Mikaila's Hitting the Bottle Already! I didn't start until I was 10.....

Ok, I am tired. Very tired. Just got back from a trip to Rochester a minute ago that began with my drive west more than 16 hours ago. I almost didn't do a post tonight but I wanted to keep my Ripkenesque (you have to be a baseball fan to get the reference) streak going and there really is news to report. My mind is very mushy so please lower your expectations. This morning Mikaila's feeds were increased to 22 mls. She handled the additional calories without issue. The real news is that Mikaila was bottle fed for the first time with her 2pm feed. Nurse Amy was astounded by both her instincts and her progress. Mikaila was able to take 16 mls from the bottle! Remarkable. She was given the balance through the tube. Amy made everyone that entered the room aware of Mikaila's feat. Of course, I wasn't there to see it. Luckily, Kim had Amy snap a few pictures of this epic event. Enjoy. Quick addition Thursday morning, Mikaila gained 35 grams and now stans at 1140 grams or 2 lbs 8 ounces.

Back on O2 but that's OK

Last night Mikaila had a few more episodes of de-satting so her team put her back on the trickle of oxygen. Again, she is taking the slightest amount possible and it has helped her immensely. Her sats are stable in the high 90's. In short, the supplemental oxygen allows Mikaila to direct her energy toward growth rather than breathing. This focus on growth spearheaded another tremendous growth day. Mikaila added 40 grams to her slight frame and currently stands at 1105 grams or 2 lbs 7 ounces. She is now up almost 500 grams from birth.

We've included a little video of Mikaila taking her binky to school. It's a short clip that was recorded on our camera (not our camcorder) that only caught the tail end of her session. Enjoy.


I'd like to ask everyone to add Mikaila's little friend Maddy to your prayers. Maddy is a former resident of the Albany Med NICU and has progressed very well since her release. She had a little episode and had to spend the day next door in the PICU. Little Maddy looked great when we saw her and will be going home very soon. Mikaila asked me to pass this along.

Productive Day

Mikaila gained another 20 grams today. At present, she stands at 1065 grams or 2 lbs 5 1/2 ounces. Today Mikaila attempted to breast feed for the first time. This was a practice session really but Mikaila displayed outstanding instincts. Breast feeding is great deal of work for her at this point so they limited the session to just 10 or 15 minutes. They will probably wait a few days before they try again. She really needs to direct her calories to growth.

She was taken off of caffeine today. Apparently, she is beyond the point of concern as it relates to apneas. She had a little de-satting today but as is her way, she bounced back nicely. She did have a slight episode during breast feeding and required a little blow by oxygen but had no problems after that. They will be adding iron tomorrow to her supplementation regimen.

That's about it. All told it was a productive day for our little peanut.

Very Strong Day

Mikaila had a very good day today. Early this morning, her team decided to try her on room air again. She had been satting in the high 90's so their decision was completely supported by her parents. She has performed like a star today. Her satts have consistently stood in the mid to high 90's. Initially, they left the canula in during the test. After a few successful hours, they decided to take the canula out completely. This is a very good sign related to her BPD.

She was weighed prior to her 8pm feed. She is up another 35 grams to 1045 grams or slightly under 2 lbs 5 ounces.

Kim will be attaching pictures any second now (that's her job in this process.) Enjoy.

Very Quick Update

As expected, Mikaila bounced back nicely gaining 30 grams yesterday. She now stands at 1010 grams. Note to the Milestone Crew and you know who you are, she has already passed this threshold and you have rewarded her appropriately with gifts; no need to celebrate this again.

She had a very strong night; no aspirates, apneas or de-satting. They will likely try her on room air again today.

Quick Update

Mikaila’s feeds were bumped up to 21 mls every 3 hours. I will save you the math to avoid condemnation from my friends in teaching (apparently I’m a much better practitioner than I am a teacher) but I will say that she is up to roughly 150 calories per day. They started her at 8 calories/day a scant 33 days ago. She had no problem fully absorbing her additional calories. I failed to mention yesterday that her team added a multivitamin to her daily regimen to help her to better absorb the calcium and phosphorous.

We don’t have any news to report on her BPD. It appears that they will hold off x-raying her again if they can to minimize her exposure to radiation. They will instead monitor her vitals to ascertain her bronchial status. She had a strong day respiratory-wise. We spent 2 ½ hours with her today and she consistently satted in the 99-100% range. Her heart rate was back to it’s typical 158-162 bpm. She is still on the slightest amount of oxygen. From our perspective, she really doesn’t need it.

I kangaroo’d her today for 90 minutes. Other than requiring a bit of suction to eliminate a little congestion in her nose (she can’t blow her nose on her own), she had a very comfortable session.

