What's the deal with the nicknames?

Anna is "Mouse" because she squeaks.  Other than the cry she gave when she was delivered, it's the only sound I've heard her make.

Evelyn is "Kitten" because she makes little mewling sounds that could almost be meows.  That's not the only sound she makes, but "Hannibal Lecter" would invite too much explanation to the preschool crowd.

Any news today?

Not really.  Ginger spent the day with them; I split my time between Charlie and work.  They continue to make progress; Evelyn's up to 40 ml per feeding, and Anna's just slightly less.

Ginger had a visit from the lactation consultant.  She was holding Anna at the time.  As the consultant launched into a series of basic beginner tips on how to lay the groundwork for Anna eventually to nurse, Anna just went ahead to latch and begin nursing.  (Show-off.)

We're still in holding pattern on the transfer.  No word yet, but apparently we're still waiting for open beds.

Haven't you forgotten something pretty important?

This one is from my wife.  I can't go to bed without mentioning that both girls nursed today.  Removing the OG tubes and replacing them with NG ones seems to have made it possible for both girls to latch properly.  Anna had been able to do so even with the OG tube, but Evelyn hadn't.  Today, she did.  They said it couldn't be done, and that 33 weeks gestational age is too young to do so much.  I guess they didn't count on Ginger, Anna and Evelyn.

Evelyn Kitten.

Anna Mouse.

What was new today?

Slight change in feeding methodology.  Anna's had one or two episodes of emesis -- what is called "spitting up" outside the NICU.  So they want to slow down her feedings to see if she'll keep more down.  The gravity-feed method they were using previously will only go so slowly, and the nurse can't stand there forever with the syringe in hand.

Much better than gravity is the device pictured.  It's got a syringe with breastmilk laid horizontally, then a piston that extends out to the right and gradually plunges the syringe down the very narrow NG tube and into the stomach.  In this case, Anna and Evelyn each had 30 ml of milk administered at a rate of 60 ml/hr.  In other words, the machine pushed 30 ml of milk into each of their tummies over the span of half an hour.  A speed that slow would be impractical for a nurse to do manually, and it better simulates the rate of milk intake from nursing.

The amount of each feeding is now going to hold steady at 30 ml, but they're fortifying the breastmilk with more calories, gradually increasing the richness of the milk to speed weight gain.  A nurse said today that we're probably not too far off from weaning them from the feeding via the tubes (the technical term is "gavage"; I recommend against Googling this because it's also what they do to geese destined for pâté de foie gras).  They'll then be on a combination of nursing and bottle feeding for a while, then (it is sincerely to be hoped) breastfeeding exclusively.

Can we have more technical details, please?

Of course.

To the right is a snapshot of the monitor screen.  The green waveform and number is heart rate, measured via the adhesive pads affixed to their torsos.  (This particular screen shot is Anna's, but Evelyn's looks basically the same).  At this particular moment, it shows a heart rate of 149.  (Duh.)  The smaller green number further to the left says "PVC," which in this instance stands for "premature ventricular contraction," which for our purposes here is equivalent to a coronary hiccup.  The current count is zero, but I've seen some on Anna's monitor.  They're relatively benign, unless they're not.  We've not been told that the occasional PVC on Anna's monitor is any kind of indication of a problem, so we're not worried about it.  Note that there is a number for "Pulse" in blue.  That's because it's measured by another monitor entirely.  The green data comes from one probe, the blue from a second, and the white from a third.  So heart rate and PVCs are monitored by the green probe, but pulse (which a medically trained individual can tell you is merely a symptom of heart rate and is not the heart rate itself) is measured by the blue probe.

The blue pulse data, blue waveform and large blue number are the data from the oximeter.  The waveform shows the pulse as it goes through the right foot.  As you can see, the heart rate and pulse correspond in a general sense.  (The disparity between the measured heart rate of 149 and the pulse of 148 is probably a result of the fact that the heart rate is dynamic and at any given moment the number is changing, and then being multiplied to give a per minute figure.) The large blue number is the oxygen saturation.  At this particular moment, Anna is at 100% saturation, which is as good as it gets.  No one's worried if it occasionally drops below 90%.  If it's regularly low, or if it suddenly drops into the low 80s or 70s, there might be a problem to be solved.  At the moment this photo was taken, Anna was steady as a rock at 100%.  During the same timeframe, Evelyn was fluctuating around 97%.

The white waveform and number is the respiration rate, measured as respirations per minute.  I've happened to have caught Anna during a particularly steady period of breathing while she was asleep.  This waveform is the most variable of all; it could be all over the map if the baby is awake.  There are periods of a few seconds in which short, sharp, ineffective breaths are taken; the nurses call this "zipper breathing" (because of the shape of the waveform) and it's nothing to be particularly concerned about at this gestational age.  This is the waveform that would be flat during an apnea event.  An apnea of longer than 20 seconds is met with some kind of intervention, such as a pat on the back, a poke in the ribs, or tickling the feet.  Recurring apneas can be treated with medication -- in this case, caffeine.  I'm not kidding.  They administer caffeine because it is a benign central nervous system stimulant.  They haven't administered any caffeine to the girls yet, but it amuses me to think they would be hooked on a drug their father had to wait 'til college to discover.