Visiting Rules

We are at home, so in an effort to get the word out, I wanted to post this information for everyone. I stole most of it from a caring bridge web page, but we got the same discharge information. I'll post the more exciting stories about the past week soon.

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Because Naomi was born 11 weeks early, her immune system will be under-developed for a year or so. She was working hard on her own for 11 weeks rather than kicking back and relaxing in the womb. She'll be at high risk for RSV, colds, and the flu. RSV, cold, and flu season is from the beginning of October to the end of April.

If you plan to visit Naomi, please be up to date on your own immunizations including the flu shot and DTAP (covers whooping cough). Naomi will get some vaccines before she leaves, but she isn't old enough for a flu shot of her own.

One of the vaccines Naomi will get is a monthly vaccination for RSV. Because RSV, colds, and the flu spreads very easily, it is important to keep her away from public places, young children, and people who are sick

We are planning to ask that children do not visit until after April 2012. This is an easy, but not enjoyable decision. The consequences of Naomi catching RSV are potentially severe. For full-term babies, RSV typically isn't worse than a common cold, but for preemies, RSV is quite serious. Babies born earlier than 36 weeks are at the highest risk for serious complications from RSV such as pneumonia, asthma, bronchitis, and other sometimes fatal complications. When we left, young babies with and without RSV were showing up in the NICU and ICC.

Preventing the spread of RSV is very difficult, so we will be extremely vigilant during RSV season. The virus is spread through physical contact, in the air via a cough or sneeze, or by touching an infected object. RSV can live as long as six hours on hands and up to twelve hours on objects. It spreads very easily, especially from child to child. Studies have also shown that infants pose an even higher risk of spreading RSV to others.

You may ask “Can’t they fight it off and build up their immune system? Kids need to get sick, right?” The simple answer is NO! Since Naomi is pre-term, she did not acquire the necessary immunities to effectively fight off infection. And even more importantly, her respiratory tract was not fully mature when she was born. Her lungs missed a very critical developmental period. If Naomi contracts RSV, she will be hospitalized and may develop one of the complications mentioned above, or die.

We want everyone to be able to come and visit her but we ask that you come only if you are healthy. Also, please plan to wash and sanitize your hands frequently.

In order to try to prevent Naomi from getting RSV or any other illness, our doctors strongly recommend that all visitors follow these guidelines until the end of April:

1. When you arrive, please wash your hands and use hand-sanitizer.

2. Please get a flu shot.

3. Please refrain from visiting if you are not symptom-free for at least five days.

4. If you live or have been in close contact with someone who is sick, please refrain from visiting for at least five days.

5. If you smoke, we ask that you change your clothing and refrain from smoking prior to visiting. A preemie’s lungs are very sensitive to smoke. Most RSV sites recommend against passive smoke exposure (including smoke that is in clothing).

6. If you are a parent to a baby or toddler, please refrain from bringing them to our house during RSV season.

7. Please refrain from touching Naomi, unless invited.

We do not mean to offend anyone, or to be "those parents". We simply want you to understand why we are being incredibly cautious. Thank you all for your understanding! Please also note that during RSV season, we will not be taking Naomi out in public or to family events/holidays until the end of April. We will be safe and snuggled in our home and thrilled to send her out into the world next summer!

Just an extra reminder: the best way to prevent illness is by washing your hands often and not touching your face!

We're going home!

More news soon!

Bada Bing, Bada Boom, ICC

Naomi's world has been rapidly changing. After weeks on the digestion roller coaster ride, Naomi has appeared to given us a break. Her digestion and belly seem to be doing better after a week on her fully digested formula.

During the past weekend we were waiting to see how Naomi was doing on the formula. It was kind of a wait and see final plan since she didn't seem to be digesting any of the other formulas. In the back of my mind, I still think it was the fortifiers that were giving her digestion problems.

They also wanted to take a break from mom's milk. Mom was allowed to nurse once a day, but they weren't expecting Naomi to succeed. In an effort to track how the nursing went, Naomi was weighed pre- and post-nursing to see how well she was doing. Saturday she gained 30 g which is approximately 30 mL of milk.

The other big event of the weekend was a little less apparent to us. We were informed that Naomi's auto-heater 3000 was turned off over Friday night and that she was maintaining her own body temperature well. If she continued to do well, we would switch to a crib in a few days.

Ana and I were both sick over the weekend. We donned our face masks routinely as we entered Children's and washed our hands frequently. I've been hands off for over a week now because of the complications that could arise if Naomi becomes ill. It's been hard not holding her for a week, but hopefully soon I'll feel better.

In the meantime, I've been working on Naomi's room at home with Grandpa Menk's help. He's done most of the work, but as Great Grandpa Menk taught me long ago, supervising is 90-percent of the work. The original plan was to start working on Naomi's room in September, but with Naomi's arrival we haven't had a lot of time to focus on her room.

Monday was a big day. Naomi received her first bath! She was maintaining her body temperature so we were allowed to unwrap her, take off her leads, and give her a scrub down. Naomi had the fewest wire connections yet with just her O2 sensor and NG tube connected. She didn't seem to particularly enjoy the bath at first, but after a few moments she calmed down and was satisfied to just give us her stink eye look. Afterwards, Ana quickly dried her off with the help of the nurse and we bundled her up so she could stay warm. The bath was followed by a shampoo. The nurse informed us that most babies like to get their head washed and Naomi seemed to validate that claim.

After snuggling Naomi back in, we started her other new feature, music boxes. Early birds usually don't get to listen to music until they are around Naomi's current age (36 weeks) because of the stress that it may cause them. I would have preferred to bring in my own cd, but I was content to hit play and listen to nursery rhymes and a toy's interpretation of classical music.