They didn’t weigh her at 8 so I will have to update later with her weight. I expect a nice little bounce back

BPD

Today, for the first time in quite a while, Mikaila had an issue that caused us a bit of concern. This morning her team took a chest x-ray to further explore the de-satting issue. When they examined the film they noticed that Mikaila had extra fluid in her chest likely indicating a condition known as bronchial pulmonary dysplasia. Essentially, BPD is an abnormality in the lungs caused by the ventilators, sipap and canulas that are designed to serve her. Her attending sees Mikaila’s case as being very mild and expects she will bounce back after a course of diuretic. The diuretic should help to rid her lungs of the excess fluid. Only through growth will Mikaila actually correct the underlying issue. She was given the diuretic today and as you might expect, she gave back the gains she made yesterday. She is back down to 980 grams.

Independent of her need for a diuretic, her team, during rounds decided to bump up the calories. As of this morning she is on the 27 calorie blend. Once she has passed the BPD, she should resume her tremendous growth spurt. She had no problems today with aspirates.

One last thought on the BPD. More than half of low weight preemies experience some form of respiratory issues. Fortunately, Mikaila’s issue is considered mild and shouldn’t cause any issues down the road.

That's it for tonight.

Happy 1 month Birthday!

Today marks Mikaila’s one month birthday. I’ll pause while you in sequence break out in a round of “Happy Birthday.”




































Ok, we’re back. Mikaila had some more bouts of de-satting so her team bumped up her oxygen intake a smidge. Again, that isn’t at all a big deal. She simply needs a few days to allow her lungs to catch up with the rest of her body. Keep in mind, she has grown 60% (in body weight) in one month.

I do have some significant news to report. During rounds, her team determined that Mikaila’s system was strong enough to accommodate additional volume during feeds. She was bumped up to 20 mls every 3 hours. She handled the incremental amount during her 2pm and 5pm feeds without issue.

They will likely weigh her at 11 so stay tuned.

Here are a few pics of the peanut for your viewing pleasure. Fashions conceived and paid for by Davia and Kelly and Mike Sr.



Quick Update: We called just a moment ago to check on her weight. Mikaila gained 35grams today. She has blown passed the 1 kg mark and stands at 1015 grams or a hair under 2 lbs 4 ounces.

Exhale

As we have all seen, Mikaila has made tremendous progress over the course of her month of existence. She has met with great success it seems each and every day. It has been my great pleasure to report those successes. That said, there was a day and procedure that was looming; her third and final ultrasound- the 30 day ultra sound. In this procedure they are looking for specific evidence of trauma resulting from the restricted flow of blood from her umbilical cord. This trauma often manifests in the form of cysts. Mikaila had her ultrasound done this morning and thankfully, the results were favorable; no abnormalities were present. Exhale.

When we called at 8:30 to check on her status, we learned that she had gained 25 grams. She is now tipping the scales at a beefy 980 grams or roughly 2 lbs 2 ½ ounces. Progress, sweet progress.

We had a chance to speak with her new Attending doctor this afternoon. It just so happens that we purchased a treadmill that she had listed on Craigslist.org about 6 months ago. Small world. The treadmill is going strong by the way; likely from lack of use. Her new Attending had a few nuggets of news for us. If Mikaila continues to progress at her current stellar rate, she will probably be able to come home in 3-4 weeks. Keep in mind that Mikaila is gestationally only 32 weeks right now. Her due date was June 18. Dr. Khalac also asked if we had considered moving her to Bellevue Hospital. The notion was pitched to us earlier in the week but we really hadn’t given it much thought. You see, if the pregnancy had gone as planned, Kim would have delivered at Bellevue. We were only transferred to Albany Med when problems arose. It is hard for us to fathom making the move back to Bellevue when by their own admission, they lack the resources, infrastructure and expertise to accommodate the needs of micro preemies. However, if space at the NICU becomes an issue, we may not have a choice. Stay tuned.

That’s all for now.

Up 15 Grams

Mikaila gained another 15 grams today so at present she tips the scales at 955 grams or slightly more than 2 lbs 1 1/2 ounces.

High Rent District

When Kim called this morning to check on our little girl, she learned that Mikaila was moved from her customary position in Nursery 1 to Nursery 6, aka Intermediate Care. Although we thought their decision a bit hasty at first, we were assured that she was more than qualified for the upgrade. Typically, babies are moved to Intermediate Care when they are off of the Sipap and they are no longer in need of an IV. Nurse Amy remarked that she was surprised Mikaila lasted as long as she did in Nursery 1. Apparently, there are other babies that are in need of more care than our Mikaila. I guess it is a graduation of sorts. Don’t worry, Mikaila’s chair remains at the ready at her new bedside in the high rent district.

Despite her upgrade, Mikaila had several bouts of de-satting. As such, Nurse Amy suggested and her team agreed that her canula be reapplied. She is getting the slightest measure of oxygen but it really has helped her maintain her numbers.

