Sunday, November 28, 2010

3 Pounds and Then Some!

Prayers before bedtime
 Team Altman

Joshua sleeping

Right after bath time and wide awake!

Fast asleep after afternoon feeding

Kangaroo Time

Mommy and Joshua love being together

Spending time with daddy!
As of this morning, our little peanut weighed in at a whopping 3 pounds and 1 ounce. Joshua still looks small, but we can definitely see the difference from when he was first born. He is almost at full feeds, he is up to 26 mL every three hours- 30mL is a full feed. Because he is now eating so much, they were able to take his IV out which was supplying extra nutrients. One less thing attached to him is one more blessing!  He is making significant progress with feeding; when it comes close to feeding, he is showing signs of being hungry such as sucking on his fingers and reacting to stimulation around his mouth. Because he is starting to show signs of wanting to eat as opposed to just eating, the doctors are going to start bottle feeding him hopefully by next week. Currently there is a feeding tube that runs into his mouth and down to his stomach, so he doesn't taste anything he just feels his stomach get full. Bottle feeding is one of his milestones he must reach before he can go home. I hope he tolerates it well!

Today was bath day, and mom got to do the honors! The bath usually wears him out, by the end of it all he is already passed out in a deep sleep. Because Joshua cannot regulate his body temperature yet, they can't actually submerge him in water, so instead he stays in his incubator and we bring the bath to him. His temperature has to be about 98.0 or above in order to give him a bath. The little gold sticker attached to his tummy is a temperature probe and it is constantly reading his temperature and automatically adjusting the incubator, or isolette, to warm up or cool down according to the reading.

In my last post, the doctors had taken Joshua off the caffeine in hopes that he would not have any bradycardias or apneas. He has been having a few, three last night, but fortunately he was able to recover all on his own without stimulation from the nurses. The other day while holding Joshua, he had a bradycardia in my arms and it was very scary. His face turned blue and his heart rate dropped below 80 bpm, the normal range is about 130-160 bpm (beats per minute). The nurse came over and firmly patted his back and his heart rate came back up.

Joshua's breathing is doing excellent. He still has his nasal cannula which is supplying him 2mL of oxygen. Hopefully they will ween him down to 1mL and then after that it comes out of his nose and he is free of another tube attached to him! He is always pulling this out of his nose and getting extra attention from the nurses. Enjoy  the photos I have posted, and check back for another update! Thank you again for your continued prayers.

Tuesday, November 23, 2010

The Big 5

Joshua has gained 5 ounces....I know this doesn't sound like a lot, but considering his size it is quite a lot! His current weight is 2 pounds and 12 ounces. We can't wait for him to move past the two's and into the three's!

The big question I have been thinking about is when Joshua will be able to come home. Surely the best christmas gift this year would be for him to be home on Christmas day with all our family, but we have to be patient. I asked the doctor today what she thought, and she said it is completely up to him. Joshua has to complete a checklist before he can be are his 5 criterion:

1. No Apneas or Bradycardias for 5-7 days
2. Maintaining body temperature in an open crib
3. Gaining weight consistently
4. Feeding consistently from a bottle 
5. No other complications

Joshua's progress with these:

1. Joshua has not had A's or B's, but they think the reason for this is the caffeine. Remember the caffeine stimulates his brain and reminds his brain to breathe. So the question is, can he do this without the caffeine? They stopped his caffeine today, and they will see whether or not he starts to have any A's or B's while off of it. Hopefully he wont, because this is the hardest thing to grow out of. Babies usually have to be about 37 weeks before they grow out of this. 

2. Joshua has not yet been able to maintain his body temperature. He is in his incubator 24 hours of the day, which is maintaining his body temperature for him. Until he is able to really gain significant sources of fat, he will not be able to do this. So the weight gain is a great step towards this!

3. Joshua has this one down. He seems to be gaining about 1 ounce a day or half a pound a week. His feedings have gone up dramatically so that will certainly help with the weight gain. 

4. Joshua has not developed the capability to swallow yet. The doctors say this is something that comes around 34 weeks of gestation. Until he is able to swallow, breathe, and suck all at the same time, he will continue to be fed via the feeding tube. FYI - He hates his feeding tube; he pulls it out all the time!

5. These complications include breathing on his own, which he is doing well with. He currently has a nasal canula which is giving him very little oxygen and he is tolerating it well. 

