Zachary Hits the Baby Gym

Zachary has made great progress the past week and a half. He is now over 34 weeks gestational age and about 2 months old. A week or so ago, he had a Holter monitor on for 24 hours to track his long Brady's but didn't have one when he was wearing it so the cardiologists gave up on him and declared him a medical mystery. However, he hasn't had one of those long asystolic events in over 5 days now. We are hoping he has grown out of them.

Growing into the hat Claire made for him 

A few highlights from the past week:

Weight gain: Zach is now over 3 1/2 pounds and growing steadily.

Recreational breastfeeding: Doesn't that sound strange? It sounds like a sport. In a sense it is, Zachary burns lots of calories when breastfeeding. Each time he does it, it is like he is visiting the baby gym. Recreational feeding means he is still getting full feedings through his tube but is learning to breastfeed. To breastfeed (or feed with a bottle) babies need to be able to do three things at once: Suck, Swallow, Breathe. It takes a lot of work and coordination to do this, especially for preemies.

So far, he is doing well but it will take a while to really get comfortable with his new workout regimen. Zachary is good at latching on and suckling but gets tired and falls asleep pretty quickly. Right now we are limited to trying this once or twice a day to balance the breastfeeding practice with his need to sleep and grow. Nadia has been pumping ahead of time so he doesn't get overwhelmed with milk. Once he starts getting more milk in a given session the nurses will adjust his feedings and slowly wean him from relying on the feeding tube. This process could take a while but it is exciting that we were able to begin this past week.

Body Temperature: We are trying to get Zachary out of the incubator and into an open crib. This requires that Zach regulates his own body temperature. For this to happen, he needed to have more fat on his body. Now that he is over 1500 grams, the medical staff hopes he can start to keep himself warm, so on Friday they turned the incubator temperature down and so far he has been staying warm on his own. We'll see if that continues to be the case.

In other news, a preemie baby whose parents we have gotten to know well was discharged this week. The intense environment of hospital life can create friendships in a short time. It has been really helpful to discuss treatment and worries, big and small, with others in this situation. Our new friends generously gave us their son's preemie clothes, and after they wrote about Zach on their blog, one of their friends even bought Zachary a present, despite never having met him or us. We hope that the relationships we are creating now lead to long-term ones as we continue this journey. We've been joking that this baby is Zachary's first friend and we are looking forward to playdates together.

We can't believe Zachary has been in the hospital for almost 9 weeks now. This journey has made us realize the importance of strong relationships with family and friends. We feel so grateful for all the love, and supportive messages, that you have expressed towards Zachary and us.

We can't wait for the day when Zachary gets to come home too.

Three Pounds

Zachary has been growing consistently, and today made it to the three pounds milestone. Nadia's hindmilk (the last part of the breastmilk that comes out, which is higher in calories) is being combined with a high calorie fortifier and it seems to be doing the trick. He is finally starting to fill out and we can see a hint of the baby pudge to come. Zachy's head is definitely getting bigger, he seems to go through hats very quickly these days! In our extremely biased opinion, he is getting cuter by the day.

Is that a smile?

He is also more alert and opening his big eyes to look around with interest. He had his first eye exam last week and we were told all looks well for now, though he will continue to get exams every 2 weeks. The doctors told us he can only see light and shadow, though Zachy seems to stare right into our eyes, so we aren't sure we believe that. Apparently babies acquire adult vision around 2 years of age, which is related to the time they begin to walk. He told us that humans are unlike other animals in that way because it takes us so long to become mobile. Many animals can see well at birth because of dangers in their environment. Think of a baby zebra looking out for the lion.

Zachary & Daddy cuddle time. Do you see the resemblance? 

Zachary's biggest challenge right now is his bradycardia (rapid decrease in heart rate). Recently he suddenly started having episodes of asystole during Brady's, which is when the heart rate goes to 0. While Brady's are common in preemies, asystoles are more worrying. For the most part he comes back on his own, sometimes crying, and the nurses and doctors wonder if the monitor is picking up correctly. However the machine printouts show long pauses between heartbeats, which is alarming. To get to the bottom of this we have been working with pediatric cardiologists, and today Zachary is being fitted with a Holter monitor to wear for a few days (see description here) It isn't invasive and we hope that the monitor will tell us the pattern of these events and whether they are true asystoles or just machine error.

In other news, we have finally started working on the nursery again. We are hoping Zachary will be home before Thanksgiving, if all goes well. This past weekend Aaron worked on painting the walls and we are starting to empty the room in preparation for a crib. We even made our first baby-related purchase on Craigslist. The doctor who delivered Zachary did mention that we would end up doing all the things that expectant parents do to prepare for the new arrival, but that we would do them in a different order than most parents.

Something to Grow Into

Zachary at 2.5 lbs, 1 lb above his birth weight

People are often surprised when they hear how little Zachary weighs, and it can be hard to visualize. We heard a story about a couple who took a picture of their preemie baby next to a football when he was in NICU and then again when he got bigger.

Aaron bought Zachary this baseball mitt as a present. It is Aaron's size but everyone says that Zachary has Aaron's hands and long limbs so we hope it will one day fit him! We thought it would be fun to see him grow into this mitt and eventually be able to play catch with it.

Zachary is around 6 weeks old and 32 weeks in gestational age. He now weighs a little over 2 1/2 pounds.

1,000 Grams!

Zachary reached the 1,000 grams milestone today! For the past week, Nadia has been splitting her milk partway through the pumping process so that the NICU staff can feed Zach only the high calorie hind-milk that is produced in the later stage of milk let-down. Zachary has been doing his part as well by sleeping a lot and "tolerating" his feeds (i.e. digesting the food in his belly).

I want my milk! Sleeping while clutching the feeding tube

Zachary's main challenge this past week has been issues with bradycardia (dramatic slowing of the heart rate.) Sometimes his heart rate picks back up on its own and sometimes he requires stimulation, or even resuscitation. It is common for preemies to have episodes of bradycardia, but Zach's episodes have increased in intensity and frequency in the past week or so. Doctors have been investigating the cause and have been experimenting with different types of breathing support as well as testing for infection. So far they found some fluid in his lungs, for which he is being treated, and today they identified an early-stage bacterial infection that should go away after a few days of antibiotics. We are hoping that once the infection and fluid issues are resolved Zachary's Brady's will also become less frequent, though the doctors warn us to expect episodes of apnea, bradycardia and desats in oxygenation (called the A, B's and D's) for another month or so.