The Legend of Lobo

Last weekend Logan passed both the three-week and the three-pound marks, and he’s now a whisker away from the big 1500 gram milestone (prematurity and weeks of hospital life have converted us to the metric system). We had a few sleepless nights recently while he battled an intestinal infection, but it looks like it was caught early and has been resolved. For a few days Logan’s feeding was suspended and IV nutrition resumed, but yesterday morning they started his feeds again and he’s doing well. He’s somehow maintained his weight gain during this bump in the road.

This afternoon his nurse gave him a break from the CPAP, and he did well breathing unassisted for about ten hours before he became tired. It’s always great to see him without all the respiratory accessories. Today’s photo shows him looking plumper and rounder as he sleeps deeply on Ash’s chest after a big lunch. He’ll make a great fly-catcher some day.

He does not enjoy wearing medical gear, and his latest trick is to rub his face against his bedding to wiggle his CPAP prongs out of his nose and into his mouth. He then sucks air and blows bubbles into his CPAP water cylinder just as if he were breathing normally, so the monitors stay quiet. He completes this escape maneuver in less than 5 seconds, and a nurse won’t know the difference unless she looks closely. He can hide in a darkened isolette like this indefinitely, but we’re onto him now!

In addition to this nimbleness, Logan has gotten bigger and sturdier in the three weeks since his birth. He’s developing an affectionate and quirky personality, and the nurses seem to love him as much as we do. His arms and legs are strong and he responds to my voice and touch. He likes to open his eyes and look around, but it’s hard to keep them open in the bright lights of the NICU, so he blinks and squints quite a bit. Yesterday I was standing a few yards away from him, talking with another mother. A nurse beside Logan’s isolette noticed that he turned his head and looked across the room at me when I laughed. I guess he came to know that sound well during his six months in utero. For everyone’s sake, I hope Ash and I remember to laugh during these anxious days.

Logan is two weeks old today and he’s growing fast. It usually takes newborn babies—full-term as well as preemies—about two weeks to return to their birth weight after an initial dip. Logan caught up a few days ago, and his momentum is high. He’s expected to gain up to an ounce each day from here out. He’s now four ounces heavier than his birth weight and closing in fast on 3 pounds. Ash and I will have a big celebration that day!

Lillian O’Leary is Logan’s primary day nurse, and she’s wonderfully attentive and sharp.  I’ve already learned so much from her, and it’s deeply reassuring that she’s caring for Logan.

Logan is taking quite a bit of my milk through gavage (a naso-gastric tube, the blurry white line in this photo), and he’s now up to “full feeds.” This means his IV nutrition line has been removed and he’s getting everything he needs through his stomach, which is a big milestone. The breast milk is fortified with extra calories — fat and protein plus good things like iron and calcium to help him sprint ahead on his weight gain and development. It will be a while before he can take in food orally, but for now we’re thrilled he’s able to digest milk so early—truly amazing for a creature who wasn’t designed to eat for 10 more weeks! Our little guy is a hard worker.

Logan’s still getting help with his breathing, which is normal and expected, but we’re very encouraged with his progress so far. Repeated tests show no signs of infection, intestinal problems, or brain bleeds—the major hurdles for preemies this young. In a few weeks his vision and hearing will be tested and we’ll know a bit more. Many pieces of the preemie puzzle will fall into place gradually as he develops over the next two years or so, but from what we can determine now Logan is doing very, very well.

I’m healing quickly from my surgery and feel fine most of the time. I’m frustrated that I’m not allowed to drive for a few more weeks, but apart from that I really have nothing to complain about. Ash and I are starting to relax for the first time since July, and we’ve managed to have a few evenings at home that felt almost normal. Who knew cooking dinner and watching a video could be so satisfying? We’ve been sleeping soundly in our own bed each night for the past week and waking up hopeful in the mornings.

Warm thanks to everyone for your love and support. We’re feeling so very blessed!

As we’ve been told repeatedly, with a preemie it is often two steps forward, one step back. Yesterday we were thrilled to hear that Logan had been taken off of the CPAP altogether, only to have him back on it today. He is still at only level 5, which is good, and getting no extra oxygen, which is even better, but it was nice to have all the headgear and hoses taken off.