We ask for continued prayers for Joshua and we thank everyone for all their continued support. Josh and I were able to return to church on Sunday together for the first time in several weeks and it felt great. Our pastor delivered a powerful sermon about Thanksgiving and the bible. He said the bible does not ask us to be thankful FOR all circumstances. Of course we will never be thankful for cancer, broken families, unemployment, or other unfortunate circumstances. What the bible does say is that we should "be thankful in all circumstances" 1 Thessalonians 5:18. We are sad that Joshua is not with us but even in this circumstance we are reminded how thankful we are that he arrived safely into this world and that he is receiving the best of care. We are so thankful for Joshua. Happy Thanksgiving!

Wednesday, November 17, 2010

The Beginning

Feeding Joshua his first milk

Daddy picking up Joshua

Happy Moment

Holding Joshua for the first time
Where to begin.....

It has been quite a journey just in the past 8 days, and I know the days to come will hold news of joy and possibly some tears. I have been writing down thoughts here and there when I get a chance and I thought I would share this with everyone through this blog.  It seems easier to post updates here than it does through mass emails every day, so you can tune in whenever you have time and read what is going on with Team Altman. Enjoy!

Joshua Marshall Altman was born on November 9, 2010 at 8:46pm. His arrival was bittersweet, being that he was not due until January 10, 2011. Most of you know that I was put on bed rest at about 27 weeks due to my blood pressure rising to very high levels. At 31 weeks I finally started to develop signs of Pre-Eclampsia so the doctors determined that the risk of carrying Joshua any longer was too great. He was delivered by c-section within 6 hours of making the decision.

This experience has been one that has evoked every emotion I can think of. I had dreamed about the day he would arrive and I would get to finally hold him, but unfortunately our first meeting was not until the next day. There were 5 nurses patiently waiting in the operating room for him and as soon as he came he was rushed out of the room and up to the NICU. I actually never even layed eyes on him until the next day, but Josh told me how beautiful he was. The next three days in the hospital were spent juggling time between recovering, sleeping, and wheeling up to the NICU to see Joshua. Josh never left my side, and I don't think he ever got a good night sleep in the "chair bed" that was too short for anyone over 6 feet. I really have an amazing husband who makes Team Altman stronger every day. Until baby Joshua comes home, I will refer to our family as a team because we are all working to make our family strong and healthy.

Day 7 in the NICU
After one week in the NICU, Joshua has made some great improvements. When Joshua was first born, his lungs were not fully developed. Most babies develop mature lungs by 36 weeks of gestation. Because Joshua was born at 31 weeks, he had a hard time breathing, and the nurses had to intubate him. Intubation is the insertion of a tube through the mouth and into the patient's lungs which helps them breath. As of two days ago, Joshua was extubated, meaning they took out the tube and he is now breathing on his own. What a great accomplishment for him!

Another complication that goes along with the immature lungs is Apnea and Bradycardia or "The A's and B's" as the nurses would say. Although Joshua is breathing on his own now, he can still forget to breath sometimes and this is very common with premature babies. Apnea is the absence of breathing and an alarm will sound if he has an irregular breathing pattern which consists of intervals of pauses longer than 10-15 seconds.  Bradycardia is the reduction of heart rate and an alarm will sound if his heart rate falls below 100 beats per minute. He actually experienced this last night when I was able to hold him for the first time. He was so relaxed in my arms he forgot to breathe, so the nurse had to come by and tap on his back and then he started again. It was very scary the first time, but I am told I will get used to it happening and he will eventually grow out of this.  An interesting remedy for this, they actually give Joshua a daily dose of caffeine which stimulates and reminds his brain to breathe. Caffeine affects infants differently than adults, so its not the same as drinking a latte!

Last night, was the first night I got to hold Joshua. Let me just was one of the best days thus far. They actually refer to this in the NICU as "Kangaroo Care." The infant is tucked into the shirt of the mother so that there is skin to skin contact similar to the mother Kangaroo and its baby in the pouch. The direct contact between mother and baby helps to regulate his body temperature since he is unable to do so on his own yet.  Premature babies are born with little body fat and immature skin so they are unable to maintain body heat which is why he is kept in an incubator.

Joshua is finally able to digest small amounts of milk, his digestive system is still immature so the feedings consists of very small amounts, about 3mL twice a day. He has had an infection in his stomach which still seems to be there, so they are taking his feeding very slow. Because breast milk has natural antibodies from mother, it should help build up his immune system slowly.

This is quite a long post being that it is seven days wrapped up into one, so I will post shorter and more frequent posts from here on. Again we ask that you keep baby Joshua in your thoughts and prayers. Thank you so much for all the support thus far, it has been comforting to Josh and I.

Much love.