Triston McKinley Makes His Debut 9-8-11

Hello Friends!
I am sorry for the long pause between posts.  The doctor decided to move forward with my c-section last week because my contractions would not stop, I was dilated 2cm, and despite being on high doses of Procardia my blood pressure and heart rate went to a dangerous level. More on the c-section itself in a separate post.  Today I want to introduce my new little love. My handsome baby boy decided last week on Thursday, September 8, 2011 that he was ready to make an entrance into this world. He was born at 6:10 pm and weighed 5lbs, 5 oz and was 19" long.  A great size for a 34 weeker! (Well actually he was almost 35 weeks at 34 and 6 days).

Like my oldest, he was born with his eyes wide open ready to take in the world.  As they removed him, I could hear my OB's associate, who was assisting in the c-section, talking to my baby boy.  Apparently he was staring intently at my doctor. Once they got him out and suctioned his mouth, he let out a very powerful cry. It was the most glorious sound.  My youngest only let out a faint wimper when she was born before they put her on the ventilator, and my oldest cried briefly at birth but was more interested in looking around at everyone and everything around her. But not my baby boy, his cry was intense and loud.  And it was beautiful.

I started to cry because it meant he was alive and breathing and perhaps would not need oxygen assistance. Still on the operating table while my doctor worked on me, I glanced at my hubby sitting next to me holding my hand, and he was also shedding silent tears. I knew he was as relieved as I was to hear that glorious sound.

Triston continued to cry while he was cleaned up and weighed, but once he was placed on my chest he stopped crying and tried his best to look at me through the goopy stuff the always put in the baby's eyes. I marveled at his size, his full head of hair, and as I gave him kisses and picked up his hand I realized his hands were blue... My heart sank. In a matter of seconds I rationalized that he would probably only need a little O2, but my mind couldn't help but worry. He was quickly whisked away and taken to the NICU. 

 

It's not quite been the ride we experienced with our 24 weeker, but he has had his own set issues. We are hoping to bring him home in a couple of weeks, but his lungs have to get stronger and he will have to be able to eat on his own. I have been pumping furiously to get enough milk supply built up for him. At first my milk would not come in like it usually does (I produce massive volumes of milk once it comes in), however after a couple of consultations with the lactation consultant I figured out the problem.  

Today, at 6 days old he is now taking a bottle with my milk every other feeding and gavage feeding (tube feeding) on the others. To read more about gavage feedings please see this link His feedings are basically every 3 hours. He usually wears out by the time half of his bottle is consumed, so they have to give him the other half by gavage. Currently he receives about 40 ml's of my milk each feeding.  Last night, the nurse practitioner decided she wanted me to start attempting to breastfeed him.  We tried it two other times, but he was too weak to actually nurse. I was pleased that last night he actually nursed for 8 minutes!  Today, for his morning breastfeeding session he nursed for 11 minutes! Progress! And it helped my milk to come in even more. Many NICU mom's can relate that giving your baby your milk in the NICU is one of the things that make you feel like a "normal" mom. 

So far, during his 6 days of life he has had a a whole host of issues. We had hoped this would not be the case due to the fact that he was a good size for his gestation and he was literally hours away from being 35 weeks. The doctor thought he had given me the steroids for his lungs, and he mentioned this moments before they wheeled me into the operation room, but of course by then it was too late. I am sad that my baby boy did not get the benefit of the corticosteroids as I truly believe they would have helped.

I am trying to maintain a happy disposition for my children, but I am very exhausted.  I wasn't anticipating that my child would have ended up in the NICU.  Even after I had to go for my c-section, I was encouraged with his cry and truly hoped for the best. Clearly his stay in the NICU has been nothing like our daughter's, but it is still stressful because each day seems to bring a mixture of good news and bad news.

Early on the nurses noticed Triston was struggling to breath at even a high level of oxygen, so on day 1 of life he was placed on a CPAP machine with oxygen set at 100%.  The next day he started doing better and was placed on a high flow nasal cannula and eventually that day low flow oxygen. We were ecstatic!Unfortunately, he began to struggle once again and on day 2 an x-ray revealed that he had developed a pneumothorax in his lung. Basically it was described to us that an air sac in his lungs ruptured and caused air to escape from his lung to a space between his lungs and chest wall. To read more about pnuemothorax, please visit the following site.  It was explained to us at this point that Triston has RDS or respiratory distress syndrome.

When they first found the pnuemothorax on Saturday September 10th, they thought they could take care of the problem by using a small needle to extract the air.  But after extracting 60ml's of air, he appeared to get better and then he went downhill later that day and was struggling to breathe. By this point his entire left lung was in distress and he required a chest tube to vent the air and allow the hole to heal so his lungs could once again expand. We waited with baited breath to hear news that his lungs had healed and they could remove the tube. 

