I think there is a baby dinosaur in Naomi's room

It will be one month of home life this coming Friday. It really has been a wonderful change from the hospital, but that probably goes without saying. Naomi has settled into home life and we have settled into Naomi life. Most days are filled with eat, sleep, poop mixed in with a lot of grunt and squeal time. Sometimes I swear there is a baby dinosaur in Naomi's room, but every time I go to look, all I find is Naomi sleeping peacefully.

Naomi's eating style is very barracuda-ish. Mom handles the majority of meal times, but I still deliver two bottles. One in the wee hours of the morning and one while mom takes her late night nap. The bottle feedings start out looking like hand to hand combat, followed by a wide-eyed chug fest, followed by burp time. Based on Naomi's response, I think she is burping shrapnel. Once the torture of burp time is over though, Naomi tends to fall asleep in our arms.

Since gas, and possibly reflux, have been problems for her, we invested in some anti-flatulence drops. It has yet to be determined whether they will actually work, so I've thought about adding them to mom's coffee to see if I notice any reductions.

Naomi gave up her caffeine habit last week. If you recall, Naomi came home on caffeine to help her remember to breath. Daughter and dad would enjoy their morning coffee around 9 or 10 AM each day. I take mine black and Naomi takes hers white. Since she had no apnea or bradycardia spells for three weeks, she was taken off caffeine. She will wear a monitor for one more week to verify that she remembers to breathe and then... she'll be cord free!

Naomi is also starting to have awake times now. They tend to last three hours at a time and their occurrence is highly correlated with the times that mom and dad are most tired. Regardless, they are great. Sometimes we hang out in the sun room watching the birds at the bird feeder enjoying binkies and coffee, sometimes we work on tummy time, and sometimes we stare at ceiling fans. I try to tell her that grandpa put it up there and he hasn't had one fall down yet, but she still gives it the wary eye.

Naomi's sleepy time is filled with grunts and other noises. We were told before we left Children's that early birds tend to make a lot of noise through the night and at one point, one of the nurses told me that Naomi was one of the louder babies she had watched. So, mom and dad's sleep cycle seems to be listen to Naomi grunt for a couple of nights followed by a solid night of sleep due to exhaustion. We've tried various solutions without a lot of success. What seems to work one night fails to work the next, but as Naomi grows she is sleeping a little quieter each night.

On a last note, mom seems to have forgotten her physics lessons, or more importantly, she doesn't fully grasp baby physics. When observing a diaper change, do not stand at the end of the table. The consequence can be rather smelly. Of course, this may also be related to dad's poor diaper changing skills.

One Last Week in the ICC

Sorry for the delay. Time seems to have rearranged itself on us. The minute hand and the hour hand have switched places as the minutes seem slow and the hours seem fast.

This story starts the week before discharge day (10-26-2011)!

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Our life of routines has been replaced by Naomi time. What used to be three hours of temp taking-diaper changing-syringe feeding-tucking in for sleep has been replaced with, when I'm hungry or stinky or cold, I'll let you know.

It all started earlier this week. Mom has been working on nursing and after a few hurdles things were figured out. I tend to compare it to synchronized swimming. There's some arm waving, some breath holding, and when it all works out, it's quite the spectacle.

We were still on nurse time, so Ana would arrive around 9 AM and spend most of the day with Naomi. Cares were every three hours starting at 9 AM. However, after weeks of tummy measurements, cold stethoscopes, and bright lights at night, Naomi was letting us know that she wanted her own schedule. So sometimes Naomi would eat well and sometimes she wouldn't. Like her mom, she tends to be sleepy early in the morning and not interested in waking up to eat. I think Ana and I would both be okay with that schedule, but we also need Naomi to keep gaining weight if we want her to come home soon.

In response, after a few days of some successful nursing and some observation by the nurse practitioner, Ana was given the green light to try a twelve hour shift of feedings. They would allow Ana to feed Naomi when she showed signs of being hungry. So we shifted to Naomi time. On average, it's the same as nursing time, but her variation is much greater. Sometimes she is hungry one hour after eating and sometimes she isn't hungry for four hours. We do our best to keep her full.

Ana's first twelve hour shift was a day of two Naomi's. The first six hours was a fight to keep her awake and interested. By the time Ana called at 3 PM, she was tired and frustrated. Mom stuck with it though and the final six hours were great. Naomi was awake and eating. She was even giving us a burp or two.

