Originally I started writing this blog to give the girls a record when they got older of what their first few weeks were like. Since then I've really appreciated the nice feedback I've had from people around the world who are using the updates to keep track of the progress of the girls. A few people have commented that it is a bit like a soap opera - each week has ups and downs and seems to end on a cliffhanger! I was happy to hear that - it means I've been able to convey a bit of the emotions that Stacey and I have been riding. It certainly feels the same for us.
This week began with the usual mixed bag of news - I'm happy to tell you this time it has ended on a positive note .. (touch wood!).
On Monday we went into the hospital and got some sobering news. Tessa's heart murmur had returned. The concern was that her PDA had opened, a third time in total. This time around the medicine that had been used previously would not be an option, because of the nasty intestinal bleeding that Tessa had suffered last time. The PDA was to be confirmed on Tuesday, following an echocardiogram.
But talk about mixed emotions. Georgia was continuing to grow, and on the same day for the first time she tried bottle feeding (only 5 mLs but hey you have to start somewhere!). As I mentioned previously, the staff all expected that she would lose weight as a result of the extra effort - we'd have to wait to the next day to see if this was the case.
Tuesday was much like Monday. Tessa's PDA was confirmed with the echocardiogram. This time we learned that her PDA was 2.2mm in diameter - the first time it had opened, the hole was 2.8mm, whereas the second was 2.6mm - maybe this was progress? Because the Indocin was no longer an option, the doc's advice was to try to let her grow and close it herself. Apparently prem babies with PDAs have a 60-80% chance of closing it themselves, if drugs are not an option.
In contrast, the news on Georgia was again good - despite the expectation that she would lose weight, she actually put on 40g overnight. By Tuesday afernoon she was taking a whole feed (22 mL) in a bottle feed, and doing three of her 12 feeds through the bottle.
But the big news of Tuesday was that both babies had their ROP examination and had sailed through - the first time they had passed an exam! There was no damage to their eyesight as a result of the oxygen provided early in their life, although they need to be re-examined in two weeks. We learned though that because they are premature, there is a higher than normal possibility of short-sightedness - this of course though is treatable.
Wednesday and Thursday were (thankfully) quiet days. Georgia graduated from her humidicrib (which the nurses called her 'condo') and moved into a baby cot. The cot was nothing special - its a plastic tub on wheels that all full-term babies get put into in the hospital - but we were so proud you would have thought she had bought her first car. By Thursday night, Stacey and I were wiped out. Throughout this experience, we've just pushed and pushed ourselves, to get on with life but also to spend the maximum time with the girls in the hospital, and every now and then exhaustion just hits and we collapse. Thursday was one of those days.
With hindsight it was lucky we got some sleep, because Friday was a big day. Dr Tan told us that Georgia was progressing so well that she would be home with us by the end of the next week. Oddly, for parents that had spent the last five weeks waiting and waiting for this news, it came as a shock and suddenly doubts flooded in - were we ready? Originally I told you there were two criteria for coming home - 2kg and 35 weeks. Over time, the staff at the hospital had pointed out a third. The girls need to be feeding from a bottle at three hourly intervals, and completing these feeds within 20 minutes. Stacey and I also needed to demonstrate our competence to the staff in feeding and caring for the babies - they are more careful with parents of premature than full-term babies, because these babies have less-developed systems and so are more vulnerable in every sense. We went home, our heads swimming with the idea that our little girls might be coming to an end of this first, tough phase of what we hope will be happy lives.
By Saturday, Georgia moved to three hourly feeds starting at 8am. Her feeding tube was removed at 5pm on that afternoon because she was taking all her feeds by bottle for the first time, and as of this afternoon had still not been reinserted. Dr Tan told us that discharge day had now moved forward to Wednesday - our swimming minds started to paddle a little bit harder, and we rushed out to buy all the things we realised we suddenly needed.
Today (Sunday) we went in and the intention was for me to prove my competence at feeding (Stacey gets her chance tomorrow). Georgia had moved up to 37 mLs every three hours. The first bottle from me at the 11am feed took nearly an hour, and I think secretly the nurses thought they may be stuck with Georgia for good. Happily the second bottle I fed at 2pm took 8 minutes - I have a sneaking suspicion that Georgia was messing with me for the first feed - that doesn't bode well for when she gets older!
Meanwhile Tess has been showing signs of instinctive sucking when she is fed. Today the nurses starting giving her 1 mL or so of milk, to taste and to swallow, in order to get her ready for a move to bottle feeding as soon as she crosses 1.8kg. Tess put on 200g over the week, and now weighs 1.75kg. Georgia put on 220g and weighs 1.97kg. In terms of weight gain over the last two weeks, Georgia has averaged 35g daily, while Tessa has averaged over 22g. The doctors have been been very happy indeed with the rate of growth of both babies.
So the next week will be another busy one. Georgia will be coming home on Wednesday – I’ll be taking a couple days off at the end of the week to stay at home to be ‘dad’, so if you email me and don't get a response, don't worry I'll get around to it!
Part of our trepidation of bringing Georgia home comes from the knowledge that it will make things that little bit more complicated. Two babies in the NICU has been tough, and we expect that two newborns at home will also be tough. However managing the week or so of having a newborn at home with a second in the NICU will be very difficult, logistically and emotionally.
Tessa will be getting bigger and moving to bottle feeding, hopefully sometime in the next two days. She should be graduating from her ‘condo’ to a normal baby cot too in the next few days. Her PDA remains open but the doctors are prepared to discharge her if it is not having any negative effects on her breathing, with regular monitoring. The doctors and nurses think she could join Georgia in her new home in the next ten days or so.
Tomorrow Raffles Hospital is having an Infection Control Day – all the nursing staff from the various departments have to prepare a song and dance about one aspect of controlling infection. The maternity unit staff have a song and dance about proper washing of your hands, to the tune of ‘My Humps’ by the Black Eyed Peas (“my hands, my hands my hands my hands …”). We found this out when the nursery was erupting in laughter as the predominantly Filipina nursing staff excitedly got their song and dance routine down pat. Stacey even got a special invitation to go along tomorrow to watch the performance, and she’s threatened to put their efforts on YouTube where it could match the popularity of the Filipino dancing prisoners. There is heavy press constantly about superbugs in the US and UK, but I wonder how an organised education event, requiring karaoke efforts from staff that they rehearse in their own time, would go down amongst hospitals in a Western country?