Saturday, August 23, 2008
Friday, August 22, 2008
When are they coming home? (Updated.)
A bit of a blow yesterday. As you know, one of the benchmarks we've been dealing with is that, to be discharged, a baby must go a week without a serious oxygen desaturation episode. Anna had one last Saturday; Evelyn didn't, and that's why we were concerned that Evelyn might be discharged mid-week and Anna would have to stay until Saturday.
Well, Ginger arrived at the hospital Thursday morning to learn that Evelyn had a serious desat the night before. This re-sets her discharge countdown clock by a week. Anna's still cleared to come home on Saturday, when her countdown from her last desat runs out, but Evelyn will need to stay in the SCN at least until Thursday the 28th.
We're struggling to figure out what our lives will look like with one baby in the SCN and one at home. We're told the hospital doesn't enforce any "no siblings" rules as to twins, but once Anna is discharged, she's not a patient and the nurses won't be able to treat her as one. There are therefore some serious impracticalities to bringing Anna to the SCN every day, and even more serious impracticalities to leaving her at home. And the idea of spending more time at home with Anna and spending less time with Evelyn is, under the circumstances, abhorrent. This little twist is during out to be a major drag. Putting aside the actual medical issues, it's the first real inconvenience we've encountered in having twins -- or, specifically, the first inconvenience related specifically to having two kids each with a different compelling need from us at the same time.
Well, Ginger arrived at the hospital Thursday morning to learn that Evelyn had a serious desat the night before. This re-sets her discharge countdown clock by a week. Anna's still cleared to come home on Saturday, when her countdown from her last desat runs out, but Evelyn will need to stay in the SCN at least until Thursday the 28th.
We're struggling to figure out what our lives will look like with one baby in the SCN and one at home. We're told the hospital doesn't enforce any "no siblings" rules as to twins, but once Anna is discharged, she's not a patient and the nurses won't be able to treat her as one. There are therefore some serious impracticalities to bringing Anna to the SCN every day, and even more serious impracticalities to leaving her at home. And the idea of spending more time at home with Anna and spending less time with Evelyn is, under the circumstances, abhorrent. This little twist is during out to be a major drag. Putting aside the actual medical issues, it's the first real inconvenience we've encountered in having twins -- or, specifically, the first inconvenience related specifically to having two kids each with a different compelling need from us at the same time.
Wednesday, August 20, 2008
When are they coming home?
We've wanted to know the answer to this question for a while, and we finally have something on which to pin our hopes -- Saturday morning.
Today Evelyn is 2395 g, which translates to a little over 5 lbs 5 oz. Anna is 2085 g, which translates to almost 4 lbs 10 oz. Each is just over a pound past her birthweight. Neither of them is yet showing a consistent weight gain on the 22 calorie fortified breastmilk. However, the neonatologist is not concerned because she thinks going home will help. So Saturday it is, unless one of them has some kind of episode that concerns the doctors.
So here's the story on the fortified milk: Ordinary breastmilk (and the ordinary infant formula that aspires to replicate it) is 20 calories per ounce. Babies in need of faster weight gain are sometimes prescribed high-calorie formula or fortified breastmilk -- either 22 or 24 calories per ounce. The baby formula manufacturers sell special formula in both concentrations for preterm infants, and there is a powder you can add to the breastmilk in order to boost its calorie content. I gather the special powder consists of -- get this -- regular formula powder. So it's a bit like making hot chocolate by melting superpremium Scharffen Berger chocolate into superpremium milk from a very very local organic dairy, and then adding Nestlé Quik because it wasn't chocolatey enough. Anyway, this is part of the reason that, when they're home, we'll only be nursing them on a limited basis. The rest of the breastmilk needs to be pumped, fortified, put into bottles, and then fed to them. Our guess is this cycle will require nearly constant attention on our part -- or so we've been warned.
Today Evelyn is 2395 g, which translates to a little over 5 lbs 5 oz. Anna is 2085 g, which translates to almost 4 lbs 10 oz. Each is just over a pound past her birthweight. Neither of them is yet showing a consistent weight gain on the 22 calorie fortified breastmilk. However, the neonatologist is not concerned because she thinks going home will help. So Saturday it is, unless one of them has some kind of episode that concerns the doctors.
So here's the story on the fortified milk: Ordinary breastmilk (and the ordinary infant formula that aspires to replicate it) is 20 calories per ounce. Babies in need of faster weight gain are sometimes prescribed high-calorie formula or fortified breastmilk -- either 22 or 24 calories per ounce. The baby formula manufacturers sell special formula in both concentrations for preterm infants, and there is a powder you can add to the breastmilk in order to boost its calorie content. I gather the special powder consists of -- get this -- regular formula powder. So it's a bit like making hot chocolate by melting superpremium Scharffen Berger chocolate into superpremium milk from a very very local organic dairy, and then adding Nestlé Quik because it wasn't chocolatey enough. Anyway, this is part of the reason that, when they're home, we'll only be nursing them on a limited basis. The rest of the breastmilk needs to be pumped, fortified, put into bottles, and then fed to them. Our guess is this cycle will require nearly constant attention on our part -- or so we've been warned.
Tuesday, August 19, 2008
What's new this morning?
We both visited this morning. Tried tandem nursing, which looked simultaneously touching and funny, like a really good Carol Burnett Show sketch, only with less Lyle Waggoner. It was a glimpse of what we'll be spending 80% of our time doing for the next stage of things.
Evelyn only gained 10 grams overnight on the 22 calorie fortified breastmilk, which means we're looking at Thursday at the very earliest (if she shows improvement tomorrow, that is). Anna's definitely staying until Saturday. The doctor is supportive of keeping Evelyn until Saturday and releasing them together, but if she resumes gaining 40 to 60 grams a night, the insurance company will start wondering why she's staying in the SCN. So weight gain is a good thing, but will inspire mixed feelings also.
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