But the rest of the news today was good. He is passing solids now, which is a very good sign that his digestive system is slowly coming online. His feedings are way up and he’s keeping down more, meaning that he is that much closer to being off the nutrition IV. The nurse said maybe in a day or two, which is good timing because they finally had to take the umbilicus line out. Now the line is going through an IV either in his hand or foot, which is a drag for Logan because those lines don’t last long thanks to the still-fragile nature of his veins. Going on milk full-time means a lot fewer needle pricks.

The best news today was his weight. He is at 1190 grams or 2 pounds, 10 ounces, which is about 2 ounces above his birth weight! Preemies often get to go home when, along with other conditions, they reach around 4.5 pounds or 2050 grams. So, Logan is doing great in the weight gain department.

There was other good news today: recent tests showed no signs of any infections (which was one hypothesis for the slow digestion) and no bleeding or swelling in the brain. His skin is also starting to take on a more peachy hue rather than the purpley-reddish look he’s been sporting. We are trying to increase the length of time we give Logan kangaroo care—there are all kinds of studies showing the correlation between k-care and more rapid and healthy development in preemies.

In all, we are feeling very positive about how things are going with our beloved son.

Today Ash and I celebrated Logan’s first week in the world. We had a great visit to the NICU and got to snuggle with him without his breathing gear. His CPAP (pressurized air for breathing assistance) was lowered for the second day in a row, down to level 5, and his bilirubin phototherapy has been discontinued so his shades were off, too. He’s becoming less dependent on devices and monitors. When we left, he was swaddled in a blanket for the first time, and soon he’ll be wearing tiny baby clothes.

There were other small victories as well—more food is staying in his tummy, and he’s gained a few grams. The thin tube in this photo is a feeding line that goes through his nostril into his stomach. The nurses feed him tiny amounts of my breast milk through a syringe at the top of the tube. Little by little, the milk will replace the IV fluids and nutrients that are delivered through a line that enters a large vein in his umbilicus. Logan has a big job: breathe, eat, poop, and grow. This week he made amazing strides in all four areas.

Logan’s nurses are wonderful.  The NICU is staffed with nearly 200, but the same dozen or so are usually in room C, Logan’s home.  The ratio in level III care is one nurse for every two babies, so he’s well looked-after.  Sara Francis is his “night primary” and she’s been tremendously supportive and helpful to us during this anxious time.  Christine Curley is a room C regular as well as a terrific lactation consultant.  She’s been a great coach and advocate for us.

His eyes were open today, and he was clearly following us with his gaze. He still looks like a wrinkled little old man, but the baby-ness is starting to emerge. You can get a better look at our little guy in our most recent pictures.

Ash and I came home tonight feeling happy and grateful, sometimes even euphoric. Logan has made a lot of progress in just seven days, and we’re very excited about bringing our baby home sometime soon, possibly even before his due date. Now we have to start shopping for his car seat, bassinet, changing table, and other infant gear. It will be fun madness trying to get our home ready before he is.

Logan continues to do pretty well after his first week…the nurses say that he is usually comfortable and that he is currently displaying a pleasant comportment or personality, meaning he is able to protest and struggle, but is mostly cooperative.

He continues to have apnea “spells”, meaning he forgets to breathe for several seconds, which is typical for preemies his age and nothing to worry about. The air pressure from his CPAP was reduced yesterday from a 7 to a 6, so that is a step in the right direction, and he continues to breathe mostly room air, meaning he is able to absorb all the oxygen he needs on his own, which is fantastic (and helps avoid a lot of developmental problems related to adding extra oxygen).

The only real problem Logan has had is with his digestive motility. He is able to take in a small amount of Mom’s milk, which is very good, but most of it still comes up. This isn’t a dangerous situation because he is getting all the nutrition he needs via his umbilical feed. It is a bit of a mystery and there are multiple theories as to what is happening. The hope is that there is simply a plug of meconium in his gut, which is the initial waste product that all fetuses express in the womb…if this is the case, with the help of suppositories he might eventually pass it and everything will start flowing. A scan taken of his abdomen the other day showed nothing out of the ordinary, so they suspect that there are no problems with the physical system itself, although that hasn’t been completely ruled out yet.

The good news, strangely enough, is that during our visit yesterday, he had a relatively large, um, delivery in his diapers. We are hopeful this means Logan is moving whatever is in there along and will soon have a functioning digestive system. If this turns out not to be true, then on Monday they will do more intensive investigations.

Janet and I both kangaroo’d Logan yesterday, which was really wonderful. We both continue to be astounded and comforted by the excellent care he is getting at BWH.