Day 23 in the NICU



Mom Hayes & Rylan



Can't believe we have been in the NICU for over 3 weeks now with our little ladies; In some ways it feels like about 3 years. The commute from Boulder down to Aurora we now know all too well. It's 45 minutes from the house, depending on traffic, and all I think I could do this drive in my sleep now.



Sara's parents left yesterday, and flew home to California. I have to admit, I'm lucky to have some pretty amazing in laws. They are super fun, positive people who really help out. Ann & Tony watched and played with Rylan a ton, in addition to; cooking, cleaning, painting, laundry, handyman projects (Tony is really good), errands, and everything else. The nicest thing about having them around was that we could get up and go to the hospital at any time, because they would watch Rylan. So now, the burden will shift to my parents, who are equally awesome in their help factor. We have amazing parents on both sides.

I think its pretty rare for your in laws move into your house for a month and that you don't get sick of them. Not to say it wouldn't be nice if they just MOVED out here permanatly and/or split their time between CA and CO (I know you're reading this guys!), but nonetheless, they are pretty awesome and always welcome.

Some more ups and down in the NICU to report, so here goes:

Hanna:

• She continues to be a rockstar....No major issues. Growing now and weighing in around 3 lbs 3 Oz now..Feeds continue to increase. She still has a higher hear rate, but that's old news.
• Sara did her first breastfeeding session today with her! The goal was just to get her lips latched onto the boob. However, as the outperformer she is, she even sucked! Pretty unusual for a 32 week old preemie, but a good sign for the future.



Ashlyn's "Echo"



Ashlyn:

• Ahhhhh...The problem child.
• Yesterday brought good news, then bad news, then good news, then bad news. That's right, double good-double bad. Such is life on the NICU roller coaster.
• Good news: She took her first POOP! Yes, imagine if you had to hold it for 22 days...Yikes! This is great news that the plumbing is working and her feeds are taking.
• Bad news: Late yesterday afternoon, Ashlyn started deteriorating...Oxygen requirements increased, heart was enlarged, heart rate was high....The doctors stopped feeds and were thinking the very worst; The chylothorax had returned. They immediately requested an echo (echocardiagram, basically an ultrasound of the heart.)
• We were anxious to hear last night what the Echo showed, but didn't learn anything until today.
• We came in this morning to catch the morning rounds and were greeted with another round of good/bad.
• She is not showing effusion in the plural space....AKA they feel fairly confident that she is not showing any sign of a Chylothorax! This is great news, as Chylothorax is potentially deadly.
• The bad news: The echo revealed she has a moderate/severe PDA "duct".....Her indomethacin treatments from 2 weeks ago had seemed to close the duct, but it has reopened. Bad. The plan for treatment is a diaretic medication called aldactaside...The hope is some blood thinning will reduce her symptoms and give her time to let the PDA close.
• The doctors are saying they would like to give it about a week to see if the duct will close on its own....If not, the only way to really get it closed is surgery. Not fun.

So in summary: Hanna is good, and Ashlyn's Chylothorax might have closed, but she has a PDA.

For those who love the details, like me...I'll leave you with some educational reading.

 Next update midweek.



Amanda visits the NICU



What is a Patent Ductus Arteriosus (PDA)?

Answer: Patent ductus arteriosus, or PDA, is a heart condition that is common in premature babies. Babies born very early have a greater risk of patent ductus arteriosus than babies born closer to term; about half of all micro preemies have a PDA, about 15% of babies born at 30 weeks have a PDA, and only a small percentage of late preterm babies have a PDA.

What Causes a Patent Ductus Arteriosus?

Before birth, a baby’s blood is oxygenated by the placenta, not the lungs. Because of this, the circulatory system of a fetus is very different from that of a newborn baby. A small amount of blood goes to the lungs to nourish them, but most of a fetus’s blood bypasses the lungs completely. Instead of going to the lungs, blood flows through the ductus arteriosus (a hole between the pulmonary artery and the aorta) and out to the rest of the body.
After birth, the baby begins to breathe and the lungs start to oxygenate the blood. When this happens, the PDA should close, allowing blood to flow freely to the lungs. However, when the ductus arteriosus does not close, deoxygenated blood flows through the PDA, into the aorta, and out to the body instead of going to the lungs to become oxygenated.

What Symptoms does a Patent Ductus Arteriosus Cause?

A heart murmur is usually the first symptom of a PDA. A small PDA may not cause any other symptoms, so it is usually not treated. A larger PDA can cause other symptoms, including:

• Low oxygen saturation
• Fast or labored breathing
• Poor feeding
• Bounding (very strong) pulses
• Weight loss
• Lethargy

How is a Patent Ductus Arteriosus Diagnosed?

Doctors and nurses may suspect a PDA when a baby has a heart murmur, especially if the baby is also breathing fast, has bounding pulses, and periods of low oxygen saturation. If a patent ductus arteriosus is suspected, an echocardiogram of the heart will be ordered. Also called a cardiac echo, this painless test is a sonogram of the heart.

How is a Patent Ductus Arteriosus Treated?

Most small PDAs will close on their own, with no treatment. Unless a baby is having a lot of symptoms from a PDA, doctors will simply monitor the baby closely and wait for the ductus arteriosus to close. A baby may be put on fluid restriction while doctors wait for a PDA to close. This helps reduce the symptoms of a PDA because the heart has less blood to pump and doesn’t have to work as hard.
If a PDA is causing a lot of symptoms, then doctors will try to treat it with medication. NeoProfen, a special form of ibuprofen, is the medication most commonly used to close a PDA. In fact, that’s one reason why moms in their third trimester of pregnancy should stay away from ibuprofen - the fetus needs to have an open ductus! If NeoProfen doesn’t work, doctors may try another medication called Indocin.
In some cases, surgery may be needed to close a PDA. Called PDA ligation surgery, this is a relatively common surgical procedure that usually has very good results.