Gestation: 39 weeks, 2 days
Weight: 5 pounds, 3 ounces
Feedings: Continuous feeds of HMF fortified milk through a post-pyloric feeding tube on a pump running at 16 ml per hour plus 6 ml by mouth every three hours

Well, the staff decided to wait until today to feed Abby anything by mouth or into her tummy, but we had a full weekend anyway.

Over the past week, Dan and I had noticed that Abby just wasn’t doing very well. She was sleepy all the time. She was moving backwards in her development. She used to be so bright-eyed and noticed everything. She would turn to the sound of Dan’s or my voice. She could look all around and track you as you moved over her from one side to the other. But all of that stopped and she was just sleepy all the time. Even when she was awake she would just stare off in one spot. She stopped sucking on her fingers. Then we noticed that her heart rate was continuing to increase from the low 100’s at rest to high 100’s and even low 200’s at rest.

So on Saturday as I was holding Abby, I was praying for her as I often do while holding her nowadays. Suddenly as I prayed a thought flashed across my mind: “iron”. For the past two months Abby has been receiving iron supplements to fight her anemia of prematurity. When she started getting rice cereal added to her feeds they cut out the iron because the rice cereal was fortified with iron. However, UofM took Abby off the rice cereal and never put her back on iron supplements. As I looked at Abby I started to notice how pale she looked and started thanking God for bringing this all to mind.

I went to find my nurse, but couldn’t, so I found a tech instead. “Is Abby getting any iron supplements?” I asked her, but she couldn’t figure out where to find that information in her charts. So she summoned a resident to come talk to me. A few minutes later the resident came in only to assure me that Abby was getting “the correct amount” of iron just from the HMF in her feeds. I was so surprised that I could only nod and thank her before doing my own research to find that, indeed Abby was getting way less iron than she had at St. Joe’s. In fact, Abby was receiving iron while on HMF at St. Joe’s.

I didn’t want to be annoying to the resident, so I asked our nurse if he could check her latest hematocrit level. Now, in the past Abby’s hematocrit had reached its lowest at around 7 weeks old and then started coming back up. Those who have followed Abby’s progress long enough may remember my saying that if it got as low as 23 Abby may have needed a transfusion. If it reached 20 she would definitely need a transfusion. Her numbers over the course of the past month were 27, 26.5, 24.5, and then back up to 28.3 (measured weekly). Abby’s hematocrit at UofM hadn’t been checked since she was admitted, and at that time it was 27.1. So I asked the nurse if it’s normal for it to decrease.

The nurse spent half an hour explaining to me that Abby is not anemic. She doesn’t need any more iron than she gets from my milk and the HMF. He told me that she had a good color to her skin and wasn’t showing any signs of anemia. I listened, asked lots of questions, and finally thanked him, still unconvinced.

When Dan came back from his walk with Lydia I relayed all of my thoughts, observations, and conversations to him. And he agreed. So when we went back to the hospital we asked to speak with the resident again. Again she came and assured us that Abby was getting sufficient iron. But because we were so persistent, she finally agreed to check her blood count the next morning.

On Sunday morning Abby’s hematocrit was down to 22.8 and she had already received orders to start taking a large does of iron daily. By Sunday night, we were already noticing improvements as Abby seemed more alert and bright-eyed once again.

Today Abby gets to have her first milk by mouth in over a week. The plan is to feed her 6 ml (a little over a teaspoon) once every three hours to see if she keeps it down or spits it up. If Abby tolerates the 6 ml, tomorrow we will increase her amount. If she spits it all up, tomorrow she will probably get another ultrasound to test for pyloric stenosis.

At 11 PM, Abby refused to nurse but took in 2 or 3 ml by bottle. Then she spit it all up. She didn’t seem to have any interest in eating at all, let alone nursing. So it’s really looking like she might be getting an ultrasound tomorrow.

Praise the Lord
-for showing me that Abby needed iron before she was in need of a transfusion
-that God is taking care of Abby especially when the doctors fail

Please Pray:
-that Abby will have a conclusive test for pyloric stenosis in the next couple of days
-that, despite the days she’s spent not eating, Abby would quickly “remember” how to eat and nurse
-that God would keep showing us what Abby needs that may otherwise be overlooked
-for Dan and I as we are still struggling with this transition to UofM

Gestation: 35 weeks, 6 days
Weight: 4 pounds, 12 ounces
Feedings: 42 milliliters every 3 hours by gravity or bottle

The roller coaster continues. Yesterday our nurse was pleased to tell us that Abby took all of her feedings by bottle overnight. At rounds the doctor said she may come home next week.

Last night we found out that Abby stopped stooling again. And she’s been back to having residuals. I was surprised, though, when she nursed 20 ml and then took a few more from a bottle. Still, it’s hard not to wonder if we’re going to have a repeat situation with the residuals and no dirty diapers. The nurse ended up giving her a suppository, which helped her to go.

