She was still on CPAP to help her breathing on Monday.  Her oxygen saturation had improved but not as quickly as anyone had hoped.  We thought that the extra blood would at least give her a hand in this regard.

Tuesday brought the ultrasound brain scan, to monitor the progress on the intraventricular haemorrhages in both babies that had been detected the previous Tuesday.  Here was some good news – the bleeding had largely resolved itself in both, though small cysts remained.  Dr Tan assured us that the cysts were expected, were very small (less than 2mm) and would resolve themselves.  Even better was the progress later that day – the blood transfusion had good effect.  Tess came off the CPAP, her body colour was much better and her oxygen saturation was holding.  We hoped that maybe that would be the last time she needed assistance with her breathing.

Stacey and I headed to the hospital on Wednesday with a little trepidation – could Tessa hold onto the gains she had made the previous day?  We were delighted to see she had. Her colour remained good and she was off CPAP.  The nursing staff were very happy with them and made it clear that the challenge now was to see the babies grow.  To help the girls with this effort, their milk was being supplemented with proteins and vitamins in addition to the MCT oil.  They slowly increased their milk, until they were taking 19 mLs each every two hours.  After the first week or so, when they regain their birth-weight, premature babies are expected to grow on average at 1% a day, or 10g per kilo.  And sure enough, in the last seven days both Tessa and Georgia had gained 110g, leaving them at 1.44kg and 1.48kg respectively.  (It is interesting that despite her breathing challenges, Tessa had gained more weight proportionally.)  Based on this and all going well, if they keep growing at that rate we're looking at discharge for both babies in early November.

All going well.  Of course with premature babies its never that easy.  Stace and I reflected today that things seem to happen on weekends – the PDAs of both babies on their first weekend, Tessa returning to CPAP on the third.  Today just before we left for the hospital my phone rang, and as soon as we saw it was the NICU at Raffles Hospital our hearts sank.  Dr Tan seems to have developed a habit – when the news is good, he’s happy to call Stacey – my phone seems to ring with mediocre news.  Sure enough it was Dr Tan, calling to let us know that the heart murmur had returned for Tessa.  In his view, the most likely cause was a recurrence of the PDA that we thought Tessa had beaten.

We returned to the hospital this evening, and by that point Dr Tan had already used an ultrasound imaging device (for those interested, Raffles uses an Agilent Sonos 4500 for this task) to confirm it was indeed a PDA.  Tessa was back on an intravenous drip, they had cut back her fluids to reduce the pressure on her circulatory and respiratory systems, and began treatment with Indocin (the same drugs as used to previously treat both babies’ PDAs).  At least her oxygen saturation was holding – as I mentioned in the earlier post, a PDA puts pressure on the baby’s lungs by flooding the lung cavity.  If the PDA isn’t fixed in short order, then Tessa will go back onto the CPAP to relieve the pressure on her lungs.  She hates it, and we hate to see our little girl struggling with that machine although we know it does so much good.

Its interesting though – Stacey and I feel more confident this time around with Tessa’s PDA than we did last time.  She is two weeks older, bigger and has stronger lungs.  We’ve seen the medical staff treat it before and we believe it will close permanently this time around.  There are three doses of Indocin in the course over the next 24 hours, so we’ll know by mid-week at the latest if they have been successful.

The end of the week will bring the next hurdle for the girls.  Both girls are at risk of retinopathy of prematurity, or ROP, which is a disease of the eye that affects premature babies.  The history of ROP is actually an interesting story and an unfortunate illustration the law of unintended consequences – it is another example of celebrated progress that seemingly delivers so much but ends up doing enormous unforeseen damage.  That test should come before next weekend – it is quite a difficult test for the girls and so the doctors will wait until they are strong enough.  Because the girls were both reliant on oxygen to assist their breathing early in life, the doctors are expecting a Grade 1 or at worst a Grade 2 finding; we’re certainly hoping that’s the case.

I haven’t had an opportunity to talk much about Georgia today – maybe that’s a good thing!  Tomorrow is another little milestone that we are looking forward to.  The nursing staff at Raffles are believers in kangaroo care of premature babies – the idea that premature babies should be held in skin-to-skin contact with their mothers as soon as possible, to aid their growth.  Kangaroo care was developed in Colombia, as a naturalistic response to the issues they had around lack of resources for dealing with premature babies, in particular an absence of incubators.  It had wonderful outcomes and it is being widely adopted in many countries now.  Georgia has progressed to the point where Stacey should be able to spend some time with her tomorrow in kangaroo care – in our view it can only do good for all concerned.

So another up and down week – more ups than downs as we like to say, the babies look better and better.  We’ll overcome Tessa’s PDA and keep her off CPAP so she can join Georgia in kangaroo care, and deal with the ROP test when it comes.  Early November can’t come soon enough.