As I was leaving the hospital this morning, I bumped into the good doctor Rios. Dr. Rios was the Attending NICU doctor in the delivery room when Mikaila was born. We are big fans of Dr. Rios. He has a terrific way about him. He assuaged my fears related to Mikaila’s episodes of de-sating. Most preemies, especially those of Mikaila’s size, almost without fail have episodes of de-satting as they grow. Apparently, her lungs at this point simply can’t keep pace with the rest of her system. Dr. Rios was VERY excited about her progress and added that it is only a matter of time before her lungs catch up.

When they weighed Mikaila last night she was up another 25 grams to 940 grams (roughly 2 lbs 1 ounce.) She has now gained weight for seven consecutive days. It appears we are in the aforementioned “grow like a cute little weed” stage. We are excited about this stage.

That’s about it for tonight.

She is doing very well... De-Satting explained... Change of scenery

No time to elaborate during the day. We have news to report but you will have to wait until this evening. She's doing well so no worries.

Perspective

Mikaila had quite a few episodes of de-satting today. She tends to drop below the line for just a moment or two before quickly recovering to resume her rightful place in the high 90%s. Twice today, they gave her what they call blow-by oxygen (think of it as supplemental ambient oxygen.) I was fortunate to be present as the rounding doctors discussed Mikaila. I posed the obvious question to her team prompting the Attending to take a closer look at her respiratory trend. Apparently, momentary lapses are quite common with preemies of her size and vintage and although they will monitor this tendency, he assured me that we should not be alarmed. In fact, the Attending was very pleased with her respiratory prowess.

This afternoon, Mikaila’s favorite nurse shared with Kim and I a photo album of one of her former primaries. The lad in the album is now roughly 7 months old and is really thriving. However, he was still on supplemental oxygen at discharge and in fact was just taken off of oxygen within the last month or so. Gazing at a photo of this little guy with a high flow canula in his nostrils at 7 lbs really offered us perspective. It is not at all abnormal for these little guys and gals to need respiratory assistance for several months. Mikaila has consistently over achieved and we have to understand just how remarkable her progress has been. If they decide to offer her a bit of assistance for her breathing, we really should view it as a side-step along the path rather than a setback.

Mikaila’s counts were slightly low and as such, her team decided that a third transfusion was in order. Again, consider this small transfusion as the third act of what is likely at least a three act play (transfusion). One unit of blood is good for roughly a month. Knowing that she would need blood at some point in the next week or so and also understanding that the unit of blood ordered initially would “expire” in the next several days, her team decided that the time was right to build back her levels. The transfusion may help with her de-satting. Remember that red blood cells serve as the primary oxygen delivery mechanism in the body.

That’s about all there is to report. Her transfusion (a three hour process) should be wrapping up right about now so they were not able to weigh her early. Perhaps they will weigh her at the 11 pm feed. If they do, I will post her weight tonight. If not, I will wait until tomorrow.

She's a Two Pounder!!!

As I’m sure you can surmise from the clever title, Mikaila passed a major milestone today surpassing the 2 pound mark. She is officially 915 grams, or slightly more than 2lbs. I know I went on and on about artificial milestones but this one feels more substantive. This is a very exciting day.

I had a chance to Kangaroo Care Mikaila for 90 minutes this afternoon. The session went very well for both father and daughter. I’m sure there was a period of adjustment for her as my chest is slightly hairier than is Kim’s but she forged ahead without complaint. I have attached a few pictures of our time together. It appears from the picture on the left that Mikaila isn’t the only one to put on a few grams. Daddy is still carrying a bit of pregnancy weight.

As is her way, Mikaila had no problems today with her feeds. Her ability to completely absorb her feeds has fueled her impressively consistent growth this week. We expect she will keep it up.

Mikaila will be 4 weeks old tomorrow evening at 8:19. Wednesday, she should have her third and final head ultrasound. Assuming all goes well, and it will, there are no further scheduled examinations of her head.

That is all I have for this evening.

Solid

Mikaila, for the most part, had a very solid day. They weighed her on the early side again today and we learned that she gained another 15 grams. Although the number itself is far from noteworthy, the recent trend certainly is. She has experienced five consecutive days of gains. And, when you consider her substantial gain from the day prior, you really have to be pleased.

During the day, Mikaila did have brief periods where her oxygen saturation levels fell slightly below the desired level (known as de-satting). Typically, Mikaila's numbers are in the high 90's. If her level fall below 85%, her monitor alarms, alerting the nurse. During her Kangaroo Care session with Kim, she fell slightly below 85%. She had a few other instances throughout the day. The likely explanation is reflux. You will recall that her team bumped up her feeds to 18 mls every three hours. 16 to 18 may seem inconsequential but imagine how your GI tract would react to raising your daily intake by 12.5%; now think of the impact on a 1 lb 15 ounce baby. We have been assured that reflux is quite typical and that we have no reason to be alarmed. She had no problems today fully digesting her new allocation so it appears all is well.