This morning Lydia started throwing up. Dan and I have tried to be very careful about staying away from anyone who is sick because of the strict NICU rules about not allowing sick people in. NICU rules are that no one is allowed in if they’ve had any signs of illness within the past 48 hours. Dan stayed home with Lydia while I went in to nurse and hold Abby this morning.

Abby didn’t want to nurse. She took all but the last 6 ml from her bottle. Then, as I was burping her, she had a big spit up. All over me. All over herself. The nurse put her back in her crib to change her clothes and she started spitting up more and just didn’t stop for a while. She even spit up out of her nose and pushed her feeding tube out. Everything was a mess and we had to call the doctor to report it all. The doctor put in orders for Abby to get an abdominal x-ray to find out what’s going on down there. I had to leave before they came to do the x-ray, so I guess you’ll all just remain in suspense until Monday. Hopefully it’s good news.

It’s possible that Abigail could have come down with whatever Lydia has. However, by this afternoon, Lydia appeared to be better. She’s eaten two meals without any problems. And she’s been energetic and cheerful. Now, she’s down for a nap (she was a little sleepier than her normal healthy self).

Praise the Lord
We are thanking God for:
-Abby’s progress on bottles (64% yesterday)
-the possibility of going home as early as next week (depending on recent developments)
-that Lydia appears to be improving already

Please Pray:
-that we would be able to figure out what is causing Abby’s residuals and spit ups, if anything of concern
-that Abby would not get sick (that goes for Dan and I too!)
-that Lydia would get better soon
-that Abby would eat more

Weight: Just under 3 pounds, 6 ounces
Feedings: 30 milliliters fortified to 24 cal every 3 hours given over the course of 1 1/2 hours

Well, that’s right. Abby lost a little weight. It’s nothing to be concerned about, especially because her digestive system decided to kick in and she’s had three very full diapers in the past couple of days. Overall her weight trend is increasing, so no one is worried.

We’ve finally surrendered to the fact that Abigail has reflux. She just spits up. She especially spits up if you move her when she has recently eaten. She’s a strong breather though, and even when she does spit up she manages to (usually) keep her oxygen level, breathing and heart rate up. Often spit ups trigger respiratory and cardiac events, which is when the heart rate drops very low, the breathing slows down or stops, and the oxygen level in the blood drops. Lydia had more events than Abigail has so far and on one occasion Dan was there when she started turning blue. So, we are grateful that Abby doesn’t seem to have the same troubles.

This morning Abby had an eye exam while Dan was holding her. It is very common for preemies to have eye troubles, but some of them can be corrected if caught early enough. Todays exam was normal. Her eyes are developing just how they should.

The doctors and nurses are full of encouraging words for Abigail (and us). She’s right on track and, mostly, we’re just waiting for her to get a little bigger and a little older. Then the next hurdle will be learning to eat.

On Monday night we had our first real difficulty with Lydia. She’s been a trooper all along and has even enjoyed spending so much time with other families while Dan and I go to the NICU. This Monday we decided to let her stay up a little later while a couple from church came over to babysit. We got her ready for bed but told her she could play for a while after we left as long as she would go to bed when she was told to. When Dan and I were about to walk out the door, Dan turned to say goodbye and Lydia suddenly realized we were leaving and just lost it. Dan held her while she cried for a while and eventually we were able to distract her a little, and then we left. I guess she was fine after we were gone, but Dan and I think she’s getting just a little tired of spending so much time away from Mommy and Daddy. Having to leave a crying toddler to go see your other baby makes the goodbyes a whole lot harder.

On the other hand, Lydia absolutely loves her little sister. Often when we are in the NICU together, Lydia asks if she can “hold her!”. At home, she asks to and practices sometimes with her dolls. When we leave the NICU, Lydia insists that we all hug and kiss Abby’s isolette. When we have her out, Lydia often gives her a kiss or pets her head. When we read books, Lydia points to the girls in the pictures and says, “Abigail”. And when we pray for Lydia at night, she interrupts our prayer whispering, “Abigail! Abigail!” until Dan prays for Abigail too. We try to encourage her to look forward to when Abby can come home and then we’ll let Lydia hold Abby.

Praise the Lord
We are thanking God for:
-the good report from Abby’s eye exam
-Abby’s strong lungs, able to keep her going even when she spits up
-that Lydia loves Abigail so much

Please Pray:
-that Abby will not have any more weight losses, only gains (and big ones!)
-for Lydia as we continue to leave her for a few hours almost every day
-for us as we often have to leave one daughter to be with the other, Dan often tells people this feels like having two separate families and it really wears you out (in every way)