Saturday, April 28, 2012

Update on little C.

Our post-birth hospital stay has been somewhat more eventful than with the other two boys.

Day 0:

Little C was born at 4:10am on Tuesday 7lb8oz, 20.5".  We weren't able to do skin to skin immediately because the cord was wrapped around his neck, but he was given to me pretty quickly.  We made a first attempt at nursing sometime between 5 and 6, after they'd finished sewing me up and I'd delivered the placenta.  It went okay, we were able to get a decent latch, but he didn't suck all that much.

After that, he slept and slept and slept.  The pediatrician came by to do a newborn check, and he passed with flying colors.  But, in the midst of her exam, he threw up a whole bunch of clotted greenish brown stuff.  Thank goodness she was in the room at the time, it would have freaked me out!  They took the clothes away for some testing, and found that it was blood, most likely ingested during delivery.  Also a likely cause for him not wanting to eat much, as his stomach was already full!  That was probably around 10 in the morning.

The neurologist team (attending, fellow, resident, med student was my impression) came by to examine him, and all the reflexes and things they checked were also normal.  Also good news :)

A few checks of his temperature were on the low side, so we did some skin to skin, and after that didn't work, he had to go under the warming lights.  As he was not eating often (we did attempt a few times, but he was just fast asleep), the nurse suggested that I pump and we try and syringe feed him.  So I did, and amazingly got about 10mL out of each side!  I had no idea there was that much colostrum in there; everything you read says it's very small amounts. They checked his temp, and it was low for the fourth time, which they found concerning.  Particularly because I was GBS positive and did not get the full dose of antibiotics, they wanted to be proactive in treatment, so decided to start IV antibiotics.  Apparently in infants their temperature goes down with an infection rather than up, who knew!  We syringe fed him while they were putting the IV in, which really helped calm him down (although he really was a champ through the ordeal, barely made a squeak!).  They also took blood to do a bacterial culture, complete blood count (CBC) and blood sugar (which was low).  He took a total of about 8mL.  He finally woke up again around 11:30pm and nursed reasonably well.  CBC came back with low platelets but otherwise normal.

(funny, I'm already having trouble remembering some of the sequence of events!)

Day 1, Wednesday:

Started out relatively uneventful.  We syringe fed C again at around 6am as he still hadn't woken up again, took ~6mL.  FINALLY at noon he seemed hungry, so I nursed him.  We also had the kidney ultrasound scheduled at 1pm, so it was perfect timing.  Of course, when it rains it pours, and right before the nurses and DH were taking C to the ultrasound, the neurologist showed up to examine C.  He also didn't find anything that concerned him.  More yay.

DH said that C was actually awake most of the way down to the ultrasound, but nice and cooperative, and they were able to get the images they needed.  Unlike in the OB office, you don't get your own monitor to watch, and the u/s techs aren't supposed to tell you anything, so all he managed to get was that the one kidney was measured at 4.73cm.  (I had no idea kidneys were so relatively big!)  Didn't see them measuring the dilation at all.  So that test was finally checked off the list.

After that, C nursed nicely from 2:30-3:30 (with Uncles J and K visiting, that was mildly awkward for me, lol), 4:50-5, 6:30-6:40.  At that point I wanted to take a shower, so I sent him off to the nursery.  DH was home with the other boys, and I didn't feel comfortable leaving Cam alone in the room (the bathroom was right there, but still I couldn't necessarily hear him if he started crying, or hear if someone else came into the room).  When I was done in the shower I popped over to the nursery to get him, and found that they were in the middle of his antibiotic infusion.  He was acting hungry again, so I nursed him from 8:30-8:40 or thereabouts.  Afterwards he needed to be weighed, so the nurse took him and got that accomplished.  (7lb1oz, so a drop of about 5%, not too bad).

When she was dressing him again, all of a sudden he turned a funny color.  She mentioned it, I agreed, and asked if he was breathing.  She responded, "NO", and immediately picked him up and went to get oxygen.  She sent me to get another nurse, fortunately there was a nurse and a pediatric resident right outside the nursery door.  DH was asking later, why did she send me to get help rather than pressing a button or something to call people - my friends suggested maybe she just didn't want me to see anything further!  By the time I got back in there with the other two he was looking pinker, but still taking very shallow breaths.  Within another 30 sec to a minute he was back to normal again.  Thank *goodness* it happened with the nurse right there!

They then paged the neonatologist on call, who was there within two minutes.  He took a brief case history, and told me he would talk to the NICU team to decide where C should go, because clearly it wasn't safe at that point for him to be in the room with me in case another incident occurred while I was sleeping.  He thought that C would probably go to the "special care nursery" with full time monitoring by a nurse, but when he returned he said that given the ACC (agenesis of the corpus callosum), and the fact that his blood sugars and temps had been low, they would feel more comfortable with us going to the NICU.

While they got him prepped, I went back to the room to grab some stuff and to call DH and let him know what was going on.  I couldn't get it out without sobbing; once that started I made sure to let him know the most important thing - C was OK!  I can only imagine how scary it must have been for DH, getting a call from me where I started to tell him about C and then burst into tears!  I eventually managed to get it all out.  It really was absolutely terrifying seeing C go that funny color and realize that he wasn't breathing.

When we got down to the NICU they immediately wanted to run some more tests, which meant more heel pricks for poor little C.  Another CBC, a chemistry panel to check on kidney and urine function, and another blood sugar.

The CBC results showed a high hematocrit (red blood cell marker), so the attending wanted to start Cam on IV fluids (nutrition and hydration) - the thought was that the excess red blood cells could be making the blood thicker, harder to get where it needed to go, which could explain the sleepiness, low blood sugar, low temps, and potentially the apnea.  It was nice that the IV line was already in from the antibiotics, so they could just start pushing fluids.  And then we finally both got to go to bed!  Actually not true, I pumped again (40mL, around 1.3oz), THEN got to go to bed.  But because he wasn't nursing I got a decent six hours sleep before I got up to pump again (up to 2oz).  I already felt like my milk was coming in so I wasn't worried about my supply!

Days 2+ coming!  (This is getting a bit lengthy!!)


sarah (SHU) said...

that is amazing how fast your milk came in!!!

and i'm so glad it sounds like he is doing well now (i'm keeping up on FT but haven't had time to write a proper post yet). i wanted to tell you that a's big toenails are triangular looking, too -- kind of similar to dad :) i also think it's CUTE!

J o s e y said...

Stella had the same issue with the gunk in her belly in the beginning. She kept puking it up the first 36 hours and not wanting to eat. Can't say I blame her!

How scary that C wasn't breathing. :( I'm so glad the nurse was there and he was able to get the help he needed asap! Hanging on for the next update....

Anonymous said...

Thanks for keeping us updated, Nico! Thinking of you anf your beautiful family!