As I mentioned in my last post, a week ago today we heard the news from Dr Tan that Tessa's PDA had re-opened and she would again undergo the treatment to close it.  On that evening Stacey and I were of course concerned but nonetheless more relaxed than the first time around.  We'd crossed this particular bridge before.

On Monday we headed to the NICU to check on her progress.  Tess was back on the Indocin - she had completed the first dose overnight and was due the second dose over the course of the day.  It was horrible to see our little girl hooked up to the drips again - we thought we were through that - but we knew how necessary it was.  Dr Tan also reduced her feeds, from 20 mL every two hours to 12 mL.  The idea here was to reduce the fluids in her body, in the hope it would reduce the pressure on her lungs.  The last thing we wanted was for Tess to return to the CPAP.

On the same day, Stacey began kangaroo care with Georgia, which involves skin-to-skin contact between mum and baby to help stimulate the baby's growth (I've put in a couple photos on this post).  I cannot find words to explain what this meant to Stace and me.  For a month we'd been watching our little kids in the capable hands of the staff at Raffles Hospital, but feeling helpless throughout - there was very little we could do to help them, and I think every parent understands how that would feel.  Kangaroo care offers parents a chance to get directly involved in supporting the progress of their babies, and after a week I am a strong advocate.  One of our doctors is less keen on account that he is concerned about the oxygen saturation of the babies, but overall I can't fault it if it is timed appropriately.

As soon as it began it was clear Georgia was loving the experience.  She was cooing and nestling, and this behavour was understandable.  For a month these kids have been lying in humidicribs, and while the nursing staff have been fantastic and hands on in caring for them, they have received very little of the human touch that most newborns receive.  For the first time they have sustained contact with their mother, and it is absolutely apparent that they know Stacey is the one holding them.  Amazing stuff.  Every day since, Georgia has enjoyed time with mum in k-care (as we call it) - over that time frame she has put on 270g, and now weighs 1.75kg.  Even if the kangaroo care had negligible effect on this growth (and there are plenty of contributing factors, lets face it) the positive effect it has for mum alone is worth it.

However, while Georgia was benefiting from the kangaroo care, Tess was still on her Indocin medication through the drip which meant she couldn't join in.  On Tuesday Stacey headed in, hoping to hear that the course was finished and all was well, but that wasn't the case.  The doctor told Stacey that overnight there had been evidence of internal bleeding in Tessa's intestines - different from the gastric bleeding that Georgia had suffered from the earlier treatment, and not what he expected.  He feared it was Necrotizing Enterocolitis (or NEC), an infection in the intestine - if it was, he advised that would be bad indeed and could even be fatal for Tess.  Stace called me with the news in tears and once again I headed for the internet for a speed course in yet another frightening medical condition.  All food to Tessa had been stopped immediately which of course halted all growth.

The only bit of grim humour in my day came when I found this site, listing all the common health problems for premmie babies - our little Tessa seemed intent on working her way through the list, checking everything off, some of them twice ...

For the first time in three days, Wednesday brought better news.  X-rays had confirmed Tess didn't appear to have NEC - and Stacey and I began to breathe easier.  The bleeding was likely to have been caused by the Indocin, which meant it should repair itself over time.  Tess was cranky like we had never seen her - she hadn't eaten in a two days or so which explained it!  But the doctors planned to bring her back to food on Thursday if there was no more evidence of blood in her stools.

By Thursday morning, Tessa was back on her milk.  To ease her into it and to check if her intestines had repaired, they began her on 3 mL every two hours (compared to the 20 mL she was on before Indocin treatment).  Once it was apparent she was handling that, they increased it to 6 mL, and then 9 mL for the 2am feed on Friday morning.  Our little kid was back on track.

By Friday she was well enough to be taken off the drip, and to join Georgia in the kangaroo care (the other photo you can see in the post, with the two of them with Stacey - its a tight fit!).  This was important to us because we wanted her to get the benefits of the skin-to-skin contact, and she needs to re-bond with her sister and with mum.  As was the case with Georgia, Tessa immediately settled with Stace.  I'd love to tell you that there was recognition from each of them of the other, and some big reunion, but they seemed to spend most of the time jockeying for space inside the shirt!  We're guessing they spent months doing the same thing inside the womb, and old habits are hard to break ...

Over the weekend, both girls have continued to grow.  Tessa reversed the weight declines she suffered during the week and is now 1.55kg, compared to Georgia's 1.75kg.  Over the seven days, Tessa put on 110g compared to Georgia's 270g, which is remarkable considering what she went through.  Georgia will be moving to bottle- and breast-feeding in the next week which will be another major milestone.  Her growth rate will taper off over that time (believe it or not, the mere effort of swallowing is enough to consume the extra calories they've been getting so she's likely to drop weight for a day or so).  Hopefully Tessa will join her bigger little sister soon.

A junction is approaching - now that Georgia is 200g ahead, she is likely to be able to be discharged earlier than Tessa, by maybe a week.  The doctors all advise to take one baby home and settle it before bringing the other - it makes the adjustment easier for both, and for the parents.  We don't really like the idea of separating the girls but understand the rationale, so we're likely to follow the plan.  It will make the day-to-day a bit tricky though, with managing one newborn baby at home whilst still visiting the other in hospital twice a day ...

If you read the last post you may have wondered what happened to the test for ROP - because of Tessa's setbacks this week, it was considered that both babies weren't up for it.  The test is now scheduled for Tuesday and Stace and I are hoping for the best.