn't caught up to his brother quite yet.

Field Trip

We had bad timing during our visit to the hospital today. To begin with, we must have arrived just as the "prepared childbirth" classes were getting out, because there were several pregnant women and their husbands carrying pillows back to the parking garage as we were driving in. (We were supposed to take that class in June, but instead, we had an unprepared childbirth!) Anything that brings up the thought, "I should still be pregnant" is not very helpful for me at this point, and a parade of preggy ladies falls in that category.

Then we were getting ready to hold the babies, and first there was a problem getting Matthew's CPAP in the right position (you might be sensing a theme with this; I have a feeling it'll be a struggle until he "graduates" from it!), and then the word came that the babies would be moved to a different room.

Our NICU is organized into six "pods" (insert your own pod people joke here), identified by letter. Our boys are in Pod F. (The letters don't signify anything; babies are placed in pods based on where there are openings when they arrive, and with twins they always try to put them next to each other.) Because there are relatively few babies in the NICU right now, they're doing a big floor cleaning, which involves moving everything out of the room/pod being cleaned. Yesterday we had several "guest babies" in our pod while theirs was being cleaned. (Interestingly, Matthew's new neighbor was also a 27-weeker, born a day before our boys, and at the exact same birth weight as Mattie!) Today they were ready to clean our pod, so our babies were moved temporarily into Pod D around the corner. The move didn't bother them at all. And the one advantage of Pod D is that it has very nice pictures of doggies on the wall, including beagle puppies! (Each pod has pictures that start with its letter. James is under a flamingo and Mattie is by some fish.)

But, with all the commotion of the move, we didn't get to hold the little guys today, which was disappointing. They're doing well, though. Mattie is even starting to look a little chubby, relatively speaking! (This picture is from a couple of days ago -- he's filled out even more since then.)

Cousin Daniel

The babies had a visit from their cousin Daniel (and Auntie Nora and Uncle Adrian) when they were first born. Daniel didn't actually get to meet his new cousins because visitors to the NICU have to be at least 13 years old. This was probably for the best because at nine months old, Daniel is in the "I want to grab whatever you have and put it in my mouth" phase, and that would be Not Good in the NICU.

At his recent pediatrician appointment, Daniel weighed in at about 20 pounds, so this is probably the only time in his life when he can say he's 10 times as big as his cousins!

Two Weeks

The boys are two weeks old today! They had a good day. Matthew is tolerating his feeds well, so they're going to gradually increase the amount he gets. And when the doctors were doing rounds, the nurse practitioner commented on how good James was looking -- very nice to hear!

We went in this evening and got to hold them for a while (Mike had James this time, and I had Matt), which was really nice. After James went back in his crib, they had some trouble getting his CPAP calibrated right, which was a bit unsettling because his blood oxygen dropped for a little while. It was nothing serious, but it was a reminder that he's still a little fragile.

We're hoping the next two weeks are much less eventful than the last two!

Videos of Matt and James

Matthew had his CPAP breathing mask off for a little while yesterday (the 26th). He was especially alert, but he seems a little suspicious of the activity around him. Or maybe not. At this age, he probably can't see too far away!

James is doing much better than he was a few days ago. In this video clip from Monday he is on the ventilator, but as of Wednesday May 27 he was off the ventilator and back on the CPAP.

Finally, yes, they can cry at this age. Matt is the feisty one in this video.

Bye-bye (for now) to Grandma

We were lucky enough to have my mom staying with us since the boys were born. (She thought she was coming up to visit my sister, and then she thought she was coming down from Virginia to keep me company for a couple of days when I was on bedrest, and then lo and behold she had two new grandsons!)

Even the NICU recognizes that grandparents are special -- grandparents are the only people allowed to visit the babies without the parents present.

Mom went back home today (since my brother and sister are down in Florida visiting). We'll miss her!

Relaxing

Today was a good day at the hospital. Massage students from one of the local colleges were offering free hand massages and facials for NICU families, and it was wonderful! It was so nice to relax and be pampered for a little while without having to make any special arrangements.

And after that, we got to hold the boys for about an hour, doing "kangaroo care" (skin to skin contact). Mike held Mattie again, and I held James. Both of the boys did really well. (The kangaroo care is good for them, but it's also a little taxing on them to be moved around so much at this age. When they're older, we can do it for longer periods of time.) And it certainly helped us feel good!

(If you're wondering what the NCCC stands for in the photo, it's Newborn Critical Care Center.)

Progress

Matthew had his second echocardiogram today, and the preliminary report is that his PDA (heart murmur) has closed up -- yay! We're still waiting on the official report, but it sounds like even if it's not completely closed, it's smaller (and smaller is better!) He's also continuing to gain weight, and they're starting him back on feeds this evening. (I don't know if we mentioned this before, but for now their feedings are breastmilk given though a stomach tube.)

It looks like James had a clear-enough X-ray today, so apparently this is Day 1 of his bowel rest. (Our impression from the nurse is that the little problem area is still there, but that it's either not changing or getting better, so they're not worrying about it.)

Instead of having one nurse each, the boys now have one nurse who takes care of both of them during any given shift. At first I thought this was just during the holiday (Memorial Day), but it seems to be a permanent change. It's probably a good sign that they're more stable and don't need the constant care, but at the same time, it makes me just a little nervous -- I want someone paying attention to my precious babies all the time! Really, though, they're hooked up to lots of monitors, so if something happens (say, Matthew pulling his CPAP out, as he likes to do), the monitors beep and someone is right there to take care of it. And even though there is just one nurse whose primary responsibility is the twins, there are several other nurses in the room at all times (in charge of other babies), but who can step in as backup.

Our Family

We got to hold James today! Here's the first picture of all four of us together, although you can't actually see much of the boys. (When we're holding them, they have to stay under blankets to help maintain their body temperature.) I have James and Mike has Matthew.

As we expected, Matthew wasn't quite ready for the nasal cannula -- he was on it for an hour or so and then they switched him back to CPAP. That's okay; he's got some time to grow into it!

Unfortunately, James didn't have a "clean" intenstinal X-ray today, so we're still waiting for that. It doesn't sound like things have gotten worse and the doctor didn't seem worried, but that means they don't start the clock on the 7-10 day rest period yet. He seems like he's doing better, though, and he's been fine off the ventilator.

The Daily Weigh-in, May 26

Here are the daily weights through May 26, 2009.
You need to click on the chart to see a bigger and more readable image.

Trial Run

Matthew has been doing well enough with his breathing that they moved him down to a lower level of respiratory support -- from the CPAP to a nasal cannula. (We wouldn't be surprised if they move him back up again, but it's encouraging that he's at least having a try at the lower level.) I think the cannula would be a bit less annoying for him -- smaller tubes!

Matt's other accomplishment for today is that he has surpassed his birthweight -- at this morning's measurement, he was one gram heavier than when he was born!

James came off the respirator this morning, which is also good progress. And they're hearing bowel sounds and he had a normal poop (see, here we go again with the poop!), which are both promising signs as well.