Tuesday was routine as normal for Ana. I was still sick, so I ran around town getting things to fix up Naomi's room. Wednesday, however, was a different story. Naomi was doing well when I called in the morning, mom was planning to go in around noon to nurse, and I was planning to visit after work. That all changed though at 3:30 PM. Ana called me with the latest update. She had two things to tell me, first we were head to ICC! Second, Naomi Kobayashi-ed during nurse time.

Ana and the nurse used the scale again to try to estimate how much milk Naomi received. They weighed her beforehand, nursed for an hour, and weighed her afterwards. Then they weight her again, and finally, a third time, just to be sure. Naomi received about 110 mL of milk or approximately three times her normal feedings. So while we were excited about heading to ICC, we weren't sure what to expect with her record setting performance. I guess we shouldn't doubt her prowess since most nurses comment on her 90 mph binkie habit.

At 3 PM, Naomi was still doing well. Her belly seemed normal and there were no indications of any problems. By 4:30 PM we were  packed up and ready to make the mini-parade to ICC. ICC is a step down unit before we go home. It is where Naomi will transition to nursing and bottle feeding, back sleeping, and the routines of a home. Our anticipated stay seems to be around two weeks, but as with our NICU stay, no one wants to say with any certainty.

When we arrived in the ICC, we got to snuggle Naomi into a crib. She skipped one feeding due to her large lunch at noon and had about ten new diapers during her 6 PM cares. Otherwise she was doing well. After tucking her in and getting her feeding started, we received a tour of the ICC. It's a nice unit with larger rooms and windows. Technically, it's also one step closer to home since it is the door before the NICU.

So now we are in transition mode. We've been adopting to new routines and new nurses. Hopefully our stay will be short, but we'll need Naomi to start digesting well on a routine basis. All in all though, it has been an amazing week of progress. Go Naomi!

A List of Good Things

I decided to follow the last post with a list of all the good things lately.

- Naomi's Grandma's come to visit often!

- Naomi's library is growing and she loves to listen to us read books.

- No more head IV's (for now).

- Naomi is growing out of some of her early bird outfits (this one is supposed to go to her feet).

- Naomi kicked off her first pair of socks.

- Naomi looks cute even when she is wrapped like a burrito.

- She smiles when she hears our voices.

- She gets to wear cute outfits regularly.

- She really likes kangaroo time!

- and, she knows how to hold her binkie on her own (she kind of reminds us of Maggie Simpson).

Yellow Dots

Monday was officially the beginning of the flu season at the NICU. We received a letter the day before describing the new rules during this time. Naomi can only have four visitors per day. The sibling rules don't apply to her, but I think the new rules mean that no children are allowed past the public cafeteria that are not siblings.

In honor of flu season, I promptly caught a cold, and now I am trying as hard as I can to recover quickly. Being sick means that I get a yellow dot on my name badge and I get to wear a mask and foam often. That part doesn't bother me, neither does the nasal drainage that occurs inside the mask, but I don't think I could forgive myself if Naomi got sick because of me. To keep that from happening, I've restricted my visits or skipped visiting for a day. So, needless to say, it has been a tough week.

I also seemed to have passed a milder version of my cold on to Ana. Fortunately, she has recovered, but has continued to wear a mask for a couple of days.

We've returned to our roller coaster rides. Naomi had been doing well and digesting well. Her stools were fairly regular and had shifted a couple of crayon colors in the crayon box towards yellow. Her fussiness even earned her a burrito wrap.

By Tuesday though, things seemed to be falling back. They told us in the beginning that the NICU is a series of two-steps forward, one-step back. As a new dad though, I think I'd describe it as a series of balloons. They get bigger slowly and you get excited and then they seem to pop right in front of you. It really can be deflating when you get to that step back, even when you remember how fortunate you are and how well things seem to be trending.

So Tuesday, Naomi's belly was distended again, and another belly x-ray showed a lot of air throughout.  We've been here before.  Her feedings were held for a couple of hours to see what would happen, and they discontinued the fortifier that was added to the breast milk.  Her belly measurements are one of her least favorite things, but we were anxious to have her belly measured often. So far things were headed in the right direction. Naomi's belly was getting smaller and her feedings were resumed.

Wednesday started off fairly normal as well. I made my usual call to the nurse in the morning and learned that Naomi had a good night. Her belly was feeling softer and she was still stooling regularly. The size of her belly was the same though. Ana went in and talked with the doctor. For now, they would also discontinue the iron supplements that she was receiving. The fortifier and iron have been suspects in the past, so we were hoping that by stopping them, Naomi would be able to pass the gas in her belly without holding feedings and restarting an IV.

By Wednesday evening, Naomi's belly was distended again. Her feedings were held for a couple of hours while Mom held her tight. After kangaroo time, Naomi's belly was 1 cm smaller and her belly still felt fairly soft. Her feedings were continued. At some point in the afternoon, those feedings were switched to a completely digested formula instead of breast milk. The doctor wanted to see if Naomi could handle the new formula and if it could be used as a fortifier. If all goes well, they will keep Naomi on the formula and reintroduce breast milk over the week. So I guess we are in wait and see mode again.

All in all, we have been very fortunate. While there have been problems along the way, Naomi has been a super star through all of this. Someday, I'm sure I'll be lying awake at night waiting for her to come home after her curfew. I'll probably have to give some sort of obligatory parental lecture or at least watch mom give an obligatory lecture. And someday, I'm sure I'll be lying awake at night when I am older and I'll be wondering if my daughter is okay. But between all of those late nights, both now and in the future, are and will be, days that are filled with joy. We just have a few more hills to climb along the way.