We haven't posted a picture in a little while so enjoy.

Quick Update

Doctors rounded early this morning and decided, in an attempt to fuel and maintain her explosive growth pattern, to bump up her feedings to 18 mls every three hours. Atta Girl!

Update

Well, we just called to see how she did with her 5pm feeding. As is her way, she handled the full 16 mls without issue. The real news is that they weighed her early tonight and she gained 40 grams. She is up to 880 grams. Woo Hoo!

OK. I know that most of us are metrically-challenged. I’m certainly not well versed but we have had enough questions on the topic that I think it is worth exploring. I’m a math guy so this should be fun…. at least it will be for me. Ok, a mathematical exposition: There are 1000 grams in a kilogram. There are 2.2 lbs in a kilogram and there are 16 ounces in a pound. As such, there are 35.2 ounces in a kilogram. If you divide 1000 grams by 35.2 ounces in a KG, the result is roughly 28.5. So, there are 28.5 grams per ounce. Translating grams to pounds is actually pretty simple. Think of Mikaila’s 880 grams as being 88% of a kilogram. Again, a kilogram is 2.2 lbs so, at 88% of 2.2lbs, she is 1.94 lbs. To convert the .94 lbs to ounces, simply multiply by the 16 ounces in a pound and you get just shy of 15 ounces. Mikaila is now 1 lb 15 ounces. I hope that was clear. I’m sure there is a Wikipedia entry that does a much better job.

Not much to report

We really don’t have much to report tonight. Mikaila tolerated her feeds very well throughout the night and all day. She didn’t have any aspirates. Despite my silent protestations, a rare event for me for sure, her team has not budged from their position. She will be getting the 24 calorie blend at least through the weekend. I would really like to see them bump up her calories. For now, we’ll leave it to the experts. To stay on track at her current weight, Mikaila must now gain an average of 17 grams each day. She gained 15 grams yesterday and as such, is up to 840 grams.

Today, Kim Kangaroo Cared her little girl for almost three hours. Mikaila really thrives during these sessions and today was no different. Her vitals remained stable as she settled in for a long nap.

I should add that visual inspection of little Mikaila speaks volumes. She simply looks better each day. That’s about it. If they weigh her tonight before we go to sleep, I will do an update post.

Free At Last!

We had some big news today. We no longer need worry about distracted nurses ignoring the status of Mikaila’s canula. This morning, much to our surprise, her doctors, deciding she no longer needed the supplemental pressure provided by the canula, yanked it out. Sweet! The only thing left distracting us from her facial cuteness is her feeding tube. Sadly, she’ll still need that for a little while although we have heard rumors that they may put her to breast (note to my friends, Stop It!) some time in the next few weeks.

Ho hum, another day of Mikaila tolerating her feeds all day without issue. Actually, we take that seriously and we are quite pleased. We spoke with her personal dietitian this afternoon. It appears they will stick to the 24 calorie blend for at least the remainder of the week. Her team will determine next week if a more aggressive posture is necessary. Essentially growth, both body weight and cranial, will determine their course of action. Mikaila is up to 825 grams or 1 lb 13 ounces after gaining 15 grams yesterday. She needs to average about 15 grams gained per day to stay on track. If she deviates from that trend line, I’m sure they will kick up her calories to 27 per ml.

That’s about it for me. Enjoy the pictures.

One final thought. We would like to think that this is an environment where you, the audience, feel engaged and compelled to post comments freely. This blog is a living, breathing thing. That’s the beauty of blogs. We have created a little community here where you need not be simply a reader. You can be an active participant. I would love to see additional content. A single voice can get tiresome. It takes the pressure off of me as well. Post away.

Pretty in Pink

Mikaila had a rather uneventful day. She continues to respond well to her feedings and has shown little resistance to the 24 calorie breast milk & formula mix. During rounds, her team reflected on their earlier decision to keep her at 24 calories for a few days to determine if a more aggressive course is necessary. If she grows at an appropriate rate, they may never need to explore the heavier caloric blend. They achieved consensus determining that the current course was still prudent. If her growth lags, I’m sure they will reevaluate their decision.

Did I say uneventful? Well, she was quite feisty although that is hardly news. She pulled her feeding tube out more than once. We learned that she also pulled the canula (the two-pronged device that lives in her nostrils and provides pressure to her lungs) out of her nose. In fact, she had no problem living on room air and breathed freely for roughly an hour before the nurse noticed and replaced it. That she went that long unobserved is a bit scary but I’ll move on.

This may be a very slippery slope but we took several pictures to accommodate a few specific requests. The first picture is of the now legendary chair. As you can plainly see in the second photo, Nurse Amy crafted a very artistic sign laying claim, by proxy, for young Mikaila to her chair. Apparently, Mikaila’s chair is to remain at her bedside at all times. Who knew?

