Not much. Steady as she goes.
The NICU East wing is perceptibly different from the NICU North, where we started. For one thing, it's darker, which has the effect of making it seem calmer and less urgent. Which in turn makes the whole thing seem less dangerous.
The isolettes have a feature where a red alarm goes off if any of the measured vital signs (temperature, heart rate, respiration rate, and oxygen saturation) go outside normal range. Aside from the built-in thermostat and heat lamp, it's really the only thing that's special about the isolette. It's unnerving, because it's not uncommon for one of the babies in the NICU to drop temporarily outside of the normal range, setting off the alarm. Technically, Anna and Evelyn are supposed to be in the womb, where if things had gone properly they would be practicing their breathing. And one thing that distinguishes a practice from a real game is the fact that you can stop play before time is called. So preterm babies will just stop breathing -- because their autonomic nervous system is only developed to the point where they think it's practice. This is way freaky. Even freakier is the fact that this treated as normal for preterm infants. In other words, when the alarms go off, it's not exactly pandemonium in the NICU, the way a layperson's brain would expect. I don't mean to undercut their professionalism, but rather to compliment it, when I say they're all rather blasé about the alarms -- at least the ones I've seen.
Wanna know the high-tech way they get a baby at 32-33 weeks to remember to breath again? Step 1: Open side door to isolette. Step 2: Place hand in small of baby's back. Step 3: There is no Step 3. (Unless Step 2 doesn't work. Thankfully, Step 2 was all that was necessary for the one apnea experienced by Evelyn. Anna's total? None.) Of course, at lower gestational ages, things are a whole lot more complicated. But nothing in life quite prepares you for seeing a flashing red alarm on top of a crib.
A nurse said today that the only really key number for release from the NICU is "sat" or "sats," which is short for "oxygen saturation." Oxygen saturation comes in different flavors depending on the organ at which it's measured. Each girl has a pulse oximeter taped to her foot. The oximeter produces a reading that is displayed both as an absolute number stated as a percentage that ranges between 90 and 100 (ideally) and as a waveform that shows pulse. In other words, there's one probe for heart rate and a totally different one that measures pulse at the extremities. You can see the past 10 seconds or so at any given time of three different metrics: heart rate, pulse + "sats," and respiration rate. It's really something to see, but it's also kind of stressful to have all of these things displayed on a big monitor over each isolette.
So life for a preterm baby with a gestational age of 32-33 weeks is this: You get born, one way or another. You get checked by a nurse, weighed, measured and cleaned up per usual. Now things take a different turn: Instead of being handed back to your mother wrapped up like a burrito, you're given an adhesive temp probe, heart rate monitor, and respiration monitor taped to your torso. You get an oximeter taped to the bottom of your foot, which glows an eerie red in order to shine through the skin to the detector on the other side of the foot, which measures the oxygenation of the hemoglobin in the blood flowing in the foot. You get an IV, which can be placed in the hand or foot, or, failing that, the head. (The nurses say that it's easy to find a good vein in the head, but starting there is frowned upon because it freaks out the parents.) The IV gives you a 10% dextrose solution (basically, pushing sugar into your blood), and provides a ready inlet for other supplements like vitamins. You also get a feeding tube snaked down your throat and into your stomach.
Now, a word about the feeding tube. It has little measurements on it to permit the nurse to know how far it's gone into the esophagus. It's capped off with a little blue flapper valve at the end that remains out in the real world, which can be hooked onto a syringe for feedings. It's secured to your chin by a form of double-stick tape, and it stays there all the time to reduce the trauma of having it constantly put in and taken out for your feedings every three hours (more on that later). Also, once it's in, protocols require the nurse to use a stethoscope to listen to the tummy, to make sure they're not pushing formula or breastmilk down the wrong tube and into your lungs. I asked a nurse how you would know if this had happened, and she said, "Oh, we know real quick, because they turn blue."
Other technical details: You can be face up or (horror of horrors!) face down in the NICU. That's because, like legislators, the medical profession makes sure the rules don't apply to them. And, in fairness, a baby is highly unlikely to come down with SIDS in the middle of a NICU without one of a dozen nurses and your fancy $200,000 bassinet noticing that you're in distress. They'll probably send us home with a stern warning about only sleeping on the back, unless we're willing to spring for two new bassinets.
Here's what a feeding looks like: They fill a syringe with pumped breastmilk, formula, or a mixture of each -- whatever gets them to the next progressive feeding size. They attach the syringe to the blue flapper valve at the end of the feeding tube. They pull the plunger entirely out of the syringe, and hold the syringe (which now is open-ended) over the top of the baby, letting gravity do the work. Depending on the viscosity of the breastmilk or formula, it takes about two minutes for the syringe to drain down the tube and into the stomach. The stomach wall stretches to accommodate the feeding, and triggers a hormonal response in the baby of well-being and sleepiness. The stomach, having stretched slightly, is now capable of accommodating a larger feeding next time around, which comes again in three hours, on the hour.
Evelyn and Anna are staggered on this schedule by an hour, with Anna going first. This means that if Ginger is there a half hour before Anna's feeding, she can hold and try to nurse her, getting in some skin-to-skin cuddle time. After about half an hour, she's fed using the tube. Ginger can then do the same thing for Evelyn. What's interesting about this is that the nurses vary somewhat in their level of encouragement of a mother's involvement. Some of them actively urge putting the baby on the breast even though developmentally this is too early for them to have the full set of instinctual responses that underpin nursing. Others clearly look like they're just indulging some wishful thinking on Ginger's part. However, enough of them have been supportive, and Anna and Evelyn have each showed such progress, that if they think they're indulging us, that's fine with everyone.
Posts