Ana continued with the twelve hour shifts for a couple of days before the discussion moved on to 24-hour shifts. In addition, Naomi would get 100-mL of bottle milk with Elecare and vitamins. I quickly asked the nurse if I could give Naomi her first bottle. The nurse hesitated slightly, but agreed that I could give Naomi her first bottle. Early birds tend to choke on their first bottle feeding and you need to be very focused while feeding her. You need to listen and watch to make sure they suck, swallow, and breath. You also need to hold them so they face you and you need to hold the bottle like a dart. I was a little nervous after all of the warnings, but the nurse reassured me that Naomi was mature for her age (at least when it concerned eating).

So I showed up in my finest clothes the next evening, knowing they might be urped on. The nurse watching Naomi got the bottle ready for me, I changed Naomi's diaper and took her temperature, and after a gentle swoop of the arm, we were facing each other eye-to-eye. She gave me a look that I interpreted as: those look like nice clothes to urp on, and I tried to convince her that the milk dripping all over her face was all part of the plan.

Naomi eventually opened her mouth and the bottle feeding began. The nipple we started with was a little fast and Naomi's mouth filled quickly. The nurse told me to pull back and let Naomi breath. After two attempts, we decided to switch nipples. The new nipple reminded me of the star ship enterprise, and after a quick flight, Naomi was drinking at warp speed. She was performing great and after a couple of burp breaks, she ate a total of 53 mL. I was pretty proud of my little daughter. She not only fed well, she also burped like Booger. After worrying about all of the air in her belly a couple of weeks ago, she was doing great getting rid of it. It was a relief since early birds are not the burping type.

We decided to head home shortly after that. After a couple of 24-hour shifts by mom, the nurses encouraged her to go home and get some rest. We obliged and as soon as we got home we were pretty much ready to sleep.

After a brief rest we got ready for the weekend. The plan was to stay at Ronnie's place and to pull a 48-hour shift. We still had several things to learn before going home and this seemed the best way to accomplish them in a logical order.

So Friday evening, I showed up at Children's. Ana had been there most of the day and had reserved a room for us at Ronnie's. Feedings were going well and after dinner, we checked into our room. The rooms at Ronnie's are pretty amazing. It feels like you are staying in a luxury hotel rather than a hospital. It really has been a great space for us. We quickly settled in for sleep and Ana set her phone to alarm every three hours. She would get up and walk over to ICC in the middle of the night to nurse until about 6 AM. I took over at the 6 AM shift after grabbing a cup of coffee on the way.

As the weekend continued we began to hear the D-word more often. By Saturday evening a plan had been established. Naomi would get discharged early in the week, most likely Wednesday. Needless to say, we were pretty excited.By Sunday morning however, we were starting to get a little worried. Naomi had been off of caffeine for six days to prepare to come home, however, she was starting to have poor oxygen saturation's again as a result of inconsistent breathing. I was a little worried that this would change our discharge plan. After some discussions with the nurse practitioner, we would be giving Naomi caffeine at home. Naomi would have to go home on a monitor anyways, she'd just have to be on it three weeks longer than previously thought.

At 10 AM I was learning how to give Naomi her caffeine. She takes it straight milk right before her feedings. It consists of one part liquid caffeine and one part milk for a total of approximately 5 mL. After giving her a dose, I could cross that off of the "to learn" list.

The remaining three days were filled with tests and shots. Naomi needed to pass an apnea test while sitting in her car seat before heading home. A lot of early birds tend to have apnea spells in car seats, but Naomi seemed to take it all in stride (at least with the caffeine in her system). Next, Naomi received her shots before leaving the hospital. She was officially two months old, so she could receive her vaccines. Finally, she had one last eye exam before discharge.

Everything looked good, so Tuesday night, we reserved a room at Ronnie's and waited for Discharge Day. We awoke and Ana headed off to feed Naomi while I packed away our things. The hours ticked away fast and soon it was lunch. We quickly ate one last time at Ronnie's and headed back to Naomi's room. Everything was ready to go.

We quickly got Naomi situated in her car seat in a slow, where does this towel go, drawn out fashion. The nurse took some photos for us with Naomi in her car seat and said farewell and that was it. We headed for the door dodging germs along the way. Through all this, three trips home stick in my head: My first trip home to take a shower and get some things when Ana was still in the hospital, my second trip home with Ana after she was discharged, and this trip, our first trip together as a family.

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!