We also were asked to dress her in something pink and capture the results. Well Kelly, here they are. Enjoy.












That’s about it for now. As always, if there is any news to report, we will be sure to do so.

Mikaila on the Catwalk

Mikaila was a sight to see today, resplendent in her new digs (sans hat unfortunately- she is very efficient maintaining her body temperature and thus overheats with the hat.) She of course was very cute as you can see in the pictures.

Mikaila continues to do very well with her feeds. She didn’t have any aspirates last night so her doctors, nurses and personal dietitian, henceforth referred to as her team, decided to bump her up to the 24 calorie blend. Assuming she conquers this elixir as she did her prior mix (and she did well with the 2pm feed), they will likely move her to the 27 calorie mix within a few days. That said, when they weighed her last night, she had dropped 20 grams. No big deal. Remember what I said about expectation setting and artificial milestones. She must have been extra wiggly yesterday.

We were able to drop off the chair we purchase last night during our lunchtime visit. In fact, Kim sat in said chair for 90 minutes while she Kangaroo Cared her little girl. I arrived at the NICU moments after the chairs arrival. I walked into Nursery 1 only to see Nurse Amy lounging in the chair. Needless to say, both Amy and Kim have given resounding thumbs up on the chair.

It has been suggested by someone in the comment section that this blog should be published. I can only assume that either the person commenting is a close family member of mine or that they have been drinking heavily; I should add that those two are certainly not mutually exclusive. Of course, I’m joking and flattered by the way. I do think there is merit to the general notion that learning about the experience of others going through similar, difficult times can be both educational and cathartic. Just today, I received a note from a friend of mine who had forwarded Mikaila’s blog to one of his friends. His friend delivered their child at 7 ½ months at Albany Med and he was kind enough to share his experiences. They were very helpful and I’m sure Kim and I will lean on our new friend from time to time as we continue on this journey. If we can in some way help others by relating our experiences, we are all too happy to help. We will continue to post to this blog in an effort to update our friends and family. If the results serve others in any way, we’ll view that as a wonderful little byproduct.

As always, if there is news of consequence tonight, I will repost. If not, I will wait until tomorrow.

Quick update: they weighed her early again and she regained the 20 grams she lost yesterday so she is back to 810 grams. She handled her feed well again. That's all for now.

Upward and Onward

Mikaila had another great day with her feeds. I’m not aware of any aspirates. She did so well that they decided to bump her up to 16mls every three at her 2pm feed. They decided to give her another day at the 22 calorie blend but will likely go to 24 calories with tomorrow’s feeds.

The exciting news is that Mikaila will be sporting clothes the next time we see her! Preemies of her vintage are monitored constantly for body temperature. Her monitor is easily observed in the pictures already posted; it is the silver, heart shaped probe that typically lives on her stomach. When the sensor is on, she cannot wear clothes. This afternoon, at the recommendation of her favorite nurse Amy (that's her in the photo), her doctor decided that she no longer needed constant monitoring for temperature. She has been maintaining her temperature for a while now without issue. In fact, her nurses have been lowering the temp in her isolette. So, stay tuned for some excruciatingly cute pictures of Mikaila in her various outfits. I’m sure we’ll have a few tomorrow.

The other little nugget of news is that we found an appropriate chair for Kim to use during her Kangaroo Care sessions with Mikaila. I should provide the back story. The NICU at Albany Med is sorely lacking appropriate and comfortable chairs for mothers to use while spending time with their babies. At present, there are two comfortable chairs in the entire unit. That’s two chairs for seven nurseries and somewhere on the order of 50 babies. That just won’t do. Kim and I had an idea. We decided to seek out a chair to purchase for Kim to use while she is with Mikaila at the NICU. Other mothers would be free to enjoy it when Kim wasn’t using it. When we bring Mikaila home, we would happily donate it back to the NICU as a token of our appreciation for their diligence in caring for our daughter. The idea seemed so simple, but proved a much greater challenge when we put the plan to action. After countless hours, we finally found a suitable chair at Taft Furniture. We picked it up this evening and we’ll deliver it tomorrow, hopefully in time for an extended kangaroo session.

That’s about it. If they weigh her early again, I will do a quick update post. If no news, I’ll wait until tomorrow.

Back to Kangarooing!

We went to see Mikaila today with the explicit purpose of having Kim kangaroo care her. Mikaila has missed out on her Kangaroo Care session for the last several days so she was very excited to resume her one on one time with her mother. During Kangaroo Care time, Mikaila had an opportunity to wear one of her new hats. This particular model (she, of course, has many) came from her friend Madison, formerly a resident of the Albany Med NICU.

Mikaila had another great day. She had no problem digesting her favorite cocktail, breast milk with a twist of formula. No aspirates today. During rounds, her doctors decided to continue her on her current course, sticking to formula over human milk fortifier. They will probably bump her up from 22 calories per feed to 24 calories in the next day or so. Soon thereafter they will try again to introduce the fortifier. In truth, it is better for her than the formula but we are happy that they are letting her advance at her own pace.