Because he was so ill and weak, we were not allowed to hold him. During this time he received feedings via gavage feeding because he was not strong enough to drink a bottle or try breastfeeding. Unfortunately, the tube fell out during a diaper change on Sunday night and although it was thought his lungs might be ok to leave the tube out, the tube had to be reinserted. Of course this is a very painful procedure for even an adult, and our hearts ached for our little man that he had to go through having the chest tube reinserted.  He was given a pain medication the entire time he had the chest tube, but it was obvious he did not feel well.

On Tuesday we learned that he was doing much better and the tube was left in, but had been sealed while they did an x-ray to see if his lungs had expanded once again (an indicator that the tear had sealed itself). The chest tube did it's job and he was finally over his ordeal.  In fact, the nurse practitioner decided to take him off IV fluids which was giving him TPN fluids which contained electrolytes, calories, protein, and lipids.

This brings us to today, Wednesday. With the pnuemothorax problem fixed, his care team has begun to focus on his feedings so that he can become used to drinking a bottle and breastfeeding. All of his nutrients are now coming from my breastmilk and it is important that he is able to become strong enough to breastfeed as this will be one the determining factors to when he can come home. Another factor in determining when he can finally come home will be making sure his lungs are strong enough to either breathe room air or be on a low flow nasal cannula. He is currently on high flow oxygen where they want to leave him for now so he can concentrate on mastering the art of eating. I was very encouraged with the last two nursing sessions and found out tonight that he drank his entire 45 ml's of breastmilk when the nurse fed him this evening.

I believe he is getting stronger and he is trying to do his best to get better so he can come home soon.  However, we did learn some news today that I am still trying to figure out what it all means. His doctor ordered an echocardiogram yesterday because she thought she heard a heart murmur and I was a bit taken back by the findings.  I have been assured that what they found will likely resolve on their own, but it makes me wonder what is coming next.  They discovered that he does have a narrowing in his blood vessels going to the heart which has caused an intermittent heart murmur.  Sometimes they can hear it, and sometimes they can't.  The doctor said it might completely resolve or it might be one of those things where one doctor might say they hear it and another cannot.  I actually have that problem myself.

The doctor also informed us that the echocardiogram showed something I am still struggling to understand.  She said he had an "atrial level shunt" in his heart but this was something that would resolve and children are actually born with this, but in full term children it closes at birth.  I asked if he had a patent ductus arteriosus (PDA) and she said that is not what this is. So I am still a bit confused on this one and plan to ask them to explain it to me again tomorrow.  We also learned that his pressure is slightly elevated on the right side of his heart which I understand is pulmonary hypertension.  I am also told that this will resolve and is not something they are worried about at this point. 

So all in all, at this point, we have been told that it does not appear he has anything long term that will affect him later.  We are hanging on to these words by a thread. After what we went through with our daughter, Mackenzie, we know that every day spent in the NICU brings a variety of surprises.  He looked wonderful when I last saw him this afternoon. He appears to be be very comfortable and no longer in distress from the lung issue and I am hopeful.  His doctor said that it is possible he could come home within a week if he is able to meet all of the criteria (breathing with low flow oxygen or room air, and eating). It is likely he will come home on oxygen, but luckily we have experience in that department. We have decided not to get too excited about this announcement and are still anticipating two weeks.

These pictures were taken this afternoon and I think it is obvious how much better he feels. He had just finished a feeding and was so content. His color is better, he is sleeping more sound than he has previously, and just before I left I glance done more time at his monitors to find he was still satting at 100%.  I couldn't be more pleased with his progress.

I will keep everyone updated with his progress and will post another update soon with what happened during my c-section.  I am worn out from everything and need to rest so I can heal, but with a baby in the NICU, trying to pump so he has food, still making sure my girls feel loved and secure with everything going on, it's hard to find time to just be.  I know from experience that things will calm down and we will eventually get into a groove once he comes home. I am sad that I couldn't get him to at least 37 weeks, but in my heart I know there are reasons for everything and I know I should proud that I got him to a point where he can bounce back quickly. Tonight I am feeling exhausted and a bit overwhelmed but I am confident that a good nights sleep will help tremendously.  I have no regrets though when it comes to making the decision to get pregnant again because my baby boy is a precious little soul that I know had been waiting to join our family. We welcome him with open arms and can't wait for the moment when he is strong enough to be home with us.

Thank you so much for your continued support and prayers.