They weighed Mikaila on the early side today. Prior to her 8pm feed, Mikaila tipped the scales at a robust 810 grams, or roughly 1 lb 12 ½ ounces. That is an increase of 30 grams from a day ago and exactly 200 grams from birth. She has increased her body weight by almost a third in her three weeks! It’s time for her first of many Atta Girl's!

That’s about all I have today. Enjoy the pictures. Mikaila and I had a little photo shoot this afternoon so there’s more where that came from.

Quick Update

Mikaila had no problem tolerating her feeds through the night. When they weighed her prior to her 2am feed, she was up 10 grams to 780. We are so happy that she has been able to maintain the huge gain she had a few days ago. Although her latest up-tic is somewhat modest, it is a move in the right direction. She is just 13 grams short of 30% growth (in weight) from birth. Not too shabby.

I should talk for a second about expectations. My instinct is to set milestones, monitor her progress toward achieving those milestones, and then fill everyone in on her successes and setbacks. Although I would prefer her to follow that course, that really isn't how it works. We can set artificial milestones and celebrate them as she breezed by them or we can simple enjoy the fact that she is kicking some major butt each and every day. I think I will go the second route and enjoy her continuous improvement.

She's a little Rock Star!

Mikaila had another terrific day. She completely tolerated her feeds all night and morning. With her 2pm feed, her doctors decided to explore another option to get her additional calories as well as supplemental calcium and phosphorous. Instead of adding a milk fortifier, they decided to blend a little bit of formula with her breast milk. Mikaila had no problem digesting the formula with her 2 and 5pm feeds. When we call at 11:15pm we'll confirm what we already know to be fact: that she completely tolerated her 8pm feed. This is wonderful news and should allow her to continue to grow like a very cute weed. We are really looking forward to her reaching 1kg (roughly 2.2lbs). At that point, she can begin to wear clothes. Mikaila is a clothes horse and doesn't even know it. Between aunt Kelly and Grandmas Charlene and Davia, she will never be short of options. Trust me, she will be a vision of sartorial splendor.

Kim was feeling better today so she went for a visit. Mikaila is looking noticeably better each day. Today, she executed a remarkable maneuver. She was on her tummy as she often is (to be addressed later in this post) facing away when Kim walked into the nursery. When she noticed her mother in the room, she began to fidget. Eventually, she pressed herself (think push up) and turned her head 180 degrees to face mommy. I don't know how she was able to do that. Further evidence of her strength and determination. I know some people in their 30's that would struggle to accomplish that feat.

As I mentioned, Mikaila really enjoys sleeping on her belly. In fact, she mentioned it to one of her nurses, Pam, and asked that she spread the word to her other caretakers. As you can see by the picture below (left), Pam was up to the task.













When we called a little while ago to check on her, the nurse mentioned that Mikaila had just calmed down after being very fussy. The nurse couldn't figure out what was bothering her. Eventually, the nurse gave Mikaila her pacifier and she immediately began going to town on the thing. Clearly she got what she craved as she passed out in a deep sleep soon thereafter. It looks like we will have our hands full when she comes home. We can't wait. It is this will that drives her continuous progress and will serve her well as she goes through life.

That's about it for an update. They won't be weighing her until late tonight/early tomorrow morning so I probably won't post on her weight gain until tomorrow morning.

I'd like to take a second to thank everyone again for their support. Our friends and family really have come through, not only for Mikaila but for us. We have people dropping off food for us knowing that we spend a good deal of time in the evening at the hospital. We have received gift certificates for restaurants proximate to Albany Med. We really have some amazing people in our lives. Thank you.

Quick Update

They didn't weigh her until her 2am feeding and we are far to old to be up at that hour so I put in the call to the NICU this morning. She had a good night tolerating her feeds. She didn't gain any weight but she didn't lose either. That is good news after her huge gain the day prior. Her vitals were strong, she's breathing comfortably and her girth is good. That's about it. If there is more news, I will do a more comprehensive post in the evening. If not, I'll just do a quick update.

Another good day

I've been hearing that there are a great many fans of this blog. I can only assume that Mikaila's irrepressible spirit drives that enthusiasm. We thank you for your continued interest in our little girl. I know that she feels the warmth, love and prayers of all of you and it fuels her progress and growth every day.

There isn't a ton to report at this point. She continues to tolerate her feeds without aspirates. They just fed her at 8 and will again at 11 at which point they will weigh her. Our hope is that she is able to maintain the tremendous gains she made yesterday.

We went to see her today for the first time in a few days; remember, we have been under the weather. The empirical data really has been strong from the start. Her heart rate has been perfect. Her oxygen efficiency has been off the charts. She hasn't needed oxygen at all. Her blood pressure has been terrific. But today, we got a chance to see our daughter for the first time in a few days and she just looked great. I always tell Kim that anecdotal evidence is the best kind (inside joke.) She looked calm yet vibrant. Her skin is really developing well. Her cheeks are starting to fill out. Her ears, no longer trapped by the mask that held the Sipap in place, are beginning to form. Kim swears she noticed a little calf. I'm sure she will have mad hops. She really just looked good.

That's about it for now. I may do a quick post after she is fed at 11 tonight because they will probably weigh her.

Grow Mikaila Grow Indeed!

I felt compelled to compose a quick update this morning. Mikaila tolerated her feeds last night very well. No aspirates. When they put her on the scale, she had gained 50 grams! She is up to 770 grams or 1lb 11 ounces. She is up 5 1/2 ounces from birth. At some point in the not too distant future, she will stop with the weight loss and consistently gain weight. We look forward to those days.

Here is a more recent picture. That's my (Dara's) mother's hand in the picture.

A second try....

Mikaila was given the fortifier last night with her 9pm feed. Although she did quite a bit better this time, she still didn't completely digest it. When they examined her before her midnight feed, they noticed an aspirate of 2mls and a bit of distention in her belly. They decided to hold her feed for a few hours. She was fed her full 14mls at 2am and she completely digested her breast milk. The nurse decided to hold the fortifier; a decision completely supported by her parents. Her weight last night was actually down 25 grams from the night before. Apparently, this isn't surprising. These little guys and gals go up and down daily. The important piece is the trend line and hers is fine.

This afternoon during rounds, the doctors decided to bump up her feeds to 15 mls every 3 hours to make up for the lack of fortifier. She had an aspirate of 2mls with her 5pm feed but that was the first of the day. Doctors made the decision to give her a few more days before reintroducing the fortifier. Again, we support this decision. Nurses will be weighing her later in the evening probably with her 11pm feeding.

We haven't been able to see her for a few days as we are both battling a pretty nasty cold. However, Kim's sister and mother have visited her and they say she is looking great. The nurses remain enamored with little Mikaila. Her vitals have been very strong and she has had a healthy balance of sleep and activity.

That's about all there is to report.

A very good day for Mikaila

I'd like to start by thanking everyone again for all of your thoughts, notes, prayers and gifts. We appreciate each and every one of you. We may not respond to your emails. I hope you know that we do appreciate all of your gestures.

This morning, they upped Mikaila's feeds to 14mls every 3 hours. She really tolerated her feeds well today. I don't think she had any aspirates. She did so well in fact that they have decided to reintroduce the milk fortifier for her next feed. So, by the time I finish this post, Mikaila will be getting the additional calories, calcium and phosphorous that she so dearly needs. Wish her well. We expect that she will handle it quite a bit better than she did last week. She only gained 5 grams yesterday but after gaining 35 grams the prior day, the nurses were happy that she was able to maintain her gains. They will weigh her again for her midnight feed.

They also took out her picc line today. That is very good news. As I mentioned yesterday, doctors and nurses have to be constantly cognisant of potential infection points.

We just learned a few minutes ago that they would be reducing the pressure through her nose canulets from 3 to 2. Her respiratory system has been very strong all along and this is yet another indication.

That is about all there is to report. Kim and I stayed away from her today as we are both battling colds. I guess it isn't surprising that we are a tad run down. We will update again tomorrow night.

D, K & M

Full Feeds!

Mikaila had mostly a good day today. They got her to full feeds early this morning and, for the most part, she tolerated them well. She had an aspirate (she is fed through a tube that directs the breast milk directly into her stomach, the portion she doesn't digest in any feeding is called an aspirate) with her noon feeding. However, she tolerated her 3pm feeding absorbing the entire serving. Let me expand on the feedings as I mentioned yesterday that I would. They began feeding her 3mls of breast milk every four hours or 18mls/day. They agressively pushed her, upping her feeds by a ml every 6 hours and moving her to feeds every 3 hours. I mentioned that she is at full feeds. For her size, full feeds are 13mls every 3 hours or 104mls/day. They will scale the feeds as she grows. She had a bit of a setback on Saturday. They had pushed her to 11mls every three and they decided to add the milk fortifier. The fortifier adds a few calories and adds calcium and phosphorous. These elements are critical for preemies as their bones, particularly the ones that form their rib cages, have yet to ossify. Mikaila did not react well when they added the fortifier. She became extremely distended. The doctors decided to give her a break. They held her feeds for 12 hours relying entirely on an IV to provide critical nutrients. She lost 45 grams that day; a pretty dramatic number considering she was only 660 grams at that point. When they began feeding her again that night, they moved her back to 7mls every three hours. It was a very difficult day for us. She had been progressing so well. The doctors really pushed her and when she couldn't take it anymore, she pushed back. She has recovered well and is up to 740 grams as of last night. We expect another 20-25 grams when they weigh her tonight. They will probaby try to add the fortifier again tomorrow or the next day. Wish her luck.

I said that her day today was mostly good. This morning, her belly was a bit distended and she was a bit pale. They drew some blood and did a stomach xray and saw two things; she had a bunch of air in her belly and she was a bit anemic. To remedy the first problem, they took her off of the Sipap and placed her on a nose canulet.

The Sipap was giving her constant pressure and apparently, much of it was being swallowed. The nose canulet is essentially the nose tubes connected to the mobile oxygen tanks that you see once in a while. They have since reduced the pressure in the nose canulets to stop this problem with her swallowing air. Just to be safe, they upped her oxygen to 25%. The problem with her being low on blood is not new and is pretty much expected. They have to draw blood often and she is too small to produce enough to keep up. This is actually the second time they have had to transfuse her although with preemies of her size, they consider all of these small transfusions as being part of one single transfusion. They order one unit of blood. That unit is good for 30 days. They use that same unit as needed limiting her exposure to a single donor. It is very likely that she will need more transfusions as she progresses. She reacted very well to her transfusion and is finishing the day strong.

They will probably take out her picc line tomorrow. That is good news as every artificial entry point into her body is a potential target for infection. I think that is about it for an update. Thank you again to everyone for their wonderful notes, gifts, thoughts and prayers.

Catching Everyone Up

So, we are still playing catch up here. We began this blog almost 2 weeks into Mikaila's life. She has been steadily improving with her feeds. Just a few minutes ago, they increased her intake to 12 mls every three hours. If all goes well, and we expect that it will, they will increase her to 13 mls (full feeds) at 2am tomorrow morning.

Kangaroo Care

One of the more difficult notions to come to terms with was that when we were to leave the hospital, we would not be taking Mikaila with us. However, we spend time with her every day at the hospital and have been able to establish an amazing bond. The bond between mother and daughter has grown daily through their kangaroo care sessions. Kangaroo care, where a baby is taken out of her incubator and placed inside the shirt of mom, is a relatively recent but very exciting development in the care of premature babies. Maximum skin-to-skin contact is key with Kangaroo Care. Studies have shown that both babies and their mothers benefit from these sessions. Mikaila really loves to cuddle with her mommy. Her heart rate settles down and she actually is warmer when they put her back in the heated incubator than when they took her out. Kim makes a habit of "kangarooing" Mikaila from 60-90 minutes every day.

Pacifier

Although we have been told by doctors and nurses that babies don't tend to develop a sucking reflex until 32-33 weeks, Mikaila has a keen sucking instinct. Once in a while, you can actually see her mimicking nursing. The nurses gave her a mini-pacifier (although it is huge for her) and she really goes to town on it. See picture above.

As mentioned, tomorrow, Mikaila should be at full feeds. We will do a post tomorrow on her progress related to her feeds and her growth.

Mikaila's Arrival

Mikaila Dorothy Shareef arrived with vigor at 8:19 pm on March 24, 2008. She was a day shy of 28 weeks gestation (roughly 12 weeks before her due date.) At birth, little Mikaila was 1 lb 5 1/2 ounces and 32 centimeters (12.5 inches) long.

The photo is from Mikaila's first 24 hours. To give you perspective on her size, the thing on her left arm that looks like a huge bracelet is actually Dara's wedding band.

Mikaila currently resides in the Neonatal Intensive Care Unit (NICU) at Albany Med, one of the top units in the country. Typically, premature babies stay in the NICU to due date plus or minus two weeks; Mikaila was due June 18.

Mikaila began exceeding expectations immediately. She came out kicking and screaming, a very good sign. Per protocol, doctors immediately placed her on a ventilator. Mikaila proceeded to yank it out of her mouth showing early her fiestiness. She received a score of 9 on her APGAR test. Another great sign.

To this point, Mikaila has been doing very well. The nurses in the NICU call her a superstar. She is tolerating her feeds since moving to breast milk. Bleeding on the brain is a concern for babies of this vintage. They have done two ultrasounds on her head and the results have been very favorable. Her vital signs have been strong from minute one. She is on a Sipap that provides pressure to her lungs but she is essentialy breathing on her own without additional oxygen. The Sipap simply provides pressure to keep the air pockets in her lungs open.

Like all babies, Mikaila had a PDA, which essentially is a small hole between the two sides of the heart. With term babies, they close on their own. Many preemies fail to close them on their own. The remedy is Ibuprofen and it seemed to work for Mikaila as her PDA closed after one course.

Mikaila will be 2 weeks old tomorrow night. She is very close to full feeds and should begin a rapid period of growth soon thereafter. We will update this blog as often as we can and will be sure to keep everyone aprised of any milestones she achieves.

Thank you to everyone that has offered us their support and prayers.


Dara, Kim